621 UE Skills

Passive Mobilizer Slider: Radial Nerve

1) Supine with shoulder off table 2) Clear baseline 3) start with a scapular depression, elbow extension, internal rotation and pronation. Tuck that thumb, make that fist, wrist flexion and ulnar deviation. Lastly, we're going to add the scapular abduction until symptoms Actual Test 1) wrist flexion, we elevate the scapula. (Tension distal) 2) With wrist extension, we depress the scapula. (Tension proximal)

Home Exercise Program: Stronger Movement—Radial Nerve

- this would be somebody with low severity, low irritability. - repeat 10 to 15 times

Upper extremity nerve quick tests: Upper Extremity Neurodynamics Median Nerve

1) Clear Baseline Symptoms + Check Symptoms as you go down 2) Humeral Flexion 3) Wrist and finger extension + Ulnar deviate 4) Humeral abduction 5) Once the symptoms come on, you're going to structurally differentiate by moving their cervical spine into side bend ipsilateral (should decrease) , and side bend contralateral (should increase) - Look for symptoms reproduction - Measure excursion - measure humeral abduction

Upper extremity nerve sliders: Upper Extremity Neurodynamics aka General passive mobilization: Median nerve slider

1) Spine 2) Clear baseline 3) elbow flexed at 90, humeral abduction, stabilize the scapula. You're going to supinate their forearm, change hand positions, come into your pistol grip, extend the wrist and fingers, come in, stabilize the distal aspect of the humerus, externally rotate them down. You're monitoring any symptoms. Bring them into elbow extension 4) Once you feel tension/symptoms you start technique 5) start in elbow flexion, wrist extension, and then I'm going to extend her elbow and flex her wrists to neutral 6) Move the pt back and forth 7) parameters vary based on pt irritability

Upper extremity nerve tensioners: Upper Extremity Neurodynamics aka General passive mobilization: Median nerve tensioner

1) Spine 2) Clear baseline 3) humeral abduction, stabilize the scapula. You're going to supinate their forearm, change hand positions, come into your pistol grip, extend the wrist and fingers, come in, stabilize the distal aspect of the humerus, externally rotate them down. You're monitoring any symptoms. Bring them into elbow extension 4) Once you feel tension/symptoms you start technique 5) elbow in this extended position, wrist in extended position. I'm then going to tension the nerve by further extending the elbow while maintaining that wrist extension, and then back to the starting position. 6) parameters vary based on pt irritability

Home Exercise Program: Stronger Movement - Median Nerve

1) Standing 2) humeral extension 3) elbow flexion 4) wrist extension 5) finger extension 6) Grasp their fingers with their opposite hand and cock their wrist back into extension 7) flex their humerus, extend their elbow, extend their wrist, extend their fingers, and then return to the starting position. "grasp your wrist, cock your fingers back, and then press it all up to the sky," Different forms: - Contralateral step forward (whole body) parameters are based on your patient's irritability.

Home Exercise Program: Gentler Movement - Median Nerve

1) Standing 2) humeral flexion. 3) elbow extension, 4) wrist extension. 5) wrist flexion 6) elbow flexion 7) humeral extension. "push it away and pull it back in" Different forms: - both arms - alternate arms - press with your right arm, I want you to step with your left, and then come back in parameters are based on your patient's irritability.

Upper Limb Tension Test: Ulnar Nerve

1) Supine 2) Clear baseline 3) glenohumeral abduction, glenohumeral external rotation, forearm pronation, elbow flexion, and wrist and finger extension, particularly of the fourth and fifth digits. 4) Teach C-spine side bend Differentiating Factors - C side bend - Scap depression

Upper Limb Tension Test: Radial Nerve aka upper limb neural tension test 2B

1) Supine with shoulder off table 2) Clear baseline 3) distal to proximal that includes wrist flexion, forearm pronation, elbow extension, shoulder internal rotation, shoulder abduction, and scapula depression. 4) Teach pt how to C-spine side bend Actual test - Depress scap with hip - Relieve symptoms: Weight shift back to Elevate the scapula - Head Ipsi and Contra side bend

Passive Mobilizer Tensioner: Radial Nerve

1) Supine with shoulder off table 2) Clear baseline 3) start with a scapular depression, elbow extension, internal rotation and pronation. Tuck that thumb, make that fist, wrist flexion and ulnar deviation. Lastly, we're going to add the scapular abduction until symptoms Actual Test 1) extend the wrist, elevate the scapula 2) flex the wrist, depress the scapula

Home Exercise Program: Stronger Movement—Ulnar Nerve

1) bring your hand up, palm facing toward your ear, fingers down, elbow out to the side. C-spine contralateral side bend 2) extend your elbow, flex your wrist, bend it down, and then side bend ipsilaterally. parameters are dependent on patient irritability and severity.

Home Exercise Program: Gentler Movement—Ulnar Nerve

1) bring your palm up, fingers down, palm toward your ear, and elbow out to the side. C-spine ipsi side bend 2) extend the elbow, and then side-bend the opposite way toward your left. So here, we've slackened at the elbow and tensioned at the neck. parameters are dependent on patient irritability and severity.

