Glenohumeral joint SUPINE

Long-Axis Distraction

• Indication: Loss of long-axis accessory movement, superior misalignment of the humerus
• Patient position: Supine, with the involved arm along the body
• Operator position: Stand on the involved side, straddling the arm
• Contact points: Thumb web contact in the patient’s axilla, fingers on the shoulder girdle, and a digital contact on the lateral aspect of the joint
• Vector: Long-axis distraction
• Procedure: Apply downward pressure with fingers, then perform a quick "bunny hop" movement by extending both knees and drawing the humerus into long-axis distraction

Bimanual Thumb Thenar Grasp/Proximal Humerus with Knee Extension; Anterior-to-Posterior Glide

• Indication: Loss of A-P accessory movement, anterior misalignment of the humerus
• Patient position: Supine, with the involved arm in slight abduction and the glenohumeral joint positioned off the edge of the table
• Operator position: Stand at the side of the table, straddling the affected arm
• Contact points: Both hands grasping the proximal humerus with thumbs/thenars together in the midline
• Vector: A-P
• Procedure: Provide slight distraction while applying an impulse thrust anteriorly to posteriorly with both hands

Interlaced Digital/Proximal Humerus; Superior-to-Inferior Glide in Flexion

• Indication: Loss of accessory movements in inferior glide in flexion, superior misalignment of the humerus
• Patient position: Supine, with the involved arm raised to 90 degrees flexion and the elbow bent so that the hand rests on the shoulder
• Operator position: Stand on the involved side in a lunge position, facing cephalad
• Contact points: Interlaced fingers over the superior aspect of the glenohumeral joint
• Vector: S-I
• Procedure: Apply S-I joint distraction with both hands, finishing with an S-I impulse thrust

Index/Proximal Humerus; Superior-to-Inferior Glide in Abduction

• Indication: Loss of accessory movements in inferior glide in abduction, superior misalignment of the humerus
• Patient position: Supine, with the involved arm abducted to 90 degrees
• Operator position: Stand on the involved side at the head of the table, facing caudal
• Contact points: Web contact over the superior aspect of the proximal humerus, and grasping the distal aspect of the patient's humerus
• Vector: S-I
• Procedure: Stabilize the distal humerus and elbow, and remove articular slack, finishing with an impulse-type thrust in an S-I direction

Bimanual Thumb Thenar Grasp/Proximal Humerus with Knee Extension; Internal Rotation

• Indication: Restricted internal rotation accessory joint movement, external rotation misalignment of the humerus
• Patient position: Supine, with the affected arm abducted slightly away from the patient's body and the edge of the table in internal rotation
• Operator position: Stand on the involved side, facing cephalad, and straddling the patient's affected arm
• Contact points: Grasp the patient's 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

• Indication: Restricted external rotation accessory joint movement, internal rotation misalignment of the humerus
• Patient position: Supine, with the affected arm abducted slightly away from his or her body and the edge of the table, holding the arm in external rotation
• Operator position: Stand on the involved side, facing cephalad, and straddling the patient's affected arm
• Contact points: Grasp the patient's proximal humerus with interlaced fingers
• 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

• Indication: Intracapsular adhesions in the glenohumeral joint and mobilization of the shoulder
• Patient position: Supine, with the affected arm outstretched
• Operator position: Stand in a lunge position on the affected side, facing the head of the table
• Contact points: Grasp the patient's arm to hold the patient's forearm against the operator's thoracic cage, and make a palmar contact on the posterior aspect of the shoulder and scapula
• Vector: Circumduction and distraction
• Procedure: Use body weight to assist in producing a mild distraction and circumduction movement of the shoulder in all directions

Bimanual Grasp/Hand; Pendular Abduction Mobilization

• Indication: Intracapsular adhesions in the glenohumeral joint, mobilization of the shoulder, and adhesive capsulitis
• Patient position: Supine, with the affected arm slightly abducted and the forearm flexed to 90 degrees, pointing upward
• Operator position: Stand at the side of the table on the involved side, facing the patient
• Contact points: Grasp the patient's hand with both hands
• Vector: S-I with passive rocking
• Procedure: Instruct the patient to relax the arm as much as possible, and induce a pendular motion in the glenohumeral joint by rocking the forearm cephalad and caudal, increasing the arc of abduction motion as tolerated

