126 PERIPHERAL JOINT MOBILIZATION TECHNIQUES

A

B

FIGURE 5.25 Scapulothoracic articulation: elevation, depression, protraction, retraction, upward and downward rotations, and winging.

FIGURE 5.23 Sternoclavicular joint: posterior and superior glides. (A) Press down with the thumb for posterior glide. (B) Press upward with the index fin- ger for superior glide.

FIGURE 5.24 Sternoclavicular joint: anterior and inferior glides. (A) Pull the clavicle upward for an anterior glide. (B) Press caudalward with the curled fingers for an inferior glide.

A B

Hand Placement

Place your thumb on the anterior surface of the proximal end of the clavicle.

Flex your index finger and place the middle phalanx along the caudal surface of the clavicle to support the thumb.

Mobilizing Force

Posterior glide: Push with your thumb in a posterior direction.

Superior glide: Push with your index finger in a superior direction

Sternoclavicular Anterior Glide and Caudal (Inferior) Glide (Fig. 5.24)

Indications

Anterior glide to increase protraction; caudal glide to increase elevation of the clavicle.

Treatment Plane

The treatment plane is in the olecranon fossa, angled ap- proximately 45⬚ from the long axis of the ulna (Fig. 5.27).

Indications

To increase scapular motions of elevation, depression, pro- traction, retraction, rotation, upward and downward rota- tions, and winging.

Patient Position

If there is considerable restriction in mobility, begin prone and progress to side-lying, with the patient facing you.

Support the weight of the patient’s arm by draping it over your inferior arm and allowing it to hang so the scapular muscles are relaxed.

Hand Placement

Place your superior hand across the acromion process to control the direction of motion.

With the fingers of your inferior hand, scoop under the medial border and inferior angle of the scapula.

Mobilizing Force

Move the scapula in the desired direction by lifting from the inferior angle or by pushing on the acromion process.

Elbow and Forearm Complex (Fig. 5.26)

N O T E : The elbow and forearm complex consists of four joints: humeroulnar, humeroradial, proximal radioulnar and distal radioulnar. For full elbow flexion and extension, accessory motions of varus and valgus (with radial and ulnar glides) are necessary. The techniques for each of the joints as well as accessory motions are described in this section. For a review of the joint mechanics, see Chapter 18.

Radius Distal radioulnar Humero- radial Humerus Ulna Humero- ulnar Proximal radioulnar

FIGURE 5.26 Bones and joints of the elbow complex.

T.P.

45°

FIGURE 5.27 Lateral view of the humeroulnar joint, depicting the treatment plane (T.P.).

Stabilization

Fixate the humerus against the treatment table with a belt or use an assistant to hold it. The patient may roll onto his or her side and fixate the humerus with the contralateral hand if muscle relaxation can be maintained around the elbow joint being mobilized.

Humeroulnar Distraction and Progression (Fig. 5.28A)

Indications

Testing; initial treatment (sustained grade II); pain control (grade I or II oscillation); to increase flexion or extension (grade III or IV).

A

Humeroulnar Articulation

The convex trochlea articulates with the concave olecranon fossa.

Resting Position

Patient Position

Supine, with the elbow over the edge of the treatment table or supported with padding just proximal to the olecranon process. Rest the patient’s wrist against your shoulder, allowing the elbow to be in resting position for the initial treatment. To stretch into either flexion or extension, posi- tion the joint at the end of its available range.

Hand Placement

When in the resting position or at end-range flexion, place the fingers of your medial hand over the proximal ulna on the volar surface; reinforce it with your other hand. When at end-range extension, stand and place the base of your proximal hand over the proximal portion of the ulna and support the distal forearm with your other hand.

Mobilizing Force

Force against the proximal ulna at a 45⬚ angle to the shaft of the bone.

Humeroulnar Distal Glide (Fig. 5.28B)

Indication

To increase flexion.

Humeroulnar Radial Glide

Indication

To increase varus. This is an accessory motion of the joint that accompanies elbow flexion and is therefore used to progress flexion.

Patient Position

Side-lying on the arm to be mobilized, with the shoul- der laterally rotated and the humerus supported on the table.

Begin with the elbow in resting position; progress to end-range flexion.

Hand Placement

Place the base of your proximal hand just distal to the elbow; support the distal forearm with your other hand.

Mobilizing Force

Force against the ulna in a radial direction.

Humeroulnar Ulnar Glide

Indication

To increase valgus. This is an accessory motion of the joint that accompanies elbow extension and is therefore used to progress extension.

Patient Position

Same as for radial glide except a block or wedge is placed under the proximal forearm for stabilization (using distal stabilization).

Initially, the elbow is placed in resting position and is progressed to end-range extension.

Mobilizing Force

Force against the distal humerus in a radial direction, caus- ing the ulna to glide ulnarly.

Humeroradial Articulation

The convex capitulum articulates with the concave radial head (see Fig. 5.26).

Resting Position

Elbow is extended, and forearm is supinated to the end of the available range.

Treatment Plane

The treatment plane is in the concave radial head perpendi- cular to the long axis of the radius.

Stabilization

Fixate the humerus with one of your hands.

Humeroradial Distraction (Fig. 5.29)

Indications

To increase mobility of the humeroradial joint; to mani- pulate a pushed elbow (proximal displacement of the radius).