ESAT week 1-2 Orthopedic Joint Mobilization Techniques

Bimanual Thumb Thenar Grasp/Proximal Humerus with Knee Extension

• Anterior-to-Posterior Glide: Indicated for loss of A-P accessory movement, anterior misalignment of the humerus.
• Positioning: Patient lies in supine position, with the involved arm in slight abduction and the glenohumeral joint positioned off the edge of the table.
• Contact: Proximal humerus with thumbs/thenars together in the midline.
• Vector: A-P.
• Procedure: Apply an impulse thrust anteriorly to posteriorly with both hands while providing slight distraction with the knees.

Interlaced Digital/Proximal Humerus

• Superior-to-Inferior Glide in Flexion: Indicated for loss of accessory movements in inferior glide in flexion, superior misalignment of the humerus.
• Positioning: Patient lies in supine position, with the involved arm raised to 90 degrees flexion and the elbow bent so that the hand rests on the shoulder.
• Contact: Proximal humerus with interlaced fingers over the superior aspect of the glenohumeral joint.
• Vector: S-I.
• Procedure: Apply an S-I joint distraction with both hands, finishing with an S-I impulse thrust.

Index/Proximal Humerus

• Superior-to-Inferior Glide in Abduction: Indicated for loss of accessory movements in inferior glide in abduction, superior misalignment of the humerus.
• Positioning: Patient lies in supine position, with the involved arm abducted to 90 degrees.
• Contact: Superior aspect of the proximal humerus with the cephalic hand.
• Vector: S-I.
• Procedure: Establish a web contact over the superior aspect of the proximal humerus with the cephalic hand, and use the caudal hand to grasp the distal aspect of the patient's humerus, serving as a pivot point, stabilizing the distal humerus and elbow, and finishing with an impulse-type thrust in an S-I direction.

Bimanual Thumb Thenar Grasp/Proximal Humerus with Knee Extension

• Internal Rotation: Indicated for restricted internal rotation accessory joint movement, external rotation misalignment of the humerus.
• Positioning: Patient lies in supine position, with the affected arm abducted slightly away from the patient's body and the edge of the table in internal rotation.
• Contact: Proximal humerus with interlaced fingers of both hands.
• Vector: Rotational-internal rotation.
• Procedure: Turn the humerus into internal rotation, removing articular slack, and simultaneously straighten both knees, applying a long-axis distraction to the glenohumeral joint.

Bimanual Thumb Thenar Grasp/Proximal Humerus with Knee Extension

• External Rotation: Indicated for restricted external rotation accessory joint movement, internal rotation misalignment of the humerus.
• Positioning: Patient lies in supine position, with the affected arm abducted slightly away from the patient's body and the edge of the table, holding the arm in external rotation.
• Contact: Proximal humerus with interlaced fingers of both hands.
• Vector: Rotational-external rotation.
• Procedure: Turn the humerus into external rotation, and simultaneously straighten both knees to create a long-axis distraction to the glenohumeral joint.

Bimanual Thumb Thenar Grasp/Proximal Humerus Grasp

• Mobilization with Distraction: Indicated for intracapsular adhesions in the glenohumeral joint and mobilization of the shoulder.
• Positioning: Patient lies in supine position, with the affected arm outstretched.
• Contact: Humerus with the inside hand, and the outside hand makes a palmar contact on the posterior aspect of the shoulder and scapula to provide support and lift during the mobilization.
• Vector: Circumduction and distraction.
• Procedure: Use the body weight to assist in producing a mild distraction and circumduction movement of the shoulder in all directions.

Bimanual Grasp/Hand

• Pendular Abduction Mobilization: Indicated for intracapsular adhesions in the glenohumeral joint, mobilization of the shoulder, and adhesive capsulitis.
• Positioning: Patient lies in supine position, with the affected arm slightly abducted and the forearm flexed to 90 degrees, pointing upward.
• Contact: The hand with both hands.
• Vector: S-I with passive rocking.
• Procedure: Instruct the patient to relax the arm as much as possible, and raise the arm away from the table so that it can swing freely, inducing a pendular motion in the glenohumeral joint by rocking the forearm cephalad and caudal, increasing the arc of abduction motion as tolerated.

