Upper Extremity Techniques
Kaltenborn grading for decreased joint play
0-Ankylosis 1- Considerable decrease 2-Slight Decrease (hypomobile 0-2) 3- Normal (hypermobile 3-5) 3-Slight increase 4-Considerable increase 5-Gross instability
According to the current literature, what are the lasting effects of a single bout of stretching?
24 hours
Creep
When a muscle tendon unit is elongated to a specific length, and then allowed to continue to elongate as stress relaxation occurs. Clinically, this is what occurs when a therapist performs a stretch in which joint range is increased during stretch repetition. Creep is partially responsible for the immediate increase in ROM during a stretch repetition.
Finklesteins Test
flex thumb across palm and bend fingers over top- pt then ulnarly deviates wrist + = pain in thumb extensors
Burnell-Littler Test
67
Carpal Compression Test
68
Froment's Test
69
Allen's Test
70
Flexor intrinsic testing
71
Extensor intrinsic testing
72
Wrist traction for pain and hypomobility
74
Wrist traction for restricted flexion
75
Wrist traction for restricted extension
76
Metacarpal arch mobilization for hypomobility
81
Thumb CMC traction for pain and hypomobility
82
Elbow traction for pain and hypomobility
kalnternborn mobilization pt supine with arm at side, humeroulnar joint at 70 flexion and 10 supination. **treatment plane lies with the ulna. Proximal hands stabilizes the humerus, mobilizing hand grasps the forearm on the ulnar side. Provide traction away from the treatment plane.
Yoss' findings on reflex/sensation testing and cervical radiculopathy
82% of the time diminished reflexes related to surgical findings. 65% of the time diminished sensation related to surgical findings.
Finger Traction
83
Gliding
Movement between two surfaces when the same point on one surface comes into contact with new points on the other surface. *pure gliding only occurs between congruent surfaces.
Rolling
Movement between two surfaces where new equidistant points on one surface come into contact with new equidistant points on another surface.
Shoulder Lift Off Test
Also a test for subscapularis rupture. In addition to IR lag sign test, have the pt start with the arm resting on their low back and see if they can lift it off backwards. Test is 100% specific and 80% sensitive.
Thoracic Spine PA mobs
Also done for treatment of shoulder conditions. Pt supine on table Can either provide mobs at the SPs or TPs (using split two finger method) **make sure forearm is in direction of treatment plane.
An easy way to test for posterolateral instability (besides the pivot shift test) is how?
Chair push off test Have patient sit in a chair with arms, then fully supinate their arms to grasp the backs of each chair arm and push up. Positive for pain.
Cozen's Test
TESTING: Lateral epicondylitis POSITION: the therapist stabilizes the patient's elbow 90 deg flexion with one hand while the patient is asked to pronate the forearm and extend and radially deviate the wrist against manual resistance of the clinician (+) TEST: Produces pain in lateral elbow Basically a MMT of extensor carpi radialis
Kaltenborn Traction Grades
Traction I: force nullifies the compressive forces acting on a joint. Traction II: The slack is taken up in the tissue surrounding the joint Traction III: Beyond the slack, traction force is applied so that tissue crossing the joint are stretched.
C7 Reflex
Triceps reflex -point of hammer to distal triceps tendon with pts arm dangling
Resting positions of 3 elbow joints
Ulnohumeral: 70 flexion, 10 supination Radiohumeral: full extension, full supination Proximal radioulnar: 70 flexion, 35 supination
Closed packed positions of 3 elbow joints
Ulnohumeral: full extension with supination Radiohumeral: 90 flexion with supination Proximal radioulnar: 5 supination
APTA Definition: thrust manipulation
A high velocity, low amplitude therapeutic movement within or at end ROM.
PNF stretching
A variation of static stretching that involves contracting a muscle before stretching it. It is a neuromuscular technique that enhances nm relaxation of the muscle joint complex. (inhibition)
What is a contraindication to joint mobilization?
Hyper mobility. You don't need to mobilize a joint that already has too much.
Static/passive stretching
external force lengthens a muscle joint complex to a predetermined length or tension and holds in that position until creep or stress relaxation occurs.