Palpation: Ulnar Nerve

1) just above the medial epicondyle 2) just below the medial epicondyle, around near the cubital tunnel. 3) medial to the pisiform, where the ulnar nerve may be in that Guyon's canal We're looking for a fairly broad, flat structure that may be sensitive.

Radial Nerve Palpation

1) one third of the way between the deltoid veracity and the lateral epicondyle. A rope-like structure along the posterior aspect of the humerus 2) have pt supinate. And we can palpate the supinator muscle. 3) Anatomical snuffbox - ulnarly deviate the hand and palpate the radial nerve against the scaphoid

Stationary Circles Lymph Node Regions: Popliteal

1) pt prone 2) flat hand is going to go in the popliteal fossa. I am going to bend his knee slightly. 3) PT in lunge position - bending knee as they perform circle 4) Popliteal has light downward pressure 5) 7-10 times

Specific Passive Mobilizer Slider: Median Nerve

1) pt slides so testing side shoulder is off table 2) pt AC joint right at the level of my hip - weight shift forward while arm at side and elbow bent at 90 degrees for scap depression 3) Hold prev position for all and check for symptoms at each stage - grab inner forearm and come in underneath elbow so full extension 4) Supination/External rotation 5) grasp the fingers and the wrist as well as the thumb, and you're going to bring the patient then into wrist and finger extension 6) abduct them until you feel tension or symptoms if the patient's symptoms are reproduced, you're going to perform the technique there. Technique starts 1) Ease out of scap depression 2) Allow her scapular to elevate through a weight shift as I extend her wrist back. Depress her scapula through a weight shift as her wrist flexes to neutral.

Specific Passive Mobilizer Tensioner: Median Nerve

1) pt slides so testing side shoulder is off table 2) pt AC joint right at the level of my hip - weight shift forward while arm at side and elbow bent at 90 degrees for scap depression 3) Hold prev position for all and check for symptoms at each stage - grab inner forearm and come in underneath elbow so full extension 4) Supination/External rotation 5) grasp the fingers and the wrist as well as the thumb, and you're going to bring the patient then into wrist and finger extension 6) abduct them until you feel tension or symptoms if the patient's symptoms are reproduced, you're going to perform the technique there. Technique starts 1) start in elevation in neutral-wrist position. And then I am going to depress the scapula and extend the wrist.

STM for nerve entrapment sites of the radial nerve

AKA STM for lateral elbow symptoms Purpose: lateral elbow tendinopathy, Think about issues related to muscles attached to lateral epicondyle Supinator can compress radial nerve 1) Palpate for tone 2) STM - Deeper = Slower 3) 5-10 mins looking for change in tone 4) Reassess after: perform neuro dynamic assessment or assess wrist range of motion. I can assess pain with gripping.

STM for nerve entrapment sites of the median nerve

AKA STM for medial elbow symptoms Purpose: somebody with medial elbow pain, maybe like golfer's elbow, medial epicondylitis. Think about muscles that attach to medial epicondyle. Pronator teres can entrap median nerve 1) Palpate for tone 2) STM - Deeper = Slower 3) 5-10 mins looking for change in tone 4) Reassess after: perform neuro dynamic assessment

Upper Limb Tension Test: Median Nerve General Upper Limb Neurodynamic Test (ULNT) 1

Baseline check 1) pt supine on table 2) Clear baseline symptoms 3) PROM: humeral abduction, ER, Elbow extension, Forearm supination, Wrist and finger extension, Cervical side bend both directions and back to neutral 4) AROM: Cervical side bend both directions 5) Test starts: - Stabilize scapula = using forearm by leaning on table and support elbow with that same hand - PROM abd of shoulder to 90 - Move forearm into supination + finger/wrist extension - Hold everything and move into ER (downwards) - Elbow extension (where you normally see symptoms/tension) - IF symptoms: have pt cerv side bend to testing side while holding - this unloads the nerve which should eliminate symptoms - Side bend other way = should promote symptoms b/c more tension common error - distal hand grip: And what you'll see is now the DIPs are flexing and we're not getting that full excursion.

Upper Limb Tension Test: Median Nerve Specific aka upper limb tension test 2A

Baseline: 1) PROM: Humeral abduction, humeral external rotation, humeral extension, supination, and then wrist and finger extension, scapular depression, cervical side bend 2) Clear baseline symptoms Test: 1) pt slides so testing side shoulder is off table 2) pt AC joint right at the level of my hip - weight shift forward while arm at side and elbow bent at 90 degrees for scap depression 3) Hold prev position for all and check for symptoms at each stage - grab inner forearm and come in underneath elbow so full extension 4) Supination/External rotation 5) grasp the fingers and the wrist as well as the thumb, and you're going to bring the patient then into wrist and finger extension 6) abduct them until you feel tension or symptoms 7) C-side bend to the ipsi side (should decrease) and contra side

Cervical sustained natural apophyseal glide (SNAGS): Joint Mobilization

Common errors: find yourself too close to the patient and your elbows crowding yourself. You'd want to stand far enough back that your elbows at a relaxed position and a stride stance position with your feet.

