Upper Extremity Muscle Energy Techniques
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Questions and Answers

What is the normal position of scaption?

  • 90 degrees abduction, 30 degrees vertical rotation, 90 degrees elbow flexion
  • 60 degrees abduction, 30 degrees horizontal rotation, 100 degrees elbow flexion
  • 90 degrees abduction, 45 degrees horizontal rotation, 90 degrees elbow flexion
  • 90 degrees abduction, 30 degrees horizontal rotation, 90 degrees elbow flexion (correct)

Which motion involves the anterior radial head?

  • Supination
  • Extension
  • Pronation (correct)
  • Flexion

What happens to the distal radius during supination?

  • It moves posterior and lateral (correct)
  • It moves anterior and medial
  • It moves anterior and lateral
  • It remains stationary

Which side of the clavicle is dysfunctional if it remains superior during shoulder shrugging?

<p>The ipsilateral side (B)</p> Signup and view all the answers

What is the focus of the Spencer technique?

<p>Restricted motion (A)</p> Signup and view all the answers

Which joint should the patient be seated to evaluate for restriction?

<p>Sternoclavicular joint (C)</p> Signup and view all the answers

What is the name of the technique developed by Charles H. Spencer?

<p>The Spencer Technique (D)</p> Signup and view all the answers

Which of the following is NOT a condition that the Spencer technique can be applied to?

<p>Fractures (A)</p> Signup and view all the answers

What is the main function of the clavicular part of the deltoid muscle?

<p>Flex and medially rotate the arm (A)</p> Signup and view all the answers

Which nerve innervates the deltoid muscle?

<p>Axillary nerve (C)</p> Signup and view all the answers

What is the primary action of the latissimus dorsi muscle?

<p>Extend and adduct the arm (D)</p> Signup and view all the answers

The labrum of the glenohumeral joint serves what purpose?

<p>Deepens the glenoid fossa (A)</p> Signup and view all the answers

How is rib motion divided?

<p>Pump handle and bucket handle (B)</p> Signup and view all the answers

Which part of the deltoid muscle primarily abducts the arm?

<p>Acromial part (B)</p> Signup and view all the answers

What is the axis of motion for the pump handle motion of the ribs?

<p>Costovertebral-costotransverse line (D)</p> Signup and view all the answers

In what position is the thoracic spine usually treated in relation to the ribs?

<p>Before the ribs (C)</p> Signup and view all the answers

What occurs to the anterior portion of the rib during inhalation?

<p>Moves anterior and superior (D)</p> Signup and view all the answers

Which motion predominantly affects the lower ribs (7-10)?

<p>Bucket-handle motion (C)</p> Signup and view all the answers

What type of motion is exhibited by ribs 11 and 12?

<p>Caliper motion (A)</p> Signup and view all the answers

What happens to the lateral margin of the rib during exhalation?

<p>Moves inferior and medial (C)</p> Signup and view all the answers

In predominantly bucket-handle inhalation rib dysfunctions, how does the lateral portion of the dysfunctional rib move during exhalation?

<p>Moves inferomedially (D)</p> Signup and view all the answers

What is the predominant rib motion for ribs 1-3?

<p>Pump-handle motion (D)</p> Signup and view all the answers

During inhalation, what happens to the posterior angle of the rib?

<p>Moves posterior and inferior (D)</p> Signup and view all the answers

What occurs during predominantly pump-handle exhalation rib dysfunctions?

<p>The anterior portion does not move as much inferiorly (A)</p> Signup and view all the answers

In predominantly bucket-handle exhalation rib dysfunctions, which direction does the lateral portion of the dysfunctional rib move during inhalation?

<p>It does not move as much in the superolateral direction (A)</p> Signup and view all the answers

Where is the key rib located in exhalation somatic dysfunction?

<p>At the top of the rib group (D)</p> Signup and view all the answers

What is the anatomical connection of Rib 1?

<p>Attached to the upper portion of the manubrium (B)</p> Signup and view all the answers

Which ribs are easily identified by finding Rib 2 and palpating down into the intercostal spaces?

<p>Ribs 3 to 6 (C)</p> Signup and view all the answers

What technique is mentioned to assess the position of the first rib?

<p>Placing the thumbs or fingers on the shaft of the rib (B)</p> Signup and view all the answers

Which rib is level with the medial third of the clavicle?

<p>Rib 8 (A)</p> Signup and view all the answers

In a seated-anterior approach for rib manipulation, where is the thumb placed?

<p>On the anterior shaft of the rib (D)</p> Signup and view all the answers

Which ribs are referred to as free-floating ribs?

<p>Ribs 11 to 12 (A)</p> Signup and view all the answers

What should be done if motion restriction is observed in ribs 7-10 during active motion testing?

<p>Do passive motion testing. (A)</p> Signup and view all the answers

What does the spring test in the rib area help determine?

<p>The dysfunctional side of the ribs. (C)</p> Signup and view all the answers

Which muscles are used for treating rib 6-10 exhalation dysfunction?