Neer's Test
"Impingement sign" this is a test that provokes pain. Pt seated, stabilize the scapula and passively abduct their arm above the head with hand in neutral position. This is not looking for popping or clicking, it is a test for PAIN. Test is more SENSITIVE.
Statement by Bialosky about manual therapy
"The mechanisms through which manual therapy inhibits musculoskeletal pain are likely multifaceted and related to the interaction between the intervention, the patient, the practitioner, and the environment.
The treatment plane...
**ALWAYS lies within the concave joint partner -joint mobilization, depending on type, is performed either parallel or perpendicular to this plane.
Kantenborn Grades of Gliding
**There is no grade 1 Grade II: Glide occurs until slack in the joint is taken up Grade III: After slack is taken up and more force is applied. The tissues (capsular) crossing the joint are stretched.
Maitland Grades of Traction and Gliding
**Think in 25% intervals. Grade I: small amplitude oscillations at the beginning of available ROM (pain) Grade II: Large amplitude oscillations at the beginning to mid point of available ROM. (pain) Grade III: Large amplitude oscillations from the midpoint to the end of available ROM. (stretch) Grade IV: Small amplitude oscillations at the end of available ROM. (stretch) *Grade V: High velocity thrust, won't do hardly ever
The direction of rolling in a joint
**is ALWAYS in the same direction of bone movement. This is true whether the moving partner is concave or convex.
Possibly best 3 tests for possible RCT
-Drop arm test -Painful arc -Infraspinatus test
Properties of a good diagnostic test
-Has an intended use -has a well described physical performance -has scoring criteria -should be performed on the proper population
Possibly best 3 tests for shoulder impingment
-Hawkins Kennedy -Painful arc -Infraspinatus Test
Abnormal UMN reflexes
-Oppenheim (pinch tibia and big toe goes up) -Babinski (big toe goes up) -Hoffman (PT pinches middle finger and others oppose toward each other)
Maitland Rules (5)
-Oscillation rate is 2-3 per second for 2 minutes -repeat cycles 2-3 times **treat pain before stiffness -treat in loose packed position first, then move to end of available ROM. -treat in pain free position then move to more painful position. Side notes: you should be assessing pts ROM between each cycle, try to do multiple cycles to keep improving or until the pt plateaus.
Which three muscles must be tested *at a minimum, for patients with a suspected rotator cuff pathology?
-Supraspinatus -Infraspinatus -Subscapularis
What to do before stretching
-assess all joints that muscle will ross -check length of muscle -check end feel -stretch across largest most stable joints -protect smaller less stable joints -inform and instruct patient -choose method of stretching that will produce greater results
The direction of gliding in a joint
-fixed convex and mobile concave: glide in same direction as roll -fixed concave and mobile convex: glide in opposite direction as roll.
Closed packed position
-joint capsule and muscle are in maximal tension positions -maximal congruency between articular surfaces *traction to the joints results in little to no separation of articular surfaces.
Stretching techniques
-manual passive stretching -Hold relax (HR) these 3 are PNF techniques -Hold relax with agonist contraction (HR-AC) -Agonist contraction (AC) -Ballistic
What to do to stretch
-preposition for protection -elicit contraction or static stretch -Hold 15-30 seconds **with grade 1 traction, AVOID COMPRESSION -repeat 3-4 times -gradual release, maintaining traction
Dynamic stretching
-slow to medium speed controlled movements of a muscle joint complex to the end of its ROM. -can be held for brief periods of time or not
Steps in special test selection
1. Determine pretest diagnosis 2. identify purpose of special tests 3. Identify valid tests that relate to your intended purpose 4. Elect tests that rule in or out the disorder and complement each other 5. Whenever possible, rely on likelihood ratios, they are the most powerful.
General Rules of manual therapy (9)
1. Starting position of pt: max comfort, resting position, joint partner fixated. 2. Starting position of therapist: good body mechanics, use gravity to assist in generation of force 3. Fixating hand: one joint partner must be fixated, hard enough surface, *close to the joint. 4. Mobilizing hand: as close to joint as possible, may need to move soft tissue. 5. treatment direction: convex concave rule 6. treatment for pain: traction or oscillation, 10 second intervals, no stretch 7. treatment for hypo mobility: mobilization should be held for a minimum of 5-7 seconds and up to 1 minute. **boyce says 15-18 seconds. **Grade 1 traction should always be maintained during mobilization. 8. Reassessment: before, during, and after treatment. Treatment should continue as long as pt is showing progress of motion or reduction in pain. 9. Objective: restore normal joint play and reduce pain.
