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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