GLENOHUMERAL JOINT TECHNIQUES

GLENOHUMERAL JOINT TECHNIQUES

Inferior Glide of the Humerus

Patient Position

The patient is supine, with the affected limb near the edge of the table. A strap can be used to stabilize the shoulder blade. The limb is abducted at the desired distance.

Therapist Position

With the therapist looking towards the lateral aspect of the patient's arm, the clear space of the therapist's cephalic hand is positioned at the patient's superior glenohumeral, inferior to the acromion. The assistant hand supports the weight of the patient's arm by holding the distal upper arm over the epicondyles and supporting the patient's arm against the therapist. The assisting hand or arm can also impart distracting force and change the amount of rotation. The mobilizing hand slides the humeral head down and attempts to stretch the axillary bursa or the inferior portion of the glenohumeral capsule.

Inferior Glide of the Humerus with Passive

External Rotation

Patient Position

The patient’s position is prone, with the shoulder over the edge of the treatment table. 

Therapist Position

The therapist holds the patient’s humerus in external rotation while providing an inferior-posterior glide to the humeral head . Oscillations or prolonged stretch can be used with this technique.

Longitudinal Distraction: Inferior Glide of the Humerus

Patient Position

The patient is supine, with the involved extremity as close as possible to the edge of the table.

Therapist Position

The therapist faces the joint, with the inner hand facing the patient's armpit and pressing against the scapuloglenoid. The external mobilizing hand grasps the epicondyles of the patient's humerus and imparts a distracting force that urges the inferior capsule. To increase the efficiency of the traction, the therapist can shift the weight and move the body slightly away from the patient. It is usually a prolonged stretch

effective with this technique.

Posterior Glide of the Humerus

Patient Position

The patient is supine, with the arm slightly abducted and flexed into the POS and resting on the therapist’s thigh.

Therapist Position

The therapist is seated on the couch at 45 turns from the sagittal plane. The mobilizing hand is placed on the patient's anterior humeral head, with a wedge or rolled towel under the lateral shoulder blade. The helping hand supports the patient's distal limb to facilitate relaxation. The mobilization is directed posteriorly along the plane of the glenoid. This technique is useful for reactive shoulders with posterior capsule stiffness.

Posterior Glide of the Humerus

Patient Position

The patient is supine, with the involved shoulder flexed 90 and horizontally adducted to first tissue resistance.

Therapist Position

The therapist is on the opposite side of patient’s shoulder. The mobilizing hand is on the same side as the involved shoulder. The therapist cups patient’s elbow in the mobilizing hand and assists mobilization with therapist’s sternum. The assisting hand stabilizes the scapula under the patient. Mobilization movement is along 35 of glenoid tilt. The level of flexioncan be changed to work the most restricted part of the capsule.

This technique is useful in patients with subacute and chronic posterior capsule tightness.

Posterior Glide of the Humeral Head in Side Lying

Patient Position

Patient is positioned in side lying, with the involved shoulder facing upward.

Therapist Position

With the therapist facing the patient, the therapist’s cephaladhand contacts the patient’s proximal  humerus, and the caudal hand holds the involved extremity by the elbow . The mobilization is a force couple motion, with the proximal hand providing the primary mobilizing force in an anteriorposterior

direction while the caudal hand provides a slight circumduction motion, usually opposite that of the proximal hand.

Posterior Glide Using a Fulcrum Technique

Patient Position

The patient is prone, with the shoulder near the edge of the treatment table.

Therapist Position

The therapist positions his or her left forearm under the patient’s anterior humeral head. The therapist’s right hand is on the patient’s forearm and provides a distraction and adduction force. At the same time the force is initiated, the therapist lifts the patient’s humeral head by using his or her left forearm as a lever.

Lateral Distraction of the Humerus

Patient Position

The patient is supine, close to the edge of the table, with the involved extremity flexed at the elbow and glenohumeral joint. The extremity rests on the therapist’s shoulder. A strap and the table stabilize the scapula.

Therapist Position

The therapist is facing laterally, and both hands grasp the patient’s humerus as close as possible to the joint. The therapist should assess which vector of movement is most severely restricted by starting laterally with mobilization and proceeding caudally. To improve delivery of oscillation or stretch, the

therapist should align his or her trunk along the vector of mobilization.

Anterior Glide of the Head of the Humerus

Patient Position

The patient is prone, with the involved extremity as close as possible to the edge of the table. The head of the humerus must be off the table. A wedge or towel roll is placed just medial to the joint line under the coracoid process. The extremity is abducted and flexed into the POS.

Therapist Position

The therapist is distal to the patient’s abducted shoulder facing cephalad. The outer hand applies slight

distractive force while the inner mobilizing hand glides the head of the patient’s humerus anteriorly, thereby stressing the anterior capsule. The tendon of the subscapularis is also stressed with this technique. Mobilization can be fine-tuned by changing the angle of the anterior force to the most

severely restricted area.

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