ULNT2 Median
2nd neurodynamic test for median nerve Pt propositioned in supine, depress the shoulder with stabilizing arm, extend the elbow, laterally rotate and supinate arm, extend wrist and fingers then passively abd arm to 40. Positive test is median nerve distributed pain/tingling
3-dimensional traction and gliding
A concept that uses prepositioning of joints. The joint is prepositioned in 3 planes and then a traction force is applied. **VERY DANGEROUS, but effective.
Shoulder Anterior Release
A test for anterior GH instability. This is another way to perform the apprehension test that is a little more bearable for the patient. (dorsal glide first, then anterior release) see apprehension test for more.
Shoulder posterior internal impingement test
A test for posterior GH impingement Recreate the anterior release test but you are looking for POSTERIOR pain reported by the patient when you let up on your dorsal glide. *anterior instability and posterior impingement can be related to one another.
Forced Cross Arm Adduction Test
AC joint impingement test. Pt is seated, passively take their arm and cross it over in front of their body. Pain is positive test.
Maudley's Test
AKA long finger resistance test Hand flat on table, lift middle finger against resistance
How accurate is a clinical examination in predicting rotator cuff pathology?
According to *Margarey, it has 80-85% accuracy.
How good is orthography at finding full thickness RCT's? When is it indicated?
Accuracy is 82% 80-90% sensitive and 78-96% specific Indicated with: -weakness of ER -impingement with acute pain increase -LH biceps tendon rupture. -dislocation >40 years with persistent pain p.s. MRIs are also really good at finding RCTs and labral tears, duh. Also ultrasound
Thumb UCL instability test
Apply valgus stress to thumb MP joint wit it at 0, if there is greater than 30-35 degrees valgus- complete rupture of both. Do again with thumb flexed down to isolate UCL proper.
Mobilization with movement for lateral epicondylalgia
Applying a valgus directed force while having a patient grip an object simultaneously. Kind of shutting off the extensors Also can be mobilized by the patient independently by placing strap around waist and just above lateral epicondyle. Leaning against door frame to stabilize humerus, apply valgus force at the radius while gripping a towel.
Traction occurs where?
At a right angle and AWAY from the treatment plane.
Compression occurs where
At a right angle and TOWARDS the treatment plane
Thumb grind test
Axial compression through thumb
C5 Reflex
Biceps reflex -point of hammer to PTs thumb on biceps tendon
C6 Reflex
Brachioradialis reflex -flat head of hammer to muscle belly or tendon of muscle
Shoulder external rotators stretch
Can also be used to increase shoulder internal rotation. Pt supine and arm at 90 and and 90 elbow flexion, towel roll under elbow. 2nd towel over the humeral head, therapist (behind patient) will place opposite forearm on top of that towel, provide a long axis traction with that hand, dorsal glide with that forearm, then move the arm into IR with the other hand, thus stretching the ERs.
Elbow mobilization for flexion (with belt)
Done for restricted flexion. Pt sidling on affected side, have them stabilize at the humerus themselves. Hold forearm to maintain the 10 supination and place belt around proximal forearm over your hand. Create traction away from treatment plane (ulna)
Direct an indirect ways of assessing joint play
Either manually assessing the movement (direct) or observing a patients movements (indirect)
Posterolateral instability of the elbow is caused by what?
FOOSH on a pronated arm
What is the optimal number of static stretch repetitions? and the optimal hold time? Optimal intensity?
Four. Any more than that and you aren't really gaining any more. between 15-60 seconds but lots of literature shows different things. Point of discomfort (POD) is a good measure
S1 reflex
Gastric reflex -flat head of hammer to achilles tendon with pts foot in passive dorsiflexion
Stress relaxation
If a muscle tendon unit is elongated to a specific length and held at that position, the internal tension within the MTU decreases as time goes on. Clinically, this is what occurs during a static stretch.
Tinel's test
If tingling sensation in nerve distribution, then lesion anatomically intact and some recovery is occurring Most distal point of tingling indicates limit of nerve regeneration -tapping at proximal hint and moving distal to see where the nerve regeneration has occurred.