STM/stretching Infraspinatus/teres minor

Position: Side Lying with head, Pillow in front of arm, and pillow in between knees - pt BACK NEAR edge of table BSF Impairment: Limited Internal rotation ROM (felt firm muscular end feel Activity Limitation: Unstrapping bra Palpate for tone Stabilizing hand: Anterior aspect of shoulder and Mobilizing hand: Fist w/ straight elbow Body weight shift down Common errors: pt: humerus in that anterior position and scapular abduction PT table too high Reassess with Internal rotation PROM measurement

Stationary Circles General

Purpose: 1) Prone w/ pillow under hip 2) PT wide feet (lunge position?) 3) light pressure to stretching the skin toward the axilla. That's the direction I want the lymph to flow 4) left knee is bending as I stretch the skin toward the axilla. And then as I release, that is when I allow the recoil of the skin to bring my hand back to its starting point. 5) 7-10 reps 6) Move up one hand placement Common errors: - pressure too heavy Applying downward force

Upper cervical traction and Suboccipital release: Soft Tissue Mobilization

Purpose: - improve the length of the soft tissues in myofascia at the base of the head as well as provide general traction to the joints in that area, such as the OA joint. - improve mobility in that area as well as decrease pain or headache if the person is classified as having neck pain with headache. 10-15 seconds - Following the mobilization, you may want to have your patient perform an active range of motion exercise such as a chin tuck to then use that new mobility - check their active range of motion, their resting level of pain, and if they have headache, Common errors - poor posture by the therapist, performing the technique in a slouched position, or pulling too hard on the patient's head, or pulling in the wrong direction or unequal pressure through their hands.

Acromioclavicular inferior glide: Joint Mobilization

Purpose: - patient is lacking upward rotation of the scapula during shoulder flexion, scaption, and abduction. - AC separation, you may want to use this technique at grade I or grade II - Flexor Pollicis is working the hardest Common error: - Push too hard and overly depress scapula - Poor direction of force

STM for DeQuervain's syndrome

Purpose: Decrease inflammation 1) start out with cross friction massage right across the first dorsal compartment as the tendons are passing through that synovial sheath 2) Work through the whole course of the muscle 3) Can add thumb flexion or ulnar deviation as you STM (move as you massage down)

Cervical PAs: Joint Mobilization

Purpose: Hypomobility in a segment we have improved the range of motion that the vertebrate is able to travel through which should have carried over into improving any motion, really, of the cervical spine, flexion, extension, maybe even rotation, because a P-A is just establishing a better wiggle, a better movement of the joint in general

Cervical unilateral PAs (with progression): Joint Mobilization

Purpose: Improve hypomobility. Use to treat any direction thumb-right-next-to-thumb contact over the spinous process. Push the muscles over so that you can access the joint without having to go through any tender musculature. any of the grades, we're going to probably do that for 30 seconds Combined position - have pt rotate same side your treating - brings R2 closer to you, so you do less work OR - treat pt in extension

First rib caudal glide in sitting: Joint Mobilization

Purpose: Improve mobility of first rib ex. performed your CRLF-- your Cervical Rotation Lateral Flexion assessment and found a hypomobile first rib. OR thoracic outlet syndrome Direction of force is inferior medial Common errors: - forgetting to side bend to put those tissues on slack or side bending too far. - wrong angle with the forearm-- so being too far pushing forward or too far lateral - trying to create a large weight shif

Dorsal Glide of Radius on Ulna

Purpose: Improve supination of forearm. concave distal radius is moving posteriorly on the ulna with supination 1) Sitting 2) forearm is on the table w/ pt in resting position: 10 degrees of supination 3) stability comes from holding just onto that distal aspect of the ulna, 4) Moving arm: Lumbrical grip on radius 5) Oscillatory gildes or sustained holds 6) force is in that same plane as the concave radius can improve more supination by having pt in more supination Common error: - Poor stability - pushing pt into supination

Transverse cervico-thoracic rotation mobilization in prone: Joint Mobilization

Purpose: Limited cervical rotation ROM, Symptoms in cervical thoracic region, 2 Methods: - stabilize hand: T1 spinous process with our left hand. - Mobilizing hand: hypothenar eminence on the spinous process, the lateral aspect of the spinous process of C7 on the patient's left side, we can place that there and push the spinous process into rotation to the left. Assess, Treat, Reassess

Joint Mobilization: Ulnar Glide of the Carpals on the Radius

Purpose: Osteokinematic motion of radial deviation. pt could be a drummer, and they had difficulty going into that position while they drummed. Maybe they were throwing darts 1) Sitting 2) resting their arm in the mobilization wedge or on a firm surface or table, with the elbow in flexion, the wrist in neutral (flexion or extension), and the wrist in slight ulnar deviation. 3) radius and the ulna should be lined up right with the edge of the wedge 4) stabilization hand is going to be pressing down into the radius, compressing the ulna into the wedge and into the table 5) mobilization hand, the web space from your hand, will be right over that first carpal row 6) weight shift in that ulnar direction 7) oscillatory movement, grades I through IV, or sustained motion, grades I through III. can put the patient in a greater amount of radial deviation as you provide that treatment