Long-Axis Distraction

• Indication: Loss of long-axis accessory movement, superior misalignment of the humerus
• Patient position: Supine, with the involved arm along the body
• Operator position: Stand on the involved side, straddling the arm
• Contact points: Thumb web contact in the patient’s axilla, fingers on the shoulder girdle, and a digital contact on the lateral aspect of the joint
• Vector: Long-axis distraction
• Procedure: Apply downward pressure with fingers, then perform a quick "bunny hop" movement by extending both knees and drawing the humerus into long-axis distraction

Bimanual Thumb Thenar Grasp/Proximal Humerus with Knee Extension; Anterior-to-Posterior Glide

• Indication: Loss of A-P accessory movement, anterior misalignment of the humerus
• Patient position: Supine, with the involved arm in slight abduction and the glenohumeral joint positioned off the edge of the table
• Operator position: Stand at the side of the table, straddling the affected arm
• Contact points: Both hands grasping the proximal humerus with thumbs/thenars together in the midline
• Vector: A-P
• Procedure: Provide slight distraction while applying an impulse thrust anteriorly to posteriorly with both hands

Interlaced Digital/Proximal Humerus; Superior-to-Inferior Glide in Flexion

• Indication: Loss of accessory movements in inferior glide in flexion, superior misalignment of the humerus
• Patient position: Supine, with the involved arm raised to 90 degrees flexion and the elbow bent so that the hand rests on the shoulder
• Operator position: Stand on the involved side in a lunge position, facing cephalad
• Contact points: Interlaced fingers over the superior aspect of the glenohumeral joint
• Vector: S-I
• Procedure: Apply S-I joint distraction with both hands, finishing with an S-I impulse thrust

Index/Proximal Humerus; Superior-to-Inferior Glide in Abduction

• Indication: Loss of accessory movements in inferior glide in abduction, superior misalignment of the humerus
• Patient position: Supine, with the involved arm abducted to 90 degrees
• Operator position: Stand on the involved side at the head of the table, facing caudal
• Contact points: Web contact over the superior aspect of the proximal humerus, and grasping the distal aspect of the patient's humerus
• Vector: S-I
• Procedure: Stabilize the distal humerus and elbow, and remove articular slack, finishing with an impulse-type thrust in an S-I direction

Bimanual Thumb Thenar Grasp/Proximal Humerus with Knee Extension; Internal Rotation

• Indication: Restricted internal rotation accessory joint movement, external rotation misalignment of the humerus
• Patient position: Supine, with the affected arm abducted slightly away from the patient's body and the edge of the table in internal rotation
• Operator position: Stand on the involved side, facing cephalad, and straddling the patient's affected arm
• Contact points: Grasp the patient's 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

• Indication: Restricted external rotation accessory joint movement, internal rotation misalignment of the humerus
• Patient position: Supine, with the affected arm abducted slightly away from his or her body and the edge of the table, holding the arm in external rotation
• Operator position: Stand on the involved side, facing cephalad, and straddling the patient's affected arm
• Contact points: Grasp the patient's proximal humerus with interlaced fingers
• 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

• Indication: Intracapsular adhesions in the glenohumeral joint and mobilization of the shoulder
• Patient position: Supine, with the affected arm outstretched
• Operator position: Stand in a lunge position on the affected side, facing the head of the table
• Contact points: Grasp the patient's arm to hold the patient's forearm against the operator's thoracic cage, and make a palmar contact on the posterior aspect of the shoulder and scapula
• Vector: Circumduction and distraction
• Procedure: Use body weight to assist in producing a mild distraction and circumduction movement of the shoulder in all directions

Bimanual Grasp/Hand; Pendular Abduction Mobilization

• Indication: Intracapsular adhesions in the glenohumeral joint, mobilization of the shoulder, and adhesive capsulitis
• Patient position: Supine, with the affected arm slightly abducted and the forearm flexed to 90 degrees, pointing upward
• Operator position: Stand at the side of the table on the involved side, facing the patient
• Contact points: Grasp the patient's hand with both hands
• Vector: S-I with passive rocking
• Procedure: Instruct the patient to relax the arm as much as possible, and induce a pendular motion in the glenohumeral joint by rocking the forearm cephalad and caudal, increasing the arc of abduction motion as tolerated