G-H caudal (inferior) glide
Kaltenborn mob For limited abduction Pt supine and at edge of table. Arm at 55 and, 30 horizontal add. Therapist stands on outside, one arm under the armpit and the other on the superior aspect of joint. Using the body to shift left to right (or other way) provide the glide **15-18 seconds 3-4 times. Assess ROM each time.
Shoulder ventral glide
Kaltenborn mob For limited extension and external rotation. Done in PRONE. Stabilize scapula anteriorly with a towel roll. Will stop scapula from moving ventrally during mob. 55 abd and 30 horrid add, step inside pts arm. One arm holding humerus at elbow and providing ventral glide with other hand ulnar surface. **hands move together because mob is performed by bending the LEGS, not moving one arm. 15-18 seconds 3-4 times and assess ROM
Shoulder dorsal glide
Kaltenborn mob for restricted flexion and internal rotation. Pt supine and on edge of bed. **Edge of scapula should be stabilized with towel if needed! Arm at 55 and and 30 horizontal add PT inside pts arm and holding the humerus with one hand, provide piccolo traction by turning the body and then providing dorsal glide with other hand-ulnar side. Hold 15-18 seconds 3-4 times and assess ROM.
Wrist glide tests and palpation
Kaltenborn recommended sequence
A-C joint mobilization
Kaltneborn mobilization or AC joint. This is a planar joint, so convex concave rule does not apply. Pt seated. Stabilize acromion with one hand both anterior and posterior and grasp the clavicle with the other hand. Move the clavicle in both anterior and posterior directions. Can also push the clavicle inferiorly with the fingers.
Where is the most common place for edema around the elbow?
Lateral epicondyle
APTA definition non thrust manipulation/mobilization
Low amplitude therapeutic movement within or at end range of motion that does not involve thrust. Most commonly passive in nature but can be combined with movements.
L5 Reflex
Medial hamstrings reflex -point of hammer to PTs finger on the medial hamstrings tendon
ULNT1 Median
Neurodynamic test to bias the median nerve Pt laying supine, depress the shoulder with stabilizing arm and then abduct the boulder to about 110, extend the wrist, supinate forearm, laterally rotate shoulder then extend the elbow. If no symptoms you can have them laterally flex c spine away.
Non thrust manipulations are mostly used for what?
Pain and hypo mobility. They are a passive therapeutic procedure intended to restore normal joint play. **good for REVERSIBLE hypo mobility. Example of a nonreversible would be contracture.
Gliding occurs where?
Parallel to the treatment plane.
Ulnar impaction test
Passively ulnarly deviate and axially load the pts wrist. Then passively flex, extend or rotate *Positive for CLICKING OR POPPING. This compresses the TFCC.
Big names in manual therapy
Physicians: Cyriax, Mennell, Greenmail PTs: Kaltenborn, Maitland, McKenzie
Actual resting position
Position the patient adopts, very similar to loose packed position. -used when it is impossible to place the patient in loose packed position. When you have to use the actual resting position an attempt should be made to find the 'loosest' position.
Precautions and contraindications of stretching
Precautions: -recent fracture (3D stretching) -recent soft tissue repair -osteoporosis -prolonged immobilization -pain lasting longer than 24 hours after stretch -edematous tissues -joint position sense dysfunction Contraindications: -bone block -fracture or non union -acute inflammation or infection -sharp pain -hematoma
Extensor carpi ulnaris stretch
Preposition patient in supine with elbow and wrist flexed, radial deviation fo the wrist. Passively extend the patients elbow to stretch the muscle.
Flexor carpi ulnaris stretch
Preposition patient in supine with elbow flexed. Use your hand to extend and radially deviate the wrist then passively extend the elbow. Fingers can be free.
Flexor carpi radialis stretch
Preposition patient in supine with elbow flexed. Use your hand to extend their wrist and ulnarly deviate them then passively extend the elbow to stretch the muscle. The fingers can be free.