Basilar grind test

Purpose: Scour test of 1st CMC joint 1) Ulna side of forearm on table 2) one hand to stabilize that trapezium. 3) Our their hand is going to grasp around the metacarpal and apply a compressive force 4) perform scour (circles) in both directions positive test: reproduction of your patient's symptoms with compression with a potential relief of symptoms if you perform that same movement with the distraction technique. (could be arthritis or injury to connective tissue)

Stationary Circles Lymph Node Regions: Inguinal

Purpose: Swelling in leg 1) pt finds iliac crest 2) pt slide hand down to where 3rd finger is on underwear line 3) PT puts both hands above pt hands 4) make a half a circle with me, and a release, and a half circle, and a release. 5) PT moves pt hand out of way and does it 6) next hand placement will be that adductor inner thigh 7) 7-10 times

Unilateral PA with cervico-thoracic rotation mobilization: Joint Mobilization

Purpose: Symptoms in cervico-thoracic region and loss of rotation Aggressive technique (more end range) 10-15 reps Common errors - pushing too hard on the head into the table - not side bending and rotating down appropriate to that level - not timing your mobilization with their breathing. Assess, Treat, Reassess

Elbow traction: Joint Mobilization

Purpose: Treat humeroulnar joint. Improve elbow flexion or extension - olecranon is clear from the table because we're going to be pulling perpendicular to that forearm. - tuck my elbow in so that my force can be in a posterior weight shift - Oscillations assess, treat, reassess

Passive Mobilizer Slider: Ulnar Nerve

Purpose: already performed our ulnar nerve examination, found some limitation, and I want to perform a slider as an intervention. 1) Supine 2) Stabilize the scapula. Extend the wrist and fingers. Flex and pronate. Flex the elbow and pronate the forearm. Externally rotate the shoulder, and then abduct to where there's a point of symptoms Actual Test 1) flexing the wrist, and at the shoulder by adducting the shoulder, and then tension by depressing the scapula. 2) elevate the scapula, abduct the glenohumeral joint, and extend the wrist.

Finger flexion sign

Purpose: assess the function of the ulnarly nerve-innervated muscles (palmar and dorsal interossei) in the hand. 1) Elbow on table 2) pronated position. I have her wrist in a full extension to a neutral position and keep finger straight 3) place this piece of paper in between your long finger and your ring finger and PT try to pull it out (pt using both the dorsal and palmar interossei) Neg: maintain her fingers in extension as I pull this piece of paper away Positive: fingers would try to flex as I pull this away. And that is because she does not have the strength in the interossei muscles

Rib spring test/mobilization: Joint Mobilization (ALSO Rib PA)

Purpose: assessed thoracic active range in motion and noted some symptoms in the area of the ribs. You've performed your rib differentiation test and found a dysfunctional rib with hypomobility. hypothenar eminence is going to go on that rib angle. The hardest working hand in this case is actually my stabilization hand perform 30 to 40 repetitions, rest, repeat that a few time Common errors -not stabilizing well enough - having both arms moving at the same time - pushing too hard, where we see a lot of thoracic rotation - not isolating down to that individual rib level.

Finkelstein test

Purpose: assessment for de Quervain's tenosynovitis which affects the extensor pollicis brevis and abductor pollicis longus tendons (1st tunnel issue) 1) Baseline symptoms 2) Ulna side elbow on table 3) PT support the distal aspect of the radius and ulna with my hand. 4) pt "Put your thumb across your palm and then grasp your thumb like you're making a fist." 5) PT take the wrist and move into ulnar deviation. That motion is going to stress the tendons of the extensor pollicis brevis and abductor pollicis longus Other things that can be positive: - 1st CMC (arthritic) - Scaphoid fracture - Superficial radial nerve Positive: Reproduction of pt symptoms

Watson's (scaphoid shift) test

Purpose: assessment for the dynamic stability of the scapholunate ligament. You might perform this on somebody who does a lot of weight bearing activities through their hands, or a lot of compression through their wrists, or if they have a traumatic injury where they fell on their hand and wrist. And we might be thinking about some issues or laxity of that scapholunate ligament. 1) elbow resting on the table 2) support the distal aspect of the wrist and forearm in a pronated position. 3) wrist in wrist extension and ulnar deviation 4) thumb and index finger around the scaphoid and press in this dorsal direction 5) maintain that pressure and flex and radially deviate the wrist. Neg: integrity of that scapholunate ligament will push the scaphoid down into my thumb and I'd be unable to maintain that scaphoid in a dorsal direction. Positive: press the scaphoid dorsally, I move into flexion and radial deviation, and then I release, there's a clunk of that scaphoid as I release. That clunk was because I was able to maintain that scaphoid dorsally because of laxity of that scapholunate ligament

Stationary Circles Specific Cervical

Purpose: create that negative pressure gradient centrally. stimulating flow down to the sternal notch, the venous angle, where the thoracic duct and the right lymphatic duct enter the venous system. 1) Supine w/ pillow under knees 2) pt close to edge of table 3) Boundary: cervical lymph node chain starts all the way behind the ear and is going to come all the way down the neck in about three different pathways. 4) see how many hand sizes you need (1 for this one) 5) long finger I'm going to put right behind his ear. I'm going to let my index finger go right in front. I'm going to have my thumbs just relaxed 6) stationary circle, but now I'm coming down, stretching, and releasing

