Upper Extremity Treatment

Question 1

Glenohumeral (GH) SD BLT

Answer 1

patient lateral recumbent with dysfunctional side up

grasp olecranon process of dysfunctional arm –> flex elbow. use other hand to stabilize the shoulder.

using the elbow as a lever, put the GH in its INDIRECT positioning (abduction/adduction, flexion/extension, compression/traction,IR/ER).

Hold until a release is felt –> using breathing in and out

Reassess.

Question 2

SC Abduction and Adduction evaluation

SC flexion/extension evaluation?

Answer 2

Shrugging shoulders moves the clavicles inferiorly.. this is the same as abducting arms so ABDUCTION

Bringing them back down moves them superiorly. so this is ADDUCTION/shoulder depression.

Arms to the ceiling = flexion

Arms back down = Extension.

Question 3

SC elevated/ADducted SD Still technique

Answer 3

they prefer Adduction or the SC is elevated.

Patient seated. Physician behind patient monitoring SC with one hand and grasping the elbow with the other

start with elbow adducted and slightly extended (what they prefer)

Add compression toward the SC joint

move shoulder into SUPERIOR glide and abduction, engaging in a POSTERIOR CIRCUMDUCTION motion.

remove compression and return to neutral.

Reassess

Question 4

SC Depressed/Abducted SD Still technique

Answer 4

Patient seated. Physician behind patient monitoring SC with one hand and grasping the elbow with the other

start with elbow abducted and slightly FLEXED (what they prefer)

Add compression toward the SC joint

move shoulder into adduction with ANTERIOR circumduction motion, returning to an ADDUCTIOn position

remove compression and return to neutral

Question 5

Sternoclavicular SD HVLA

what’s different between Adducted/Elevated SC or Extended/Anterior SC?

Answer 5

Patient supine. physician at head of the table

Thenar eminence of monitoring hand over restricted SC joint

apply cephalad traction on arm on SIDE OF dysfunction

apply a thrust on SC joint while simultaneously inducing a rapid TRACTION force through the patients arm

adducted SC –> inferior thrust

extended –> posterior

Question 6

AC Joint separated SD Still technique

Answer 6

Patient seated

monitor with one hand at the affected AC joint. other hand brings the arm up into full extension

you apply a traction, then move the arm into adduction/flexion

once in the final position, remove the traction and arm is returned to neutral

Question 7

How do you diagnose Ulnar abduction/adduction?

Answer 7

the distal ulna is where you’re looking at. ulnar adduction is varus testing –> also radial deviation

ulnar abduction (valgus testing) also Ulnar deviation.

Question 8

Ulnar Abduction SD HVLA

Ulnar Adduction SD HVLA

Answer 8

supinate and extend the patients elbow to 5 degrees. grasp the elbow with fingers monitoring the olecranon. move elbow into ulnar ADDUCTION. apply a medial to lateral thrust over medial olecranon.

supinate and extend the patients elbow to 5 degrees. grasp the elbow with fingers monitoring the olecranon. move elbow into ulnar ABDUCTION. apply a LATERAL TO MEDIAL thrust over LATERAL olecranon.

Question 9

Interosseous Membrane MFR

Answer 9

thumbs on proximal and distal aspects of the forearm between radius and ulna

find a tense area, load into the tissue, compress or traction until you feel tissue release in indirect or direct

Question 10

Interosseous membrane BLT

Answer 10

place indirect positioning of the distal wrist and proximal elbow (around the interosseous) to attain point of BLT at the interosseous membrane

add respiratory phases and add minor adjustments to maintain BLT

go until air hunger, back to neutral, and reassess the tissue

Question 11

Anterior Radial Head SD HVLA

Answer 11

Radial head –> anterior glide with supination (SA in SAPP)

Pronate the forearm and flex into the barrier (since it likes to be supinated)

take a breath in and out, then a rapid HYPERFLEXION while thrusting the radial head posteriorly.

reassess

Question 12

Posterior Radial Head SD HVLA

Answer 12

Radial head –> posterior glide with pronation (PP in SAPP)

supinate and extend into extension barrier (since it likes to pronate), then breathe in and out, then rapid hyperextension force while thrusting the radial head anteriorly.

Question 13

Wrist Flexor Retinaculum MFR

Answer 13

supinate and extend the wrist. put your thumbs on the medial and lateral attachments of the transverse carpal ligament

push your thumbs lateral and hold that for 20-60 seconds until release is felt.

Question 14

Radiocarpal Joint SD Articulatory with Traction

Answer 14

this is figure 8 of the wrist

you squeee between their hands, producing traction as the eminences separate.

maintain the squeeze and traction while articulating the patients wrist in a CLOCKWISE, then COUNTER CLOCKWISE motion, carrying dysfunction through the restrictive barrier…

reassess.

Question 15

Wrist Extension/Ventral Carpal SD HVLA

Answer 15

Pronate the elbow. Grasp the patients hand.

Whip like thrust moving from EXTENSION to FLEXION through the carpal dysfunction

Question 16

Wrist Flexion/Dorsal Carpal SD HVLA

Answer 16

Pronate the elbow, grasp the patients hand.

Deliver a whip-like thrust moving from FLEXION TO EXTENSION through the carpal dysfunction

Question 17

Finger Articulatory Treatment

Answer 17

lock the dysfunctional metacarpal between thumb and index

apply long-axis extension , or rotation, or anteroposterior glide

reassess

Question 18

Phalangeal Dysfunction HVLA

Answer 18

Isolate dysfunctional joint. while stabilizing the wrist, exert TRACTION AND HYPERFLEXION thrust through the SD.

reassess