Flexor digitorum superficialis stretch
Preposition patient in supine with elbow flexed. You can place a leg on the table/half sit and place patients arm over your leg. Extend the patients wrist and PIP joints while leaving DIP joints free then passively extend the elbow to stretch.,
ULNT3 Ulnar
Preposition patient supine with elbow flexed, pronate arm extend wrist, then passively move the patients bent arm up to 40 degrees.
ULNT Radial
Preposition patient supine, arm at side. Depress their shoulder with stabilizing arm. Medically rotate and pronate arm, flex wrist, extend elbow, then abduct the arm to 40. Positive test is radial nerve dsitribution
Scalene Stretch
Preposition patient: almost identical to SCM but there is no OA joint flexion. Same 'chinstrap' handhold, providing some traction at the neck and other hand stabilizing slightly on the first rib
Levator scapulae stretch
Preposition patient: flex, rotate and sideband AWAY. So if you are stretching the left pts head should be facing the right. From there on the technique is the same as upper traps stretch.
Flexor digitorum profundus stretch
Preposition pt in supine with elbow flexed. You can place a leg on table/half sit and place the pts arm on your leg. Extend the wrist, PIP, and DIP joints while passively extending the elbow to stretch.
Upper traps stretch
Preposition the head first, flex, sidebend away, rotate towards, tuck the chin. If you're stretching the right traps they should be looking over the right shoulder. Use your left hand to grab around neck and allow hand to slide up around occiput, can use your shoulder on their forehead to stabilize. Using the Rt arm (connected to your hip) stabilize the Rt scapula and keep it from coming up. Contract relax can be done by asking pt to shrug shoulder up then relax and allow therapist to push down further.
SCM Stretch
Preposition the patient: flex OA joint, sidebend away and rotate TOWARD. Is stretching the Left SCM, should be facing the left. Right hand will be wrapped around the head to the chin, provide traction, and with the other hand press down lightly on the sternum/first rib
Extensor carpi radialis longus stretch
Preposition the patient: supine with affected arm closest to you. Start with wrist flexed and ulnarly deviated with flexed elbow then passively extend it to stretch.
Elbow traction for extension
Pt sidling facing the therapist with elbow extended near end range. Humerus is stabilized by the bed. Grip forearm from the ulnar side with both hands just distal to the joint keeping forearms against body. Bend knees and direct inferior force through the arms.
G-H Caudal long axis glide
Pt supine close to edge of table, take pts arm abduct 55,horizontal add 30. Come inside pts arm and hold it against body, grabbing mid humerus with both hands. Providing traction perpendicular to treatment plane. Can also provide oscillations. **Can also be done at the wrist.
L4 Reflex
Quadriceps (patellar tendon) relex -flat head of hammer to patellar tendon, leg dependent
Application of convex-concave rule to mobilization
RULE 1: Therapist moves a bone with a CONCAVE joint surface in the SAME direction as restricted bone movement. RULE 2: Therapist moves a bone with a CONVEX surface OPPOSITE to the direction of the restricted bone movement.
Shoulder internal rotators stretch
Same as external rotators stretch but in the opposite direction. Therapist is standing in front of patient now (facing their head) and providing the dorsal glide and long axis traction with their SAME arm. Using the other arm they move the pts arm into ER thus stretching the IRs.
Extensor carpi radialis brevis stretch
Same as the ECRL stretch- starting with wrist and elbow flexed but no ulnar deviation. Passively extend the arm to stretch ECRB.
Extensor digitorum comunis stretch
Same as the ECU stretch but without any radial deviation. Start pt supine with wrist, elbow AND finger flexed then passively extend the patients elbow.
Triangle sign of the elbow
Straight line between 2 epicondyles and olecranon when the elbow is extended, this should make a triangle when the elbow is flexed. this is a NORMAL sign.
Hawkins Kennedy Test
Test for CA ligament impingement. Another provocation test, flex patients shoulder to 90 and elbow to 90. Support underneath the elbow with stabilizing hand and quickly internally rotate the shoulder with the other hand. Positive test is PAIN. Can also test in different angles to provocative pain. Test is more SENSITIVE.
O'Brien's Test (Active Compression Test)
Test for SLAP lesion of labrum Flex arm to 90 and adduct 10-15 degrees arm pronated, provide resistance inferiorly. Patient may report pain. Then supinate the hand and provide the same force, if they report no pain this is a positive test. Test is more SENSITIVE.