Hook of the hamate pull test

Purpose: determine if there is a possibility of a fracture of the hook of the hamate that is yet undetected. if this test was positive, what could be happening is that as these tendons come along the hook of the hamate, they are pulling across it and they're trying to displace that fracture

Lateral cervical glide with radial nerve tension positioning: Joint Mobilization

Purpose: different side to side in either range of motion or symptoms with our radial nerve tension testing. I might perform this in somebody with low irritability and low severity of symptoms. How it works: move the gutter of the cervical spine underneath the nerve roots that make up the radial nerve Place pt in radial nerve tension position: - tuck your thumb and make a fist. Arm down by your side, you're going to turn it in. Bend your wrist up, and then you're going to move your arm out to the side - Lateral direction of force - reassess that radial nerve position, the amount of shoulder abduction, as well as any reduction in patient's symptoms

Finger dorsal/palmar glides: Joint Mobilization

Purpose: dorsal glide if we saw limitation in extension at any of those joints or the palmar glide if we saw a limitation in flexion at any of those joints. 1) pt sitting and PT standing 2) stabilizing pt hand against PT trunk. 3) open pack position for each of these joints is slight flexion. 4) Force perpendicular to concave surface

First rib caudal glide in supine: Joint Mobilization

Purpose: localized pain around the area of the first rib, pain with elevating the shoulder or the scapula, or even somebody who has a thoracic outlet type syndrome, and you're working on mobility of that first rib and those scalenes. - first MCP on that first rib. - Tuck my elbow into my side. - shift my weight inferiorly Assess, Treat, Reassess

Stationary Circles Specific Supraclavicular

Purpose: encourage the thoracic duct and the right lymphatic duct to empty into the venous system and create that negative pressure gradient that I need to help move lymph fluid from the periphery to the central vessels. 1) Supine w/ pillow under knees 2) pt close to edge of table 3) Borders: start at the sternal notch, follow the clavicle out to the acromion. And then I'm going to be mindful of the spine of the scapula posteriorly. 4) the size of my hand and the size of Kevin's fossa, that's going to dictate how many hand placements I'm going to do the stationary circles to 5) Start w/ fingertips and hands in fossa 6) Direction of stretch is towards sternal notch 7) 7-10 reps

Palmar Glide of Capitate on Lunate

Purpose: gain range of motion to wrist extension 1) Sitting 2) patient's forearm in a pronated position on that wedge. 3) find the dorsal tubercle and find that lunate and place the lunate just proximal to that edge of the wedge. 4) Strap Down pt forearm w/ mob belt 5) edge of the wedge is blocking the lunate 6) thumb is on the capitate (FIND IT w/ 3rd MC), and my hypothenar eminence is going to go over my thumb. 7) Force in palmer direction Two to three Hertz, 30- or 40-second bouts Common errors: - see the forearm moving or the wrist moving into flexion or extension, we're probably pushing too hard

Downglides (segment specific): Joint Mobilization

Purpose: hypomobility on that side and limitations with either extension, side bend, or rotation to that side Hand placement: First MCP goes on the articular pillar. tuck elbow into side so direction of force is towards the patient's opposite hip More specific: if I was going to move C4 on C5, I'd first find C4. I start in this case with a side bend down to C4, and I rotate to the left for a right down glide. common errors: - pushing too hard (see the whole body moving) - too much side bend as we generate our force.

Closed kinetic chain scapular assist: Joint Mobilization

Purpose: improve scapula upward rotation in shoulder flexion. Follow up after assessment of a scapula assist test where it increased the patient's range of motion and decreased their pain how much shoulder flexion for the patient: -the height of the table - how far the patient steps back - leans their chest forward time your mobilization and the upward rotation of your scapula with the same time that they step their leg back Common Error - not maintaining that upward rotation - pt error over-activate or tense up their muscles

Radial head posterior to anterior glide with gripping (MWM): Joint Mobilization

Purpose: intervention on patients with lateral elbow pain when they squeeze an object. Since they are in a pronated position: line of force is medial ask for feedback from pt common errors - Staying up too tall, and you're really just compressing the radius into the ulna. You need to get your forearms down. So you're going to line to push in that anterior direction. - not stabilizing well enough and just pushing the whole arm in that direction.

Lateral ulnar glide with gripping (MWM): Joint Mobilization

Purpose: intervention on patients with lateral elbow pain when they squeeze an object. stand up towards the ceiling, gliding towards that end range in a lateral position. I can then sustain that glide and have Taylor grip the towel. Have her hold three to five seconds. And relax. common errors: - Not orienting your mobilization belt to pull up (Lateral is straight up b/c internal rotated. Pure lateral is actually posterior)

AA rotation contract relax stretching: Soft Tissue Mobilization

Purpose: lacks cervical spine rotation to the right or to the left you want the patient far enough off the end of the table-- scoot up a little bit-- so that their neck kind of clears the table. 1) Fully flex neck 2) When you rotate head, you target C1-C2 3) pt look to the to the opposite side - going to contract the smaller segmental muscles on that side contract relax 4) Relax eyes 5) pt looks toward turned side (PT applies overpressure towards same side) 6) Perform multiple times Common errors: - table height is too high. So the head is going to be up against your chest as opposed to your arms being nice and relaxed - not having the patient's neck in full flexion.