Bimanual Thumb Thenar Grasp/Proximal Humerus with Knee Extension

• Posterior-to-Anterior Glide: Indicated for loss of P-A accessory movements, posterior misalignment of the humerus.
• Positioning: Patient lies in prone position, with the involved arm in slight abduction and the glenohumeral joint positioned off the edge of the table.
• Contact: Proximal humerus with both hands, with thumbs together in the midline.
• Vector: P-A.
• Procedure: Provide slight distraction with the knees, and apply an impulse thrust posteriorly to anteriorly with both hands.

Bimanual Thumb Thenar Grasp/Proximal Humerus

• Mobilization with Distraction: Indicated for intracapsular adhesions and mobilization of the shoulder.
• Positioning: Patient lies prone, with the affected arm hanging down and off the side of the table.
• Contact: Proximal humerus with both hands, with thumbs together on the posterior aspect of the humerus while the fingers wrap around and into the axilla on the underside of the humerus.
• Vector: Circumduction.
• Procedure: Use both hands to first distract the glenohumeral joint in the long axis of the humerus, and then move the humerus toward and away from you, cephalad and caudal, in a figure-8 motion.

Interlaced Digital/Proximal Humerus

• Superior-to-Inferior Glide in Flexion: Indicated for loss of accessory movements in inferior glide in flexion, superior misalignment of the humerus.
• Positioning: Patient stands, with feet spread at least shoulder-distance apart, and the involved arm is flexed to 90 degrees, and the elbow is flexed so that the hand rests on the patient's shoulder.
• Contact: Proximal humerus with fingers interlaced on the superior aspect of the joint capsule while the thumbs wrap into the axilla.
• Vector: S-I.
• Procedure: First, draw away from the patient, creating a joint separation, and then apply a downward pressure to remove articular slack, and give a thrust in the S-I direction.

Interlaced Digital/Proximal Humerus

• Superior-to-Inferior Glide in Abduction: Indicated for loss of accessory movements in inferior glide in abduction, superior misalignment of the humerus.
• Positioning: Patient stands with legs at least shoulder-distance apart, with the involved arm abducted to 90 degrees, and the elbow flexed so that the hand rests on the patient's shoulder.
• Contact: Proximal humerus with fingers interlaced on the superior aspect of the joint capsule while the thumbs wrap into the axilla.
• Vector: S-I.
• Procedure: Back away from the patient to distract the joint while applying a downward pressure with the hands to remove articular slack, and give an impulse thrust in the S-I direction.

Bimanual Digital Thenar Grasp/Scapula

• Rotation—Inferior Angle Lateral to Medial: Indicated for loss of rotational movement of the scapulocostal articulation, dysfunctional scapulohumeral rhythm, subscapular adhesions.
• Positioning: Patient is in a side-lying position, with the affected side up and the affected arm placed behind the back, with the fist in the small of the back.
• Contact: Lateral aspect of the inferior angle of the scapula.
• Vector: Rotational.
• Procedure: Use both hands to induce a rotational, twisting action, using an impulse-type thrust to drive the inferior angle of the scapula laterally to medially.

Bimanual Digital Thenar Grasp/Scapula

• Rotation—Inferior Angle Medial to Lateral: Indicated for loss of rotational movement of the scapulocostal articulation, dysfunctional scapulohumeral rhythm, subscapular adhesions.
• Positioning: Patient is in a side-lying position, with the affected side up and the affected arm abducted, with the hand behind the head.
• Contact: Medial aspect of the inferior angle of the scapula.
• Vector: Rotational.
• Procedure: Use both hands to create a rotational, twisting action, using an impulse-type thrust to drive the inferior angle of the scapula medially to laterally.