Shoulder anterior slide Test
Test for SLAP lesion of labrum Pt seated with hand on hip, PT stabilizes scapula from behind, grabs elbow with other hand. Provide force anterior and superior direction through humerus. Pain is positive test in superior anterior part of shoulder. Test is more SPECIFIC.
Shoulder Anterior Clunk Test
Test for SLAP lesion of labrum. Virtually the same as the crank test but in the supine position. One arm under the scapula/humerus providing a force forward, moving arm is providing loading force while abducting arm simultaneously with IR/ER.
Shoulder crank test
Test for SLAP or labral (bankhart) lesion Pt seated and PT behind p and uses thumb to stabilize scapula and push humerus forward. Other hand will push arm superiorly (into GH joint) to load the joint. While providing these forces, abduct the arm while IR/ER the shoulder. Not clear on numbers.
Elbow Flexion test
Test for acute fracture. Patient asked to fully flex the elbow. Positive test is inability to do so. Test is very SPECIFIC. **Can also be done with supination and pronation, both are specific for acute fracture.
Terminal elbow extension test
Test for acute fracture. Patient asked to fully tend their elbow. Positive test is inability to do so. Test is very SENSITIVE.
Shoulder Apprehension sign
Test for anterior GH instability pt is supine and PT abducts arm 90 degrees, maximally ER arm until patient shows apprehension or pain. OR instead of doing it this way- put the patient in a more comfortable position by providing a dorsal glide and then moving into this position, then let up on your glide and look for the patients reaction. (anterior release)
Shoulder painful arc
Test for impingement or rotator cuff tear. Have pt stand and elevate the arm in abduction as far as possible, thumb facing DOWN. Pain between 45-120 degrees in likely GH related and pain above 170 degrees is likely AC joint related. Test is more SPECIFIC
External Rotation Lag Sign
Test for infraspinatus/supraspinatus rupture. Pt in standing, and arm to 60-90, flex elbow, and then ER arm to almost 90. Let go and see if the patient can hold that position. If the pt cannot hold position this is a positive test. 5-10 degrees is allowable amount. Test is more SPECIFIC. 100%. Good sensitivity too 70%
Elbow moving valgus test
Test for integrity of MCL (ulnar collateral) Supporting the arm in 90 90 position, starting the pts elbow in full flexion, direct a vagus force on the elbow and extend it at the same time. Positive test is pain. Test is SENSITIVE.
Infraspinatus Test
Test for possible rupture of infraspinatus "Weakness of external rotators" really a manual muscle test. Pt standing with elbow flexed to 90 and thumb up. Try to push arm into IR and pt should be able to resist by using the ERs. Looking for weakness or pain. Test is more SPECIFIC.
Internal Rotation Lag Sign
Test for subscapularis rupture. Pt sitting and place the arm behind the back in internal rotation. Let go of the arm- of the pts arm assumes a position supported to low back or drops out of position the test is positive. Test is BOTH specific and sensitive.
Elbow Flexion test for ulnar neuropathy
Test for ulnar neuropathy Have the patient bring arm into elbow flexion and wrist extension, like you're asking "why" positive test is pain or tingling in ulnar distribution. Test is more SPECIFIC.
Shoulder Sulcus sign
Test of GH instability Pt standing (can also be seated) with arm relaxed to the side. Place one thumb on acromion or just visualize it, with opposite hand grab elbow and pull humerus inferiorly. Positive is sulcus sign present. Either positive or negative, no in between. No spin or snout reported.
Empty Can Test
Test of RCT of Supraspinatus Like drop arm test (SS MMT) but with thumb facing downward. Looking for pain and weakness. Test is more SPECIFIC.
Shoulder Load and Shift Test
Test of anterior and posterior GH instability Pt is seated hand on thigh, and from behind, **remember 30 degree angle of scapula, grab spine of scapula and coracoid with stabilizing hand and grasps the humerus with moving hand. Load (compress) the GH joint and move the joint forward and backward. Test has grades 1-4 1-normal laxity 25 % translation 2- humeral head rides up on glenoid rim 25-50% 3- humeral head over riding the rim, but spontaneously reduces >50% 4- humeral head over rides rim and stays dislocated. >50%
Speed's and Yerguson's Tests
Test of the biceps tendon pt standing, flex the shoulder with the arm straight out in front of them, arm fully supinated, have them hold that position. First apply some pressure downward and have them resist you then tell them to allow you to push them down slowly. Yergusons: have the pt with elbow flexed to 90 resist supination, palpate the biceps tendon for subluxation out of groove.