Palmar Glide of Scaphoid on Radius

Purpose: limitations in range of motion related to the joint capsule or some pain with wrist extension. Pain when typing or pushup 2 Ways to perform: Holding onto radius (more flexibility with arm position) 1) Radial/Ulnar deviate to find scaphoid. grab the scaphoid with our mobilizing hand 2) Stabilize forearm against trunk 3) Push in palmar direction Wedge 1) distal aspect of the radius-- right at the edge of the wedge 2) find that scaphoid by our radioulnar deviation 3) Mob belt to stabilize 4) dummy thumb in this case right over that scaphoid. My hand, my hypothenar eminence, is going to come right over that thumb 5) Sternum guides line of force 6) Move via a slight weight shift in that palmar direction. Common errors: - Push too hard - see wrist flexion or elbow coming up

Radiohumeral distraction: Joint Mobilization

Purpose: limited elbow flexion, extension, or pronation in supination, and I had assessed the humeroradial the joint for limitations in motion. - traction force-- stabilizing the humerus, rotating my body, holding seven to 10 seconds for a sustained grade III hold assess, treat, reassess

Posterior Proximal radioulnar glides: Joint Mobilization

Purpose: limited pronation range of motion related to the arthrokinematics of that proximal radioulnar joint. Start pt in resting position: 70 degrees of elbow flexion, 35 degrees of supination - direction of force is related to that concave ulna. (so it doesn't matter how you rotate wrist) assess, treat, reassess

Palmar Glide of Radius on Ulna

Purpose: limited pronation, the radius moving in an anterior direction, it's concave, so our glide would be in the same direction. 1) Sitting 2) forearm is on the table w/ pt in resting position: 10 degrees of supination (Since my patient's shoulder is abducted, that 10 degrees of supination is smaller than you think - relative to humerus) 3) lumbrical grip to grab just at that distal ulna 4) thenar eminence is going to be on the distal radius. 5) anterior-directed force parallel to the surface of the concave radius. 6) Oslatory or sustained hold 7) force is in that same plane as the concave radius

Anterior Proximal radioulnar glides: Joint Mobilization

Purpose: limited supination. limited arthrokinemetic motion at that proximal radioulnar joint. Supination-- Ventral-- SUV Start pt in resting position: 70 degrees of elbow flexion, 35 degrees of supination assess, treat, reassess

Thoracic central PAs: Joint Mobilization

Purpose: localized thoracic pain with certain motions and we anticipated those facet joints being problematic Assess, Treat, Reassess

Froment's sign

Purpose: looking at ulnar nerve function in the hand 1) Sitting w/ arm supported 2) forearm in mid position, supported on the table, so that her thumb is facing upwards. 3) place this piece of paper between her thumb and her index finger in a key pinch type of grasp. 4) Don't let me take the paper and keep thumb straight negative test: The patient is able to maintain her thumb in an extended position positive test: what we would see is that the patient has weakness in those muscles. And therefore she will flex the IP joint of the thumb in an attempt to use flexor pollicis longis to prevent me from pulling this piece of paper out of her hand

Passive Mobilizer Tensioner: Ulnar Nerve

Purpose: low severity, lower irritability, and they can tolerate more of a tensioning type intervention for the nerve. 1) Supine 2) Stabilize the scapula. Extend the wrist and fingers. Flex and pronate. Flex the elbow and pronate the forearm. Externally rotate the shoulder, and then abduct to where there's a point of symptoms Actual Test 1) Teach pt to tuck chin (double chin) 2) wrist extension, shoulder abduction, she tucks the chin, or cervical flexion 3) Head goes up toward the ceiling, we release the tension by flexing the wrist and adducting the shoulder.

OA flexion mobilization: Joint Mobilization

Purpose: mobility deficit in the upper cervical spine, particularly into flexion. Oftentimes in the neck pain category of neck pain with mobility deficits or even neck pain with headaches as that is a region that could be a source of a patient's headaches. - Stabilizing arm karate chops table and pt's spinous process of C2 just below my second MCP joint. - Mobilizing arm cradle head - Put pillow case on pt head - Force: Apply posterior glide and flexion mobilization common errors - fingers collapsing when you're trying to stabilize. - lift their head up off of the hand that's trying to stabilize

Palmar Glide of Carpals on Radius for Wrist Extension

Purpose: osteokinematic motion of wrist extension. pt has pain w/ wrist in push up 1) Seated 2) mobilization wedge or a firm surface for their arm or wrist to be against. 3) sitting with a flexed elbow position and slightly pronated with their palm down. 4) Resting position: neutral flexion and extension in a slight ulnar deviation 5) stabilizing over the distal aspect of the radius and ulna. 6) on top of the first carpal row, right in the web space (Sternum guides force) 7) PT weight shift down into the palmar and slightly distal direction to get pt in more ext, you can flip the wedge and cock pt wrist into more ext Common Errors: - poor direction of force (sternum too far)