Bimanual Thumb Thenar Grasp/Proximal Humerus with Knee Extension

• Anterior-to-Posterior Glide: Indicated for loss of A-P accessory movement, anterior misalignment of the humerus.
• Positioning: Patient lies in supine position, with the involved arm in slight abduction and the glenohumeral joint positioned off the edge of the table.
• Contact: Proximal humerus with thumbs/thenars together in the midline.
• Vector: A-P.
• Procedure: Apply an impulse thrust anteriorly to posteriorly with both hands while providing slight distraction with the knees.

Interlaced Digital/Proximal Humerus

• Superior-to-Inferior Glide in Flexion: Indicated for loss of accessory movements in inferior glide in flexion, superior misalignment of the humerus.
• Positioning: Patient lies in supine position, with the involved arm raised to 90 degrees flexion and the elbow bent so that the hand rests on the shoulder.
• Contact: Proximal humerus with interlaced fingers over the superior aspect of the glenohumeral joint.
• Vector: S-I.
• Procedure: Apply an S-I joint distraction with both hands, finishing with an S-I impulse thrust.

Index/Proximal Humerus

• Superior-to-Inferior Glide in Abduction: Indicated for loss of accessory movements in inferior glide in abduction, superior misalignment of the humerus.
• Positioning: Patient lies in supine position, with the involved arm abducted to 90 degrees.
• Contact: Superior aspect of the proximal humerus with the cephalic hand.
• Vector: S-I.
• Procedure: Establish a web contact over the superior aspect of the proximal humerus with the cephalic hand, and use the caudal hand to grasp the distal aspect of the patient's humerus, serving as a pivot point, stabilizing the distal humerus and elbow, and finishing with an impulse-type thrust in an S-I direction.

Bimanual Thumb Thenar Grasp/Proximal Humerus with Knee Extension

• Internal Rotation: Indicated for restricted internal rotation accessory joint movement, external rotation misalignment of the humerus.
• Positioning: Patient lies in supine position, with the affected arm abducted slightly away from the patient's body and the edge of the table in internal rotation.
• Contact: Proximal humerus with interlaced fingers of both hands.
• Vector: Rotational-internal rotation.
• Procedure: Turn the humerus into internal rotation, removing articular slack, and simultaneously straighten both knees, applying a long-axis distraction to the glenohumeral joint.

Bimanual Thumb Thenar Grasp/Proximal Humerus with Knee Extension

• External Rotation: Indicated for restricted external rotation accessory joint movement, internal rotation misalignment of the humerus.
• Positioning: Patient lies in supine position, with the affected arm abducted slightly away from the patient's body and the edge of the table, holding the arm in external rotation.
• Contact: Proximal humerus with interlaced fingers of both hands.
• Vector: Rotational-external rotation.
• Procedure: Turn the humerus into external rotation, and simultaneously straighten both knees to create a long-axis distraction to the glenohumeral joint.

Bimanual Thumb Thenar Grasp/Proximal Humerus Grasp

• Mobilization with Distraction: Indicated for intracapsular adhesions in the glenohumeral joint and mobilization of the shoulder.
• Positioning: Patient lies in supine position, with the affected arm outstretched.
• Contact: Humerus with the inside hand, and the outside hand makes a palmar contact on the posterior aspect of the shoulder and scapula to provide support and lift during the mobilization.
• Vector: Circumduction and distraction.
• Procedure: Use the body weight to assist in producing a mild distraction and circumduction movement of the shoulder in all directions.

Bimanual Grasp/Hand

• Pendular Abduction Mobilization: Indicated for intracapsular adhesions in the glenohumeral joint, mobilization of the shoulder, and adhesive capsulitis.
• Positioning: Patient lies in supine position, with the affected arm slightly abducted and the forearm flexed to 90 degrees, pointing upward.
• Contact: The hand with both hands.
• Vector: S-I with passive rocking.
• Procedure: Instruct the patient to relax the arm as much as possible, and raise the arm away from the table so that it can swing freely, inducing a pendular motion in the glenohumeral joint by rocking the forearm cephalad and caudal, increasing the arc of abduction motion as tolerated.