<p>Serratus anterior and latissimus dorsi. (C)</p> Signup and view all the answers

During treatment of inhalation somatic dysfunction, how should the physician assist the patient?

<p>Push the rib toward exhalation during inhalation. (D)</p> Signup and view all the answers

Which ribs are associated with bucket handle dysfunctions?

<p>Ribs 6-10. (C)</p> Signup and view all the answers

What is the purpose of using post-isometric relaxation in rib treatment?

<p>To resolve muscle tension and foster movement. (D)</p> Signup and view all the answers

What is a key step in assessing the movement of individual ribs?

<p>Assess movement associated with inhalation and exhalation. (C)</p> Signup and view all the answers

What is the expected outcome of the spring test on a dysfunctional rib?

<p>Less spring than the non-restricted side. (A)</p> Signup and view all the answers

Flashcards

Scaption Position

90 degrees abduction, 30 degrees horizontal rotation, and 90 degrees elbow flexion.

Pronation Restriction

Resistance to rotating the forearm inward (palm down).

Supination Restriction

Resistance to rotating the forearm outward (palm up).

Sternoclavicular Joint Restriction

Limited movement in the joint connecting the collarbone to the breastbone.

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Acromioclavicular Joint Restriction (External Rotation)

Problem with movement around the shoulder joint where the acromium meets the clavicle, specifically limiting external rotation.

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Acromioclavicular Joint Restriction (Internal Rotation)

Problem with movement around the shoulder joint where the acromium meets the clavicle, specifically limiting inward rotation.

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Spencer Technique

Standardized shoulder treatment series for musculoskeletal dysfunction, focusing on restricted motion.

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Seven Stages of Spencer

A standardized series of shoulder treatment steps used in diagnosis, treatment, and prognosis.

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Posterior rib angle movement

The posterior rib angle moves easier in an anterior and superior direction, decreasing the A-P diameter of the rib cage.

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Bucket-handle exhalation dysfunction

The lateral portion of the dysfunction rib does not move as much in the superolateral direction during inhalation, decreasing the transverse diameter of the rib cage.

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Key rib in inhalation dysfunction

The key rib is at the bottom of the group.

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Key rib in exhalation dysfunction

The key rib is at the top of the group.

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Rib 1 attachment

Rib 1 is attached to the upper portion of the manubrium.

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Rib 2 attachment

Rib 2 is attached to the Angle of Louis.

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Ribs 3 to 6 attachment

Ribs 3 to 6 are all attached to the sternum.

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Ribs 7-10 identification

These ribs are identified by the little notches created when the cartilage of one rib connects to the rib above.

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Pump-handle motion (ribs 1-3)

Rib movement predominantly in the coronal plane, where the anterior portion moves superior and anterior during inhalation and posterior and inferior during exhalation.

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Bucket-handle motion (ribs 7-10)

Rib movement primarily in the coronal plane, where the lateral margin moves superior and lateral during inhalation and inferior and medial during exhalation, increasing transverse diameter.

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Calipers motion (ribs 11-12)

Rib motion primarily in the transverse plane, with the rib moving posteriorly during inhalation and anteriorly during exhalation, and the tip moving superiorly during inhalation and inferiorly during exhalation.

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Inhalation rib dysfunction (pump-handle)

Anterior portion of dysfunctional rib doesn't move inferiorly enough during exhalation, increasing A-P diameter.

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Inhalation rib dysfunction (bucket-handle)

Lateral margin of dysfunctional rib doesn't move inferomedially enough during exhalation, increasing transverse diameter.

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Exhalation rib dysfunction (pump-handle)

Anterior portion of dysfunctional rib doesn't move superiorly enough during inhalation.

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Mid-axillary line

An imaginary vertical line passing through the midpoint of the armpit.

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Costovertebral-costosternal line

The imaginary line along which the axis of motion for pump-handle/bucket-handle ribs movement occur.

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Shoulder Treatment Program

A program used to increase the pain-free range of motion (ROM) in the shoulder by manipulating fluids and tissues around the shoulder.

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Deltoid Muscle Parts

The deltoid muscle has three parts (anterior, middle, and posterior) each with different functions and attachments.

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Latissimus Dorsi Origin

The latissimus dorsi muscle originates from various parts of the spine, ribs, and pelvis.

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Latissimus Dorsi Function

The latissimus dorsi muscle is responsible for adducting, extending, and medially rotating the arm, as well as extending the arm at the shoulder joint and drawing it downward and backwards.

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Glenohumeral Joint Labrum

The labrum of the glenohumeral joint is a structure that deepens the glenoid fossa (socket) for stability of the shoulder joint.

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Glenohumeral Joint Type

The glenohumeral joint is a ball-and-socket joint, making it highly mobile but unstable.

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Rib Motion - Pump Handle

A type of rib motion primarily occurring in the sagittal plane. It's best palpated at mid-clavicular line.