Dorsal Glide of Carpals on Radius for Wrist Flexion

Purpose: osteokinematic motion of wrist flexion 1) Seated 2) mobilization wedge or a firm surface. And you're going to have the elbow flexed and the palm up. 3) distal aspect of the radius and the ulna are going to be right along the edge of the wedge 4) resting position of the wrist is neutral wrist flexion or extension with a slight ulnar deviation. 5)Stabilize wedge and hand in this position 6) Mobilizing hand: web space of your hand, on the first carpal row (sternum guides force) 7) dorsal and slightly distal direction of force. 8) sustained mobilization, grades I through III, or an oscillatory mobilization, grades I through IV. put in more wrist flexion if you want to make it more functional Common mistakes - don't have your center of mass in the right position - overpressing with their arms and flexed elbows.

Joint Mobilization: Radial Glide of the Carpals on the Radius

Purpose: osteokinematics of wrist ulnar deviation. difficulty following through when throwing a dart. Difficulty playing the drums 1) sitting 2) distal aspect of the radius and their ulna right in the groove of the wedge and right on the edge 3) wrist is going to start in a resting position (neutral) 4) PT stride stance 5) Stabilize hand/wedge on table 6) Radial glide 7) oscillatory glide, grade ones through four, or you can do a sustained glide, grades one through three. Hold 7-10 seconds More ulnar deviation for more intense treatment

Sternoclavicular inferior glide: Joint Mobilization

Purpose: pain or loss of range of motion with any elevation motion-- so flexion or abduction. That clavicle at the sternum glides inferiorly with that overhead motion, typically, towards the end ranges of motion. - Can place arm in further end ranges of flexion/abduction common mistakes - Being up too tall/too low, - not pushing so much that his whole body is moving.

Thoracic extension manipulation: Joint Mobilization

Purpose: patient in thoracic spine with mobility deficits, or even mechanical neck pain or shoulder pain.

Dorsal Glide of Trapezium on Scaphoid

Purpose: perform a dorsal glide of the trapezium on the scaphoid for wrist extension 2 Ways to perform: Arms to stabilize: 1) Radial/Ulnar deviate to find scaphoid 2) Stabilize scaphoid 3) grasp with our other hand the trapezium, which should be just distal to the scaphoid. 4) Stabilize against body 5) Force pulling up, so in that dorsal direction for wrist extension Wedge and mobbelt: 1) supinated position 2) get the edge of the wedge right at the scaphoid. 3) Mob belt to stabilize forearm 4) dummy thumb in this instance on the trapezium. And I'm going to use my hypothenar eminence over that thumb. Common errors: - pushing too hard, and pushing into supination, or pushing into wrist extension

Thoracic unilateral PAs: Joint Mobilization

Purpose: perform these if we have some localized hypomobility in the thoracic spine that we want to improve for different ranges of motion 2 Methods - two thumbs on the same side (stacked) - dummy thumb on the opposite side Assess, Treat, Reassess

Upglides (segment specific): Joint Mobilization

Purpose: pt has issues w/ cervical flexion or rotation OR hypomobile cervical spine segment Regular: - first MCP on articular pillar - other arm straight - provide my weight shift directed up and towards the opposite eye. Isolated upglide: - rotate down to C-spine level - side bend down to that level. - This stabilize all the way down to that C4 level - You see less motion of pt head

Thoracic flexion manipulation: Joint Mobilization

Purpose: pt thoracic pain, mechanical neck pain, or even shoulder pain - Have pt hug themselves (one arm on shoulder and other arm under the shoulder) w/ towel roll in between arms - Move pt to edge of table and have them roll towards you - gun technique: tuck my fingers into my palm (hold towel). spinous process would go right in between my phalange and my thenar eminence - Make sure the are in a neutral position to isolate segment - Breath in and out common error is to have the transverse process on that knuckle

Crossed finger test

Purpose: quick screen test that we would use as we were assessing a patient's generalized range of motion, and if we were trying to look more specifically to see if a patient has any weakness of the interossei muscles, or if we're wondering if they have an ulnar nerve issue. Rational: abduct the long finger, they have to use the second dorsal interossei, which are both muscles that are innervated by the deep ulnar nerve. 1) Sitting w/ forearm supported on the table. 2) Her palm is down so that I can observe the motion. 3) cross your long finger over the top of your index finger Negative: able to cross the long finger over the top of the index finger. Positive: patient would not be able to fully cross the long finger over the top of the index finger

UE palpation: Upper Extremity Neurodynamics Median Nerve

Purpose: reproduce mechanosensitivity along the nerve track. 1) Supine - so muscles relax and arm flexed so biceps on slack 2) want to check to see, as you press, if it creates pain or symptoms locally where you're pressing, or if they radiate down into a specific peripheral pattern. 3) Apply sustained pressure - 1st location is at brachium (deep to biceps and medial) 4) pt flexes arm so you see bicep tendon - palpate medial to biceps tendon 5) Indirect - slightly flex their wrist to shorten the wrist flexors, and then palpate indirectly at the carpal tunnel, slightly more proximal-- about 1 to 2 inches, move medial/lateral to see if it reproduces symptoms

