Periperal Mobilization

Shoulder Peripheral Joint Mobilization

No Joint Mobilization Indication Position of Patient Hand Placement Mobilization Force

Joint Traction

Caudal Glide

supine lying

1

Glenohumeral Joint

General mobility, intial treatment, pain control

supine, with arm in resting position

place hand in axila, place thumb just distal to the margin anteriorly and finger posteriorly, other hand supports the humerus from lateral

with the hand in axilla, move the arm latero ventro cranially

Increase abduction, to reposition humeral head if superiorly positioned

one hand in patient axilla, the

web space your other hand is

placed distal to the acromiom

process

glide the humerus in an inferior direction

Caudal Glide - progression

Increase abduction when range approches 90 degree

supine,with arm abducted in available range, less external rotation of the humerus mus be added

stand facing patient feet, stabilize patient arm against your trunk, place the web space of your other hand just distal to the acromiom process on the proximal humerus

with the hand on the proximal humerus, glide the humerus in an inferior direction

Elevation Progression

Increase elevation beyond 90 degree of abduction

Supine , with arm abducted and elevated to the end of its available range, then humerus extrenally rotated to its limit

same as caudal glide progression

with the hand on yhe proximal humerus, glide the humerus in a progresivelly anterior direction.

Posterior Glide Progression

Increase posterior gliding when flexion approches 90 degree, increase horizontal adduction

Supine with arm flexedto 90 degree, internally rotated, with elbow flexed.

Place padding under the scapula for stabilization. Place one hand across the proximal surface of the humerus. Place your other hand over the patient's elbow

Glide the humerus posteriorly by pushing down at the elbow through the long axis of the humerus


Posterior Glide

Anterior Glide

2 Anterior Glide Sitting or prone

Glenohumeral Joint

Increase flexion, increse internal rotation

Supine, with arm in resting position

stand with your back to the patient, between the patient trunk and arm, support his arm against your trunk, grasping the distal humerus with your lateral hand. Place the lateral border of your top hand just distal to the anterior margin of the joint, with your fingers pointing superiorly.

glide the humeral head posteriorly by moving the entire arm as you bend your knees

Increse extension; increase external rotation

Prone, with arm in resting position over the edge of the tretment plane. Supported on your thigh. Stabilize the acromiom with padding

Stand facing the top of the table with the leg closeset to the table in a forward stride position. Support the patient arm against your thigh with your outside hand. Place the ulnar border of your other hand just distal to the posterior angle of the acromiom process, with your fingers pointing superiorly.

Apply in an anterior and slightly medial direction, bend both knees so the entire arm moves anterior. Precaution; do not lift the arm at the elbow and therby cause an angulation of the humerus; such angulation could lead to an anterior subluxation of the humeral head

Acromioclavicular Joint

Increase mobility of the joint

Fixate the scapula at the acromiom process. Stand behind him and stabilize the acromiom process with the fingers of your lateral hand. The thumb of your other hand is placed superiorly on the clavicle, just medial to the joint space.

Your thumb pushes the clavicle anteriorly


3

Posterior Glide Incresce retraction Supine

Anterior Glide Increase Protraction Supine

Inferior Glide Increase elevation Supine

Superior Glide Increase depression Supine

Sternoclavicular Joint

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

Push with your thumb in a posterior direction

Your fingers are placed superiorly and thumb inferiorly around the clavicle

The fingers and thumb lift the clavicle anterioly


Your fingers pull the proximal clavicle caudally


Your index finger forces in a superior direction

4Scapulothoracic Articulation

This is not a true joint, but the soft tissue is stretched in order to obtain normal shoulder girdle mobility

Increase scapular motion of elevation, depression, elevation, protarction, retraction, rotation and winging

Side lying, with the patient facing you, the pateint arm is draped over your inferior arm and allowed to hang so that the muscle are relaxed. Winging is an accesory motion that occurs when a person attempts to place the hand behind the back, accopanying shoulder internal rotation and scapular downward rotation

Your superior hand is placed across the acromiom process to control the direction of motion. The fingers of your inferior hand scoop under the medial border and inferior angle of the scapula

The scapula is moved in the desired direction by lifting from the inferior angle or by pushing on the acromiom process.

Elbow and Forearm Peripheral Joint Mobilization

No Joint Mobilization Indication Position of Patient Hand Placement

1 Joint Traction

Traction Progression

Distal Glide Increase flexion Same as joint tracton

Humeroulnar Articulation Resting position elbow flexed 70 degree, forearm supinated 10 degree. Tretament plane; in the olecranon fossa, angled apporximately 45 degree from the long axis of the ulna. Stabilization, fixate the humerus against tretment table with a belt or use an assistant to hold it.

Intial teratment, pain control, increase flexion or extension

Supine, elbow over the edge of the tretment table or supported with padding just proximal to the olecranon process. The wrist rests against the therapist's shoulder allowing the elbow to be in the resting position.

Using your medial hand, place your fingers over the proximal ulna on the volar surface, reinforce it with your other hand.

