Upper Ext ME

Question 1

Sternoclavicular Joint

• What happens to it when the arm is abducted more than 45 to 60 degrees?

Answer 1

Sternoclavicular Joint

• What happens to it when the arm is abducted more than 45 to 60 degrees?
  
  • The pectoralis major muscle will have no mechanical advantage and this treatment will be ineffective
  • If the arm is abducted further, it could worsen the somatic dysfunction and further pull the proximal clavicle in the superior direction

Question 2

SC Joint ME

• Patient Evaluation​
  
  • PT Position?
  • Palpation?
  • Patient Action?
  • Dx?
• Patient Treatment Position
  
  • Hand Placement?
  • Movement?

Answer 2

SC Joint ME

• Patient Evaluation
  
  • PT Position?
    
    • Seated
  • Palpation?
    
    • Superior aspect of the proximal clavicle
  • Patient Action?
    
    • Shrugs
  • Dx?
    
    • The dysfunctional clavicle is the one that does not fully descend when the patient shrugs the shoulders
• Patient Treatment Position
  
  • Supine
    
    • Dr. seated on same-side of SD
  • Hand Placement?
    
    • Caudal hand on dysfunctional clavicle where it articulates with the manubrium
  • Movement?
    
    • Abduct
    • Extend
    • Externally Rotate
    • “SCAB EX^{<strong>2</strong>}“

Question 3

AC Joint ME

• How to DX?
  
  • Angles?
• Dx?
• Movements and Hand Placement?

Answer 3

AC Joint ME

• How to DX?
  
  • Scaption
    
    • Angles?
      
      • Abduct to 90º
      • Horizontally flexing the shoulders 30º
• Dx?
  
  • Less Range of Motion
• Movements?
  
  • External Rot. SD
    
    • Place into Internal Rot.
    • Stand behind PT, close to the side of SD
      
      • Middle hand stays on AC Joint
      • Lateral Hand wraps around the wrist and brings to Internal Rot
  • Internal Rot. SD
    
    • Place into External Rot.
    • Stand behind PT, close to the side of SD
      
      • Middle hand stays on AC Joint
      • Lateral Hand wraps around the wrist and brings up to External Rot.

Question 4

Radial Head ME

• What position is the Dx made?
• Where does the physician sit?
• Pronation
  
  • Where does the radial head go during pronation?
  • Where do you push the radial head in a pronation SD?
• Supination
  
  • Where does the radial head go during supination?
  • Where do you push the radial head in a supination SD?

Answer 4

Radial Head ME

• What position is the Dx made?
  
  • PT Seated
  • PT arms at 90-degree angle
  • Test motions of pronation and Supination
• Where does the physician sit?
  
  • Same Side
• Pronation
  
  • Where does the radial head go during pronation?
    
    • Posterior
  • Where do you push the radial head in a pronation SD?
    
    • Apply a posterior to anterior force
• Supination
  
  • Where does the radial head go during supination?
    
    • Anterior
  • Where do you push the radial head in a supination SD?
    
    • Apply an anterior to posterior force

Question 5

Radiocarpal (Wrist) Joint ME

• What bones are involved here?
• What are the planes of motion being assessed?
• What position do you dx the wrist in?
• Hand Placement during Tx?
  
  • Flexion SD
  • Extension SD
  • Abduction SD
  • Adduction SD

Answer 5

Radiocarpal (Wrist) Joint ME

• What bones are involved here?
  
  • Scaphoid
  • Radius
  • Ulna
  • Triquetrum
  • Lucinate
• What are the planes of motion being assessed?
  
  • Flexion
  • Extension
  • Abduction
  • Adduction
• What position do you Dx the wrist in?
  
  • Shoulders and forearms relaxed
  • Forearms at 90º flexion
  • Simultaneously flexing/extension and abduction/adduction bilateral wrists assessing ranges of motion
• Hand Placement during Tx?
  
  • Flexion SD
    
    • Pinky on posterior of PT wrist
    • Thumb pushing Upper Middle Palm
  • Extension SD
    
    • Stabilize PT forearm with outside hand
    • Use middle hand to push PT hand into flexion
      
      • Thumb and palm spread across the back of PTs hand
  • Abduction SD
    
    • Stabilize lower forearm with middle hand
    • Use outside hand to apply an adducting force
      
      • Thumb over PTs palm, index finger on PTs backhand
  • Adduction SD
    
    • Stabilize lower forearm with outside hand
    • Use middle hand to apply an abducting force
      
      • Thumb over PTs lower palm, index finger on PTs backhand