Upper Extremity Lab

Question 1

Glenohumeral ROM

[Shoulder ROM]

Answer 1

Flexion: 180
Extension: 60
Abduction: 180
Horizontal Abduction: 40-55/ 130-145
Adduction: 40-50/ 130-140
IR: 90
ER: 90

Question 2

Glenohumeral (GH) SD BLT

Answer 2

Indications: sub deltoid bursitis or frozen shoulder
Patient- Lateral recumbent and dysfunctional side up
- Grasp olecranon process of dysfunctional arm and flex elbow. Use the other hand to stabilize the shoulder
- Use the elbow as a lever, put the GH joint in its indirect position (abd/add, flexion/extension, compression/traction, IR/ER)

Question 3

Normal SC Joint Motion

Answer 3

SC Abduction- Scapular elevation leads to inferior movement of SC joint
SC Adduction- Shoulder depression leads to superior motion of SC joint
SC Flexion- protraction leads to posterior glide of the clavicle at the SC joint
SC Extension- retraction leads to anterior glide of the clavicle the SC joint
Distal clavicle follows shoulder

Question 4

SC Elevated/Adduction SD Still Technique

Answer 4

Patient- seated
Physician- behind the patient monitoring SC joint with one hand and grasping the elbow with the other
Start with elbow adducted and slightly extended
Add compression toward the SC joint
Move the elbow into superior glide and abduct –> posterior circumduction motion
Remove compression and return to neutral

Question 5

SC Depressed/Abducted SD Still Technique

Answer 5

Patient- seated
Physician- behind patient monitoring SC joint with one hand and grading the elbow with the other
Start with elbow abducted and slightly flexed
Add compression toward the the SC joint
Move the shoulder into adduction with anterior circumduction motion
Remove compression and return to neutral

Question 6

Sternoclavicular (SC) SD HVLA

Answer 6

Patient-supine
Physician- standing at the head of the table
Place their thenar eminence of monitoring hand over restricted SC joint
Apply a cephalic traction on the arm on the side of dysfunction
Apply a thrust on the SC joint while simultaneously inducing a rapid traction force through the patient’s arm
Adduction SD- inferior thrust
Extension SD- posterior thrust

Question 7

AC Joint Evaluation

Answer 7

Inspect for asymmetry
Palpate
Motion Screen-
Cross-arm adduction test: positive test- pain or increased TTA
Spring inferiorly on distal clavicle (compare bilaterally)- Clavicle Superior/Clavicle Inferior
Spring anterior to posterior

Question 8

AC Joint Separated SD Still Technique

Answer 8

Patient- seated
Physician- in front of patient
Affected side is abducted, with slight extension to open the AC joint
Traction is applied
The arm is moved into adduction/flexion
Traction is removed and arm is returned to neutral

Question 9

AC Joint- Direct Seated ART

Answer 9

Patient- seated
Physician- standing behind patient
Grasp the elbow or forearm of dysfunction side
Grasp dysfunctional clavicle between thumb and fingers of free hand
Apply anterior/inferior pressure with thumb on lateral (or posterior) aspect of clavicle while flexing patients elbow, extending and adducting humerus (to gap AC joint)
Doctor holds clavicle antero-inferior (with thumb). Shoulder is extended into a circulatory sweep, posterior, superior, then anteromedial while maintaining adduction and capsular tension

Question 10

Elbow ROM

Answer 10

Flexion: 140-150
Extension: -5-0
Supination: 90
Pronation: 90

Question 11

Ulnar Abduction/Adduction

Answer 11

Reference point for naming dysfunction is distal ulna
Ulnar adduction- coupled with wrist abduction (radial deviation)
Ulnar Abduction- coupled with wrist adduction (ulnar deviation)

Question 12

Ulnar Abduction SD HVLA

Answer 12

Patient-seated
Physician- in front of patient
Supinate and extend elbow to 5 degrees. Grasp elbow with fingers of monitoring hand on either side of olecranon. Other hand grasps distal radius/ulnar
Move elbow into ulnar abduction. Apply a lateral thrust over the medial olecranon

Question 13

Ulnar Adduction SD HVLA

Answer 13

Patient- seated
Physician- in front of patient
Supinate and extend elbow to 5 degrees. Grasp elbow with fingers of monitoring hand on either side of olecranon. Other hand grasps distal radius/ulnar
Move elbow into ulnar abduction. Apply a lateral to medial thrust over the lateral olecranon

Question 14

Radial Head

Answer 14

Anterior Glide- coupled with supination

Posterior Glide- coupled with pronation

Question 15

Anterior Radial Head SD HVLA

Answer 15

Patient- seated
Physician- standing the facing the patient
Place thumb of one hand into the crease of the patient’s elbow contacting directly over the anterior radial head. The other hand flexes elbow and pronates forearm
Exert a rapid hyper flexion force while simultaneously thrusting the radial head posteriorly

Question 16

Posterior Radial Head SD HVLA

Answer 16

Patient- seated
Physician- standing facing the patient
Extend and supinate elbow. Place thumb over posterior aspect of the radial head
Exert a rapid hyperextension force while simultaneously thrusting the radial head anteriorly. Be sure not to go past the anatomic barrier