Increase flexion or extension

Same as joint traction, except the elbow is positioned at the end of its available range of motion before applying the mobilizing force

Adjust your position to best apply the mobilization force and stabilize the forearm


2 Joint Traction

Joint Compression Sitting or supine

Humeroradial Articulation

Increse mobility of the radius, to correct pushed elbow (proximal displacement of the radius

Supine or lying, with the arm resting on the tretment table

Position yourself on the ulnar side of the patients forearm. Stabilize the patient's humerus with your superior hand, grasp around the distal radius with the fingers and thenar eminence of your inferior hand, be sure you are not grasping around the distal ulna

Dorsal or Volar glide of the radius

Dorsal glide, to increase extension; Volar glide, to increase flexion

Supine or sitting with the elbow extended and supinated as far as possible

Stabilize the humerus from the medial side of the patient's arm. Place the palmar surface of your lateral hand on the volar aspect and your fingers on the dorsal aspect of the radial head

To reduce a pulled elbow subluxation

Using the same hand as that of the patient, place your thenar eminence against the patient's thenar eminence (lockin thumbs).fixate the humerus and proximal ulna against a firm object


3Radioulnar Articulations

Proximal radioulnar joint (Resting position; elbow flexed 70 degree, forearm supinated 35 degree, treatment plane; in the radial notch of the ulna, paralel to the long axis of the ulna, stabilization; proximal ulna)

Dorsal glide, to increase pronation; volar glide to increase supination

Sitting or supine, with the elbow and forearm in resting position

Fixate the ulna with your medial hand around the medial aspect of the forearm; place your other hand around the head of the radius with the fingerson the volar surface and the palm on the dorsal surface

Distal Radioulnar Joint (Resting position; supinated 10 degree, treatment plane; articulating surface of the radius, paralel to the long axis of the radius, stabilization; distal ulna)

Dorsal glide; to increase supination, volar glide; to increase pronation

Sitting, with arm on the treatment table; forearm in resting position

Stabilize the distal ulna by placing the fingers of one hand on the dorsal surface, and thenar eminence and thumb on the volar surface. Place your other hand in the same manner around the distal radius.

Elbow and Forearm Peripheral Joint Mobilization

Mobilization Force

Force against the proximal ulna at a 45 degree angle to the shaft

Always force against the ulna at a 45 degree angle, no matter at what angle the elbow is.

Use a scooping motion in which distraction is applied to the joint first as in joint traction. Then pull along the long axis of the ulna

Mobilization Force

Pull the radius distally (long axis traction will cause joint traction

Force the radial head dorsally with the palm of your hand and volary with your fingers. If a stronger force is needed for the volar glide, turn the forearm over, relign your body, and push with the base of your hand against the dorsal surface in a volar direction

Push aong the long axis of the radius by putting preasure against the thenar eminence, simultaneously supinate the forearm.

Mobilization Force

Force the radial head volary by pushing with your palm or dorsally by pulling with your fingers. If a stronger force is needed for the dorsal glide, move around to the other side of the patient, switch hands and push from the volar surfacewith the base of your hand against the radial head.

Glide the distal radius dorsally or volary paralel to the ulna.

Wrist Peripheral Joint Mobilization


1

General Glides

Radiocarpal Joint (concave distal radius articulates with the convex proximal row of carpals which is composed of the schapoid, lunate and triquetrum)

Joint Traction Resting Position; straight line through the radius and third metacarpal with slight ulnar deviation, treatment plane; in the articulating surface of the radius perpendicular to the long axis of the radius, stabilization; distal radius and ulna

Intial treatment, pain control, general mobility of the wrist

Sitting, with the forearm supported on the treatment table, wrist over the edge of the table

With the hand closest to the patient, grasp around the styloid processes and fixate the radius and ulna against the table. Your other hand grasps around the distal row of carpals

Dorsal glide to increase flexion; volar glide to increase extension; radial glide to increase ulnar deviation; ulnar glide to increase radial deviation

Same as joint traction, except roate the forearm when doing radial or ulnar glide for ease in doing the technique

2

3

Specific gildes of the carpals in the proximal row with the radius and ulna

Stabilization; to increase flexion, the index fingers stabilize the distal bone (schapoid or lunate). To increase extension, the index fingers stabilize proximal bone (radius)

Sitting, with the hand being held by the therapist so that the elbow hangs unsupported. The weight of the arm provides slight joint traction so the therapist then needs only to apply the glides

Place your index fingers on the volar surface of the bone to be stabilized, the thumbs on the dorsal surface of the bone to be mobilized.

Scaphoid-radius (scaphoid convex, radius con cave), Lunate Radius (lunate convex, radius concave)

To increase flexion, glide radius volary on fixed scaphoid, or glide radius volary on fixed lunate. To increase extension, glide scaphoid volary on fixed radius or glide lunate volary on fixed radius.

Ulnar meniscal triquetral articulation

To unlock the articular disk, which may block motions of the wrist or forearm, glide ulna volary on fixed triquetrum

Wrist Peripheral Joint Mobilization

Mobilization Force

Put in a distal direction with respect to the arm

Comes from the hand around the distals carpals

Documents

Periperal Mobilization