Ulnocarpal impaction test

Purpose: rule in or rule out a tear or degeneration of the TFCC complex (triangular fibrocartilage complex) AND ulnar degeneration at the wrist TFCC complex is composed of the distal ulna, the meniscus structure, the distal carpals-- the proximal row of the carpals, ligamentous structures Normal: 80% of our weight bearing goes through the radius and 20% goes through the ulna. In ulnocarpal impaction there is increased loading is going through the ulnar side of the wrist b/c 1) Genetics (radius shorter) 2) radial shortening secondary to a radius fracture Perform: Hand close to body. apply an axial load right through the ulnar aspect of the wrist in ulnar deviation If positive: place pt in that same position, and then what I would do is I would perform a distraction in the same plane of movement. (should not reproduce pain)

Thoracic extension mobilization with movement: Joint Mobilization

Purpose: somebody has some thoracic mobility deficits and has thoracic pain, mechanical neck pain, or even shoulder pain. It's a way to gain thoracic extension using a movement technique. - put the spinous process right in between my thenar and hypothenar eminences - Make sure elbow is correct position for PA force Common errors: - Push the patient in a different direction - pt substitutions of thoracic extension somewhere else where you don't want it, or scapular elevation

Stationary Circles Lymph Node Regions: Axillary

Purpose: swelling in the hand, forearm, elbow, upper arm, I need to stimulate the axillary lymph node region to increase the rate of transportation. 1) Supine w/ pillow under knees 2) pt close to edge of table 3) pt humerus resting on my thigh. 4) PT forearm is going to secure his forearm against PT body. 5) place palm (flat hand) into axillary region 6) perform my stationary circle, starting inferior of the axillary region. And I'm going to make a circle to the superior region, and then I'm going to release my stretch. 7) 7-10 times

Cervico-thoracic junction seated mobilization with movement: Joint Mobilization

Purpose: to get to this as an intervention technique we would have assessed cervical rotation, look for symptoms in the cervico-thoracic region, and potentially assessed the mobility in that cervico-thoracic region. Assess, Treat, Reassess Common error: - Bad table height - PT too far

Wrist traction: Joint Mobilization

Purpose: used to improve flexion- or extension-range of motion at the wrist. Stretching the entire joint capsule 1) Sitting 2) patient will be in a pronated position w/ hand resting on wedge 3) radiocarpal joint to be really close to that line of the wedge. 4) Stabilization hand: close to that joint line 5) mobilizing hand: Around the proximal carpel row of bones next to that joint line 6) Drop forearm so its in line with pt forearm so better force line 7) Sustained hold 7-10 seconds Common error: - don't stabilize well, you can see their whole arm move - not pulling it to wrist flexion or extension when you're performing this technique

Posterior humeral glide: Joint Mobilization

lack of external rotation, or internal rotation of the humerus. start with the patient in his 55 degrees of abduction and 30 degrees of horizontal adduction. Assess Treat Reassess

Scapular mobilization in side lying: Joint Mobilization

When pt elevate their arm, they lack sufficient upward rotation Purpose: improve a number of different motions for the scapulothoracic joint-- elevation, depression, upward and downward rotation, as well as ab- and adduction concave same High table and pt close to PT - Elevation: Weight shift right (cranial) - Depression: Weight shift left (caudle) - abduction: sit my butt back, like I'm doing a squat - adduction: stand up to make sure that motion comes from my body for - upward rotation: end my right knee, straighten my left repeating that motion 15, 20 times, repeating this in sets During reassessment see if that inferior angle gets closer to the midline after performing this joint-mobilization technique. Common Errors: - Pulling trunk forward during abduction movement - During adduction make sure you are not standing up and extending pt shoulder

Inferior humeral glide in supine: Joint Mobilization

Why: improve the osteokinematic motion of shoulder flexion and shoulder abduction Position the arm into a resting position is 55 degrees of abduction and 30 degrees of horizontal adduction PT hand is angled lateral away from the patient's body. This is allowing to clear the lip of the glenoid Assess Treat Reassess

Active Quick Test: Ulnar Nerve

glenohumeral adduction or abduction, with abduction potentially increasing symptoms for ulnar nerve tension and adduction decreasing symptoms

Inferior humeral glide in standing: Joint Mobilization

mobilization technique for end range shoulder flexion and decrease pain Assess Treat Reassess common error - too much shoulder flexion. (creasing at the glenohumeral joint.) - while providing this inferior glide technique is that the elbow is too far in one direction and not directly down along the plane of the scapula. - not making sure that the patient's fully relaxed, their deltoid muscles are disengaged, and they're relaxing their arm in that position so you can provide that inferior glide. (lower the table height to make it less aggressive)

STM/stretching Thoracic paraspinals: Soft Tissue Mobilization

pt prone w/ pillow under chest and towel under feet 5-10 mins

Home Exercise Program: Gentler Movement—Radial Nerve

we pause up at the top. We're in a wrist flexion, so tension on the radial nerve. But putting on slack with elbow flexion. We're going to go back down and pause at the bottom. We put some tension on the nerve with elbow extension, but release it with wrist extension.