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.
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