Bimanual Thumb Thenar Grasp/Proximal Humerus with Knee Extension

• Posterior-to-Anterior Glide: Indicated for loss of P-A accessory movements, posterior misalignment of the humerus.
• Positioning: Patient lies in prone position, with the involved arm in slight abduction and the glenohumeral joint positioned off the edge of the table.
• Contact: Proximal humerus with both hands, with thumbs together in the midline.
• Vector: P-A.
• Procedure: Provide slight distraction with the knees, and apply an impulse thrust posteriorly to anteriorly with both hands.

Bimanual Thumb Thenar Grasp/Proximal Humerus

• Mobilization with Distraction: Indicated for intracapsular adhesions and mobilization of the shoulder.
• Positioning: Patient lies prone, with the affected arm hanging down and off the side of the table.
• Contact: Proximal humerus with both hands, with thumbs together on the posterior aspect of the humerus while the fingers wrap around and into the axilla on the underside of the humerus.
• Vector: Circumduction.
• Procedure: Use both hands to first distract the glenohumeral joint in the long axis of the humerus, and then move the humerus toward and away from you, cephalad and caudal, in a figure-8 motion.

Interlaced Digital/Proximal Humerus

• Superior-to-Inferior Glide in Flexion: Indicated for loss of accessory movements in inferior glide in flexion, superior misalignment of the humerus.
• Positioning: Patient stands, with feet spread at least shoulder-distance apart, and the involved arm is flexed to 90 degrees, and the elbow is flexed so that the hand rests on the patient's shoulder.
• Contact: Proximal humerus with fingers interlaced on the superior aspect of the joint capsule while the thumbs wrap into the axilla.
• Vector: S-I.
• Procedure: First, draw away from the patient, creating a joint separation, and then apply a downward pressure to remove articular slack, and give a thrust in the S-I direction.

Interlaced Digital/Proximal Humerus

• Superior-to-Inferior Glide in Abduction: Indicated for loss of accessory movements in inferior glide in abduction, superior misalignment of the humerus.
• Positioning: Patient stands with legs at least shoulder-distance apart, with the involved arm abducted to 90 degrees, and the elbow flexed so that the hand rests on the patient's shoulder.
• Contact: Proximal humerus with fingers interlaced on the superior aspect of the joint capsule while the thumbs wrap into the axilla.
• Vector: S-I.
• Procedure: Back away from the patient to distract the joint while applying a downward pressure with the hands to remove articular slack, and give an impulse thrust in the S-I direction.

Bimanual Digital Thenar Grasp/Scapula

• Rotation—Inferior Angle Lateral to Medial: Indicated for loss of rotational movement of the scapulocostal articulation, dysfunctional scapulohumeral rhythm, subscapular adhesions.
• Positioning: Patient is in a side-lying position, with the affected side up and the affected arm placed behind the back, with the fist in the small of the back.
• Contact: Lateral aspect of the inferior angle of the scapula.
• Vector: Rotational.
• Procedure: Use both hands to induce a rotational, twisting action, using an impulse-type thrust to drive the inferior angle of the scapula laterally to medially.

Bimanual Digital Thenar Grasp/Scapula

• Rotation—Inferior Angle Medial to Lateral: Indicated for loss of rotational movement of the scapulocostal articulation, dysfunctional scapulohumeral rhythm, subscapular adhesions.
• Positioning: Patient is in a side-lying position, with the affected side up and the affected arm abducted, with the hand behind the head.
• Contact: Medial aspect of the inferior angle of the scapula.
• Vector: Rotational.
• Procedure: Use both hands to create a rotational, twisting action, using an impulse-type thrust to drive the inferior angle of the scapula medially to laterally.