Manual Therapy Techniques for the Shoulder
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Transcript of Manual Therapy Techniques for the Shoulder
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Shoulder AbductionGrades IV IV+
Patient position: Supine
Therapist position Proximal hand: Reach under
patient and grasp the uppertrapezius muscle; forearm liesalong medial border of scapula.
Distal hand: Grasp the distalhumerus in a position to stabilizethe elbow joint.
Mobilization technique Use the proximal hand to stablize
the scapula and prevent shouldershrugging.
Bring patients arm intoabduction to find resistance.Apply small amplitude abduction
mobilizations (2-3) within thisresistance.
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Shoulder External RotationGrades IV IV+
Patient position
Supine, shoulder abducted andelbow flexed to 90, upper armresting on plinth
Therapist position Proximal hand: Grasp the distal
humerus; lay forearm acrossanterior shoulder for stabilization
Distal hand: Grasp wrist and holdin a neutral position
Mobilization technique Bring patients arm into external
rotation to find resistance. Applygraded mobilizations (~10) withinresistance.
May be performed in variousdegrees of abduction based onpatient symptoms and response
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Shoulder Internal RotationGrades IV IV+
Patient position
Supine, shoulder abducted andelbow flexed to 90, upper armresting on plinth
Therapist position Proximal hand: Grasp the distal
humerus; lay forearm acrossanterior shoulder for stabilization
Distal hand: Grasp wrist and holdin a neutral position
Mobilization technique Bring patients arm into internal
rotation to find resistance. Applygraded mobilizations (~10) withinresistance.
May be performed in variousdegrees of abduction based onpatient symptoms and response
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Shoulder Horizontal FlexionGrades IV IV+
Patient position
Supine, shoulder and elbowflexed to 90
Therapist position Proximal hand: Place the heel of
one hand under the medial border
of scapula for stabilization Distal hand: Grasp wrist and hold
in a neutral position Tuck patients elbow into your
shoulder crease
Mobilization technique Small amplitude mobilizations
into HF are applied: 1) Alonghumeral shaft, or 2) In a directiontoward the opposite shoulder.
Used independently or together
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Glenohumeral JointAP Glides in Abduction (Grades III IV)
Patient position
Supine, shoulder off plinth inabduction, elbow flexed to 90
Therapist position Distal hand: Grasp the patients
distal humerus and elbow; hold
patients forearm against yours Proximal hand: Heel of hand
placed against anterior humeralhead
Mobilization technique Graded AP mobilization is applied
through your mobilizing armagainst the humeral head.
May be performed in variousdegrees of GH ABD and HF basedon patient symptoms andresponse
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Glenohumeral JointCaudal Glides in Abduction (Grades III IV)Patient position
Supine, shoulder off plinth inabduction, elbow flexed to 90
Therapist position Distal hand: Grasp the patients
distal humerus and elbow; hold
patients forearm against yours Proximal hand: 1 st web space or
heel of hand placed against headof humerus (adjacent to acromion)
Mobilization technique Graded mobilization is applied
through your mobilizing hand toglide the humeral head caudally.
Elbow may be held stationary, orcarried on line with humerus orfurther distally depending onirritability
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Glenohumeral JointCaudal Glides in Full Flexion (Grade IV)
Patient position
Supine, shoulder off plinth inabduction, elbow flexed to 90
Therapist position Distal hand: Grasp the patients
upper arm with the lateral border
of index finger against humeralhead and thumb into axilla; holdpatients arm against your side.
Proximal hand: Heel of handplaced along the lateral border of
scapulaMobilization technique Graded mobilization is applied
through your mobilizing hand toglide the humeral head caudally.
Scapula is stabilized using firmpressure along the lateral border.
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Acromioclavicular JointCaudal Glides
Patient position: Supine
Therapist position Place the tips of both thumbs on
the superior surface of theclavicle adjacent to the AC joint;spread fingers out for stability.
Position forearms in line with thecaudal movement at the AC joint.
Mobilization technique Graded oscillatory mobilization is
applied by your arms, actingthrough stable thumbs.
Pad of your outer thumb shouldfeel the joint motion (feel for thestationary acromion process).
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Clavicle Rotation(Wiggle)
Patient position: Supine
Therapist position Stand near the patients shoulder,
facing towards the clavicle. Gently grip the mid clavicle using
your thumbs on the inferior edge
and finger tips superiorly.Mobilization technique Apply a gentle mobilization force
using a rocking or wigglingmotion through repetitive wristflexion and extension.
Works as a nice easing techniquefollowing direct AC and/or SCjoint mobilizations.