Drop Arm Test
Test that identifies tear and/or full rupture of rotator cuff. Patient standing, turn thumbs up with arms elevated in plane of scaption about 30 degrees and let go. If unable to hold or very painful, may be positive. Test is more SPECIFIC Very similar to a supraspinatus MMT, in fact it is basically a test to see if the pt has a MMT grade of at least 3/5.
Elbow varus test
Testing integrity of LCL (radial collateral) Initially done in full extension but can flex 5-10 degrees afterward. Proximal hand holding at the medial elbow and palpating lateral joint line simultaneously. Varus stress added with distal arm. Positive test is pain or laxity compared to uninvolved side.
Elbow valgus test
Testing integrity of MCL (ulnar collateral lig) Initially done in full extension of elbow Proximal hand is holding at the lateral elbow and palpating the medial joint line simultaneously. Valgus stress is added with distal arm. Positive test is pain at medial elbow or laxity present compared to uninvolved side.
carrying angle
The angle between the humerus and ulna when the arm is in anatomical position. Should be between 5-15 Cubital valgus >15 degrees Cubital varus <5 degrees
Resting position
The maximum LOOSE packed position -joint capsule is on maximal slack -joint play is greatest -articular surfaces are least congruent **where joint mobs are performed
Zero position
The position where are ROM measurements are taken from. Same as ANATOMICAL POSITION.
Finger MCP dorsal glide
for restricted extension
Wrist palmar glide
for restricted extension
Humeroradial posterior glide
for restricted extension of elbow. Start with pt seated next to bed with arm propped up in extension resting on table, fix upper arm with a wedge. Grip proximal radius around the radial head with heel of hand and provide a posterior glide.
Finger MCP palmar glide
for restricted flexion
Wrist dorsal glide
for restricted flexion
Humeroradial anterior glide
for restricted flexion of elbow pt lying supine on table with elbow in flexion. Fix upper arm forearm in full supination. Use the heel of the hand on the radial head and fingers on dorsal side. Make sure forearm is perpendicular to the treatment plane. Stabilize with other hand at the wrist.
Proximal radio-ulnar joint posterior glide
for restricted pronation Pt is supine on the table with upper arm and ulna stabilized on table. Joint in resting position, 70 flexion 35ish supination. Step inside their arm, hold patients radius with both hands, right hypothenar eminence near the joint space and apply posterior glide by bending knees.
Distal radio-ulnar anterior glide
for restricted pronation Pts ulnar side of the arm rests on the table with elbow slightly flexed. Can be pronated. Stabilizing hand grabs ulnar side of forearm with thumb and fingers and rest forearm on table. Moving hand grip distal radius with thenar eminence and perform anterior glide in direction of TREATMENT PLANE.
Wrist ulnar glide
for restricted radial deviation
Distal radio-ulnar posterior glide
for restricted supination Pts arm is placed on the table and ulna is fixed with stabilizing hand. Resting position is 10 degrees supination. Stabilizing hand gripes with the thumb and fingers around ulnar head and hand rests on table. Moving hand grips distal radius with thenar eminence and provide posterior glide IN JOINT PLANE.
Proximal radio-ulnar joint anterior glide
for restricted supination. Place pts arm on the table in loose packed position, 70 flex and 35 supination. Fix distal forearm on the table with stabilizing hand and provide anterior directed glide ON RADIUS only with moving hand-hypothenar eminence.
Wrist radial glide
for restricted ulnar deviation
Ballistic stretching
places muscle joint complex at or near its limit of available motion, then cyclically loads the muscle joint complex (bouncing motion at the end ROM). -rate is variable but often at or above 100 bpm
Joint play
term that refers to straight lined passive bone movements.
Mill's Test
test for lateral epicondylitis Start with patients wrist and elbow flexed, then stabilize at the elbow and extend it passively. += pain at lat. epic. basically stretching the extensor carpi radialis
