GH mobs-lab 1

Question 1

GH PA glide for pain Control

Answer 1

-pt supine w/ hands placed over stomach

• for pain, don’t have to take to end ROM!!
• make a triangle with fingers and place thumbs on posterior humeral head
• fingers rest on anterior shoulder
• apply a force posterior to anterior first, then pull downward on humeral head to re-position the shoulder
• since it’s for pain use grade 1/2

Question 2

GH PA glide for ROM Gains

Answer 2

• Pt prone w/ affected arm hanging off mat
• PT put palm of hand over outside posterior shoulder to perform PA glide, and hold inside of distal humerus
• Perform PA mobilization AT THE RANGE OF LIMITATION of pt. Can put pt in IR or ER to improve respective end range mobilization

increases shoulder ER and abd

Question 3

GH AP Glide for ROM Gains

Answer 3

Since majority of shoulder pathologies lead to anterior migration of the humeral head, an AP glide may be best, so stretching the posterior capsule?

• Pt supine
• PT glides pt’s shoulder to first point of pain
• Use one hand to guide arm in FLEX or ABD and then other hand is used to apply AP glide
• if pain occurs before onset of stiffness, the mobilization should be performed at that range using LESS INTENSE FORCE
• If stiffness is encountered BEFORE or CONCURRENTLY w/ pain, a more aggressive mobilization at that range or in shoulder flexion or ABD is beneficial

Question 4

GH AP for Pain

Answer 4

• for pain just do mob in relaxed position-don’t have to take to end ROM
• pt supine w/ palm of one had over GH joint to apply AP glide and other hand to hold up inside of arm
• use grade 1-2

Question 5

GH Shoulder Traction

Answer 5

Use for pain reduction

-pt supine

• PT uses forearm to stabilize anterior aspect of shoulder, w/ your elbow close to their face and your forearm over theirs
• use other hand to hold up their forearm at wrist
• is easier if pt’s forearm is in pronation to concentrate the traction force
• PT moves pt’s shoulder to first point of pain by performing long axis distraction

Question 6

GH Inferior (caudal) Glide

Answer 6

• Facilitates shoulder ABDuction
• pt supine, in neutral or slight shoulder ABDuction, w/ elbow bent
• PT puts thumb over anterior part of shoulder and the rest of fingers are on posterior side-this hand applies inferior glide
• Other hand is at the elbow and cradles pt forearm w/ yours
• PT glides humeral head inferior/down to first point of pain

Question 7

AC PA Glide

Answer 7

facilitates scapular retraction (adduction)

-pt supine

• PT places both thumbs in posterior “v” notch-contact point of thumbs is on the posterior clavicle
• hands make an W from PT’s perspective

-PT applies a PA glide to AC with both thumbs

Question 8

AC Inferior Glide

Answer 8

Facilitates FLEX AND ABD

• pt supine
• for inferior glide, PT places thumb on superior surface jut medial to AC joint
• thumbs down, with hands in a W apply an inferior glide to AC in attempt to *reproduce symptoms
• if concordant, PT may use this and adjust by moving the arm in to flexion or abduction
• So can keep one thumb on superior AC for inferior glide=>as you abd or flex, apply inferior glide at point of pain
• best response: pt only encounters pain during end ranges of movement

Question 9

AC AP Glide

Answer 9

Facilitates PROTRACTION AND RETRACTION OF SCAPULA

-pt supine

• PT places thumbs anterior on V notch-just anterior medial aspect of AC joint
• hands are in a W w/ fingers facing outward toward arm
• PT applies AP glide to AC joint to reproduce symptoms
• if concordant: PT may use this mob and adjust positon of scapula through arm movements (ex: flex, abd, or horizontal add)

Question 10

SC Inferior Glide

Answer 10

**Facilitates arm FLEX and ABD (elevation of arm)

• pt supine
• PT places both thumbs superior to SC joint, lateral to actual joint space, in a W from PT’s perspective
• PT applies inferior glide to medial clavicle
• if concordant, PT may use this as they adjust position (greater or less arm elevation)

Question 11

Hold Relax stretches

Answer 11

• Stabilize shoulder as you stretch pt out in:
• Shoulder ABD
• Shoulder FLEX
• Horizontal ADD
• ER
• IR

-push to end ROM, hold for 30 seconds?, and rest then repeat pushing a littler farther each time

Question 12

Posterior Capsule Mob in IR and Add

Answer 12

**Facilitates Flexion?

• Pt supine
• PT stabilizes shoulder blade with arm that is closer to pt’s head, while standing at side of the involved arm
• PT then IR to end range and Adducts just past midline, and flexes to about 90 degrees in order to “wind up” the posterior capsule and the arm closest to head stabilizes the shoulder
• PT maintains this position for the pt as they apply a downward/inferior force down shaft of the humerus
• pt reofrts felling of sharp sensation on posterior capsule, NOT the medial aspect of humerus
• if pain is felt medially, structures are likely impinged, and PT should readjust pt position

Question 13

Active End-Range Flexion w/ downward glide

Answer 13

• facilitates FLEX and ABD?**
• techniques performed at end range are designed to promote final degrees of flexion=typically during last stages of therapy
• pt supine
• Pt places one hand on back of shoulder, with thumb over top of shoulder and rest of fingers underneath shoulder
• as pt goes into shoulder flex actively the PT applies a downward force, PT may use this to push active flexion even further

Question 14

Active Internal Rotation w/ AP Glide

Answer 14

• often pt’s w/ limited IR w/ have tightenss in posterior capsule=this will stretch posterior capsule!**
• pt supine
• PT stands by head of pt and places medial hand over pt’s anterior shoulder and provides an AP glide while the pt moves ACTIVELY into IR
• PT uses the other (lateral) hand to support pt’s elbow as they move into IR

Question 15

Posterior Capsule Stretch (Sleeper Stretch)

Answer 15

• pt sidelying w/ shoulder that is on the mat abducted to 90 degrees
• use other (top) hand to pull arm on mat into IR=hold for 15-30 seconds

Question 16

Scapulothoracic Mobilization

Answer 16

• can improve mobility of upper quadrant, may lead to postural improvements and is relaxing for pt with high level of pain
• pt is sidelying, facing toward the PT
• PT puts one arm under the pt’s arm and uses the other to find teh medial border of the scapula and applies a downward, medial, lateral, or upward force of the scapula
• just grab the scapula and distract-then move in all planes, grab the sucker and move it around!

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