Scapular Distraction

Scapular Distraction

Patient Position

The patient is side lying close to the edge of the table, with the involved extremity accessible to the therapist. A pillow may be placed against the patient’s chest to provide anterior support.

Therapist Position

In, the chart illustrates the sloped aspect of the scapula before the therapist attempts to lift the scapula. The therapist faces the patient, with the caudal hand under the lower corner of the patient's shoulder blade and the cephalic hand holding the vertebral edge of the shoulder blade. The therapist's anterior sternum is the third point of contact that aids in tilting the scapula. Both hands tilt the shoulder blade away from the chest wall and distract the shoulder blade when the therapist leans back.

Scapular Distraction: Posterior Approach

Patient Position

The patient is side lying as previously, but closer to the posterior edge of the table.

Therapist Position

The therapist stands behind the patient, with the therapist's hips oriented perpendicular to the patient's trunk. The therapist's adjacent leg is on the table, with the knee bent and positioned along the patient's mid-thoracic spine. The external mobilization hand grasps the vertebral edge of the patient's scapula. The inner hand supports the patient's anterior glenohumeral joint. Once the hand is positioned, the therapist leans back, thus distracting the shoulder blade from the chest wall. Prolonged stretching is most effective with this technique.

Scapular External Rotation

Patient Position

The patient is side lying, with the involved extremity accessible to the therapist.

Therapist Position

The therapist faces the patient, with the caudal hand under the patient's limb through the axillary area. The cephalic hand grasps the upper aspect of the patient's shoulder blade while the caudal hand grasps the lower corner. The force is applied simultaneously, thus producing an external rotation of the scapula. This demonstrates external rotation of the scapula with the soft tissue technique which uses the therapist's elbow to mobilize the superior trapezius and levator scapulae. Assistive techniques include actively rotating the cervical spine towards and away from the affected side and spraying and stretching towards the trigger points of the upper trapezius.

Scapular Distraction: Prone

Patient Position

The patient is prone, with the involved extremity supported by the table.

Therapist Position

The therapist is facing cephalad, with the outer hand under the head of the patient’s humerus and the adjacent mobilizing hand web space under the inferior angle of the scapula. The forces are applied simultaneously. The outer hand lifts the patient’s glenohumeral joint while the adjacent hand lifts the inferior angle of the scapula.