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Thoracic Spine Treatment Priority

When treating somatic dysfunctions in the thoracic region, the thoracic spine is often addressed before ribs.

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Spring test for ribs 7-10

Gently pressing from lateral to medial on ribs 7-10 to identify restricted motion.

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Key rib identification

The rib with the most restricted motion in a group of dysfunctional ribs.

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Ribs 1-5 exhalation dysfunction

Restriction in rib movement during exhalation, specifically affecting ribs 1-5.

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Ribs 6-10 exhalation dysfunction

Restriction in rib movement during exhalation, specifically affecting ribs 6-10.

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Ribs 1-5 inhalation dysfunction

Restriction in rib movement during inhalation, specifically affecting ribs 1-5.

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Ribs 6-10 inhalation dysfunction

Restriction in rib movement during inhalation, specifically affecting ribs 6-10.

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Rib 1 exhalation dysfunction treatment

Joint mobilization using muscle force with post isometric relaxation and respiratory assist.

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Ribs 3-5 exhalation dysfunction treatment

Joint mobilization using the pectoralis minor muscle and post isometric relaxation with respiratory assist.

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Study Notes

Upper Extremity Muscle Energy

  • Normal Ranges of Motion:
    • Forward flexion: 180 degrees
    • Extension: 60 degrees
    • Internal/External Rotation: 90 degrees each
    • Abduction: 180 degrees
    • Adduction: 45 degrees
    • Elbow flexion: 150 degrees
    • Elbow extension: 10 degrees
    • Wrist extension: 70-90 degrees
    • Wrist flexion: 80-90 degrees
    • Wrist abduction (radial deviation): 15 degrees
    • Wrist adduction (ulnar deviation): 30-45 degrees
    • Supination/Pronation: 80-90 degrees

Restrictions of Motion

  • Radial Head Restrictions:
    • Pronation restriction involves the anterior radial head.
    • Supination restriction involves the posterior radial head.
    • During pronation, distal radius moves anterior and medial; proximal radial head glides posterior.
    • During supination, distal radius moves posterior and lateral; proximal radial head moves anterior.

Treatment of Forearm Pronation Restriction

  • Stand in front of the patient on the same side of the dysfunction.
  • Stabilize the elbow at 90 degrees flexion.
  • Place thumb on the anterior aspect of the radial head.
  • Apply pressure to guide the radial head posteriorly.
  • Patient attempts forearm pronation until a barrier is reached.
  • Perform 3-5 repetitions, 3-5 seconds each, until improved motion.
  • Retest.

Treatment of Forearm Supination Restriction

  • Stand in front of the patient on the same side of the dysfunction.
  • Stabilize the elbow at 90 degrees flexion.
  • Place thumb on the posterior aspect of the radial head.
  • Apply pressure to guide the radial head anteriorly.
  • Patient attempts forearm supination until a barrier is reached.
  • Perform 3-5 repetitions, 3-5 seconds each, until improved motion.
  • Retest.

Treatment of Wrist Restrictions

  • Flexion: Support distal forearm, flex wrist to barrier, extend against resistance, repeat.
  • Extension: Support distal forearm, extend wrist to barrier, flex against resistance, repeat.
  • Abduction (Radial Deviation): Support distal forearm, abduct wrist to barrier, adduct against resistance, repeat.
  • Adduction (Ulnar Deviation): Support distal forearm, adduct wrist to barrier, abduct against resistance, repeat.

Treatment of SC Joint Restriction

  • Patient seated.
  • Fingers placed superior to the medial clavicle, at eye level.
  • Have patient shrug shoulders; side where clavicles remain more elevated is dysfunctional.
  • Palpate the SC joint, abduct the shoulder until SC joint feels moved (45 degrees).
  • Externally rotate the arm, extending it from the wrist, toward the floor, until resistance is felt.
  • Patient lifts the arm towards the ceiling while resisting.
  • Treat for 3-5 repetitions of 3-5 seconds each.

Treatment of Acromioclavicular Joint Restriction

  • Patient in scaption (90 degrees abduction, 30 degrees horizontal rotation, 90 degrees elbow flexion).
  • Manually rotate the arm externally to resistance, while maintaining scapular position and shoulder joint position.
  • Perform 3-5 repetitions, 3-5 seconds each.

Other Procedures

  • Spencer Technique: Shoulder treatment method with seven stages, useful in diagnosing and treating musculoskeletal dysfunctions.
  • O.M.T on Thoracic Cage: Improves breathing, modulation of the sympathetic nervous system and facilitates nutritive support for tissues.
  • Rib Motion: Pump-handle and Bucket-handle actions (inhalation and exhalation).

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Description

Explore the normal ranges of motion and restrictions of the upper extremity, focusing on muscle energy techniques for treatment. This quiz covers key aspects of forearm pronation and supination restrictions, providing a comprehensive understanding of the anatomy involved. Perfect for students and professionals in physical therapy and rehabilitation.

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