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Questions and Answers
What is the position of the patient's arm in the Index/Proximal Humerus; Superior-to-Inferior Glide in Abduction technique?
What is the purpose of the therapist's caudal hand in the Index/Proximal Humerus; Superior-to-Inferior Glide in Abduction technique?
What is the direction of the impulse thrust in the Index/Proximal Humerus; Superior-to-Inferior Glide in Abduction technique?
In the Bimanual Thumb Thenar Grasp/Proximal Humerus with Knee Extension; Internal Rotation technique, what is the role of the therapist's knees?
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What is the restriction in the Bimanual Thumb Thenar Grasp/Proximal Humerus with Knee Extension; Internal Rotation technique?
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In the Thumb Web/Axilla with Knee Extension technique, where is the stabilizing downward pressure applied?
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What is the direction of the glide in the Bimanual Thumb Thenar Grasp/Proximal Humerus with Knee Extension technique?
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In the Bimanual Thumb Thenar Grasp/Proximal Humerus with Knee Extension; External Rotation technique, what is the direction of the rotational movement?
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What is the purpose of the Bimanual Thumb Thenar Grasp/Proximal Humerus Grasp; Mobilization with Distraction technique?
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In the Thumb Web/Axilla with Knee Extension technique, what is the purpose of the quick 'bunny hop' movement?
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What is the position of the patient's arm in the Bimanual Grasp/Hand; Pendular Abduction Mobilization technique?
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In the Bimanual Thumb Thenar Grasp/Proximal Humerus with Knee Extension technique, where is the digital contact applied?
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What is the purpose of the therapist's body weight in the Bimanual Thumb Thenar Grasp/Proximal Humerus Grasp; Mobilization with Distraction technique?
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What is the indication for the Thumb Web/Axilla with Knee Extension technique?
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In the Interlaced Digital/Proximal Humerus; Superior-to-Inferior Glide in Flexion technique, what is the position of the arm?
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What is the indication for the Bimanual Grasp/Hand; Pendular Abduction Mobilization technique?
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What is the direction of the glide in the Interlaced Digital/Proximal Humerus; Superior-to-Inferior Glide in Flexion technique?
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In the Bimanual Thumb Thenar Grasp/Proximal Humerus with Knee Extension technique, what is the position of the glenohumeral joint?
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In the Thumb Web/Axilla with Knee Extension technique, the therapist's inside hand establishes a thumb web contact in the patient's axilla and applies upward pressure with the fingers on the shoulder girdle.
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The Bimanual Thumb Thenar Grasp/Proximal Humerus with Knee Extension technique is used to treat loss of long-axis accessory movement.
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In the Interlaced Digital/Proximal Humerus; Superior-to-Inferior Glide in Flexion technique, the patient's arm is raised to 90 degrees abduction.
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The direction of the glide in the Thumb Web/Axilla with Knee Extension technique is anterior-to-posterior.
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The Interlaced Digital/Proximal Humerus; Superior-to-Inferior Glide in Flexion technique is used to treat loss of A-P accessory movement.
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In the Thumb Web/Axilla with Knee Extension technique, the therapist's outside hand provides slight distraction while applying an impulse thrust.
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The position of the glenohumeral joint in the Bimanual Thumb Thenar Grasp/Proximal Humerus with Knee Extension technique is off the edge of the table.
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The indication for the Interlaced Digital/Proximal Humerus; Superior-to-Inferior Glide in Flexion technique is loss of long-axis accessory movement.
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In the Index/Proximal Humerus; Superior-to-Inferior Glide in Abduction technique, the therapist stands on the involved side at the head of the table, facing caudal.
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The Bimanual Thumb Thenar Grasp/Proximal Humerus with Knee Extension; External Rotation technique is used to treat restricted internal rotation accessory joint movement.
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In the Bimanual Grasp/Hand; Pendular Abduction Mobilization technique, the patient's arm is flexed to 90 degrees, pointing upward.
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The Index/Proximal Humerus; Superior-to-Inferior Glide in Abduction technique is used to treat loss of accessory movements in superior glide in abduction.
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In the Bimanual Thumb Thenar Grasp/Proximal Humerus Grasp; Mobilization with Distraction technique, the therapist uses circumduction and traction movements.
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The Bimanual Thumb Thenar Grasp/Proximal Humerus with Knee Extension; Internal Rotation technique is used to treat external rotation misalignment of the humerus.
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In the Index/Proximal Humerus; Superior-to-Inferior Glide in Abduction technique, the therapist's cephalic hand removes articular slack before applying the impulse thrust.
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The Bimanual Grasp/Hand; Pendular Abduction Mobilization technique is used to treat adhesive capsulitis.
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In the Bimanual Thumb Thenar Grasp/Proximal Humerus with Knee Extension; External Rotation technique, the therapist's knees apply a stabilizing downward pressure.
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The Bimanual Thumb Thenar Grasp/Proximal Humerus Grasp; Mobilization with Distraction technique is used to treat intracapsular adhesions in the glenohumeral joint.
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In the Index/Proximal Humerus; Superior-to-Inferior Glide in Abduction technique, the patient's elbow rests against the therapist's thoracic cage.
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Study Notes
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
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