Question 17

Interosseous Membrane Examination

Answer 17

Use thumbs to evaluate dorsal and solar aspects of the forearm between the radius and ulna
Evaluate for tissue texture abnormalities, asymmetry, and/or tenderness to the interosseous membrane

Question 18

Interosseous Membrane MFR

Answer 18

Palpate for tension along the ventral interosseous membrane
Place thumbs over tense areas and fingers on the dorsal forearm
Compress thumbs firmly toward fingers, adding compression (pushing thumbs together) or traction (pulling thumbs apart) until a release is felt

Question 19

Interosseous Membrane BLT

Answer 19

Physician holds the patient’s hand/wrist with one hand. With the other hand, place index finger on the patient’s radius for monitoring. Use thumbs to monitor interosseous membrane
Perform indirect positioning of the wrist and elbow to attain point of BLT at the interosseous membrane
Add respiratory phases and make minor adjustments to maintain BLT

Question 20

Wrist and Hand ROM

Answer 20

Flexion- 80-90 degrees (posterior carpal glide)
Extension- 70 degrees (anterior carpal glide)
Abduction- 20-30 degrees
Adduction- 30-40 degrees

Question 21

Wrist flexor Retinaculum MFR

Answer 21

Patient: seated or supine with palm facing up
Physician: in front of patient
Physician’s thumbs are placed on the medial and lateral attachments of the transverse carpal ligament, with the fingers wrapped around the dorsal wrist
Exert tension on the flexor retinaculum by pressing thumbs into the solar surface of the hand and pushing the thumbs apart
Hold for 20-60 seconds until a release is felt

Question 22

Radiocarpal Joint SD Articulatory with Traction

Answer 22

Physician cups hands by approximating thenar and hypothenar eminences to form a groove inch hand
Physician’s hands are placed over the dysfunction with the grooves parallel to the joint line
Physician squeezes between his/her hands, producing traction as the eminences separate
Physician maintains the squeeze and traction while articulating the patient’s wrist in a clockwise, then counter-clockwise motion, carrying the dysfunction through the restrictive barrier

Question 23

Wrist Extension/ Ventral Carpal SD HVLA

Answer 23

Patient: Seated
Physician: standing facing the patient
Pronate elbow. Grasp patient’s hand, thumbs contracting dorsally at the proximal carpal bone (radoiocarpal joint)
Deliver a whip-like thrust moving from extension to flexion through the carpal dysfunction

Question 24

Wrist Flexion/ Dorsal Carpal SD HVLA

Answer 24

Patient: seated
Physician: standing facing the patient
Pronate elbow. Graps patient’s hand, thumbs contacting dorsally at the proximal carpal bones (radoiocarpal joint)
Deliver a whip-like thrust moving from extension to flexion through the carpal dysfunction

Question 25

Wrist Flexion/ Dorsal Carpal SD HVLA

Answer 25

Patient- seated
Physician- standing facing the patient
Pronate elbow. Grasp patient’s hand, thumbs contacting dorsally at the proximal carpal bones (radoiocarpal joint)
Deliver a whip-like thrust moving from flexion to extension through the carpal dysfunction

Question 26

Hand and Finger Joints

Answer 26

MCP Abduction- moving away from the long finger
MCP Adduction- moving toward the long finger
Thumb Abduction- Moves anterior from the anatomical position (supinated)
Individual Motion Testing: Abduction/adduction of MCP, PIP, and DIP joints

Question 27

Finger Articulatory Treatment

Answer 27

Lock the dysfunctional metacarpal between the thumb and index finger of one hand
With other hand, place thumb and index finger on the dorsal and volar aspects of the dysfunctional phalanx
Apply long-axis extension

Question 28

Phalangeal Dysfunction HVLA

Answer 28

Patient- seated
Physician- standing facing the patient
Isolate dysfunctional joint
While stabilizing the wrist, exert traction and a hyper flexion thrust through the SD

Question 29

Supraspinatus Tender Point

Answer 29

F Abd ER

patient- supine

Question 30

Levator Scapulae Tender Point

Answer 30

Abd IR Traction

Patient- prone

Question 31

Subscapularis Tender point

Answer 31

E IR
Patient- Supine
May apply some traction

Question 32

Biceps Brachii (Long head) Tender point

Answer 32

F Abd IR
Patient- Supine
Elbow and Shoulder Flexed

Question 33

Biceps Brachii (Short head) Tender points

Answer 33

F ADD IR

Patient- supine

Question 34

Radial Head- Lateral (Supinator)

Answer 34

E SUP Valgus

Question 35

Medial Epicondyle (Pronator Teres)

Answer 35

F Pro Add

Question 36

Dorsal Wrist (Extensor Carpi Radialis)

Answer 36

E ABD

Question 37

Doral Wrist (Extensor Carpi Ulnaris)

Answer 37

E ADD

Question 38

Palmar Wrist (Flexor Carpi Radialis)

Answer 38

F ABD

Question 39

Palmar Wrist (Flexor Carpi Ulnaris)

Answer 39

F Add

Question 40

First CMP (Abductor Pollicis Brevis)

Answer 40

F (wrist) ABD (thumb)