Upper Extremity Muscle Energy PDF

[Upper Extremity Muscle Energy] **Normal ranges of motion for the upper extremity** are as follows: - - - - - - - - - **Position of scaption**: 90 degrees abduction, 30 degrees horizontal rotation, 90 degrees elbow flexion. In scaption, it is important to test both active and p...

[Upper Extremity Muscle Energy] **Normal ranges of motion for the upper extremity** are as follows: - - - - - - - - - **Position of scaption**: 90 degrees abduction, 30 degrees horizontal rotation, 90 degrees elbow flexion. In scaption, it is important to test both active and passive ROM in order to determine restrictions of the **acromioclavicular joint**. A restriction of motion of the radial head can occur **two ways**: **resistance to pronation** involves the anterior radial head, while **restriction of supination** involves the posterior radial head. During **pronation**, the **distal radius** crosses over the ulna and moves **anterior** and **medial** while the **proximal radial head** glides **posterior**. During **supination**, the **distal radius** moves **posterior** and **lateral** while the more **proximal radial head** moves **anterior**. To treat forearm pronation restriction: 1. 2. 3. 4. 5. 6. 7. 8. To treat forearm supination restriction: 1. 2. 3. 4. 5. 6. 7. 8. To treat wrist flexion restriction: 1. 2. 3. 4. 5. 6. 7. To treat wrist extension restriction: 1. 2. 3. 4. 5. 6. 7. To treat wrist abduction or ulnar deviation restriction: 1. 2. 3. 4. 5. 6. 7. To treat radial deviation or wrist adduction restriction: 1. 2. 3. 4. 5. 6. 7. To evaluate for **sternoclavicular joint restriction**, the patient should be **seated**. The fingers are placed **superior to the medial end of the clavicle** with the eyes at the **level** of the fingers. Have the patient shrug their shoulders. Normally, the heads of the clavicles should hinge **inferiorly**; the side which remains **superior** is the dysfunctional side. To treat sternoclavicular joint restriction: 1. 2. 3. 4. 5. 6. 7. To treat restriction external rotation of the acromioclavicular joint: 1. 2. 3. 4. 5. 6. 7. To treat restricted internal rotation of the acromioclavicular joint: 1. 2. 3. 4. 5. *The Spencer Technique* The **seven stages of Spencer** refers to a standardized series of shoulder treatment with a broad application in diagnosis, treatment, and prognosis. The stages are useful in diagnosing and treating musculoskeletal dysfunction, including restriction and pain in the shoulder (bursitis, tendinitis, tenosynovitis, and fibrous adhesive capsulitis). It is primarily a treatment for r**estricted motion** rather than painful motion. The Spencer technique was developed by **Charles H. Spencer**, D.O. of Los Angeles, CA. They were first presented before the Section on Tehnic at the Portland Session of the AOA Convention in August **1915** and published in the *Journal of the American Osteopathic Association* in **1916**. Spencer used his shoulder treatment program to increase pain-free ROM by **pumping fluids** and **stretching tissues** around the shoulder. The three parts of the deltoid muscle fuse into one tendon. The **distal attachment** is to the deltoid tuberosity of the humerus. The **clavicular (anterior) part** has proximal attachment to the lateral 1/3 of the clavicle and **flexes/medially rotates** the arm. The **acromial (middle) part** proximally attaches to the acromion process of the scapula and acts to **abduct the arm**. The **spinal (posterior) part** proximally attaches to the spine of the scapula and acts to **extend and laterally rotate** the arm. It is innervated by the **axillary nerve (C5-C6).**  The latissimus dorsi originates from the spinous processes of the 7^th^ to 12^th^ thoracic vertebrae and thoracolumbar fascia (**vertebral part**), the iliac crest (**iliacal part**), the 9^th^ to 12^th^ ribs (**costal part**) and the inferior angle of the scapula (**scapular part**). It inserts on the bottom of the intertubercular (bicipital) groove of the proximal humerus. It is innervated by the **thoracodorsal nerve (C6-C8)** and acts to **adduct, extend, and medially rotate the arm** as well as **extend the arm at the shoulder joint** and **draw it downward and backwards while rotating it medially (swimmer's muscle).** The **labrum** of the glenohumeral joint is a fibrocartilaginous structure that deepens the glenoid fossa and provides it increased stability. The glenohumeral joint is a **typical ball-and-socket joint** that is highly **mobile**, but therefore highly **unstable**. - - - The **effects of performing OMT on the thoracic cage**: - - - - Usually with somatic dysfunctions of the thoracic region, the thoracic spine is treated **before** the ribs. *Rib Motion* Motion of the ribs is divided into two types. The first is the **"pump handle" motion**, which is predominantly in the **sagittal** plane. It is best palpated at the **mid-clavicular line**. Its axis of motion is the **costovertebral-costotransverse line**. With **inhalation**, the **anterior** portion of the rib moves **anterior and superior** while the **posterior angle** moves **posterior and inferior**; with **exhalation**, the **anterior** portion of the rib moves **posterior and inferior** while the **posterior angle** moves **anterior and superior**. The second is the **"bucket handle" motion**, which is predominantly in the **coronal** plane. It is best palpated at the **mid-axillary line**, where the axis of motion is a **costovertebral-costosternal line**. With **inhalation**, the **lateral margin** of the rib moves **superior and lateral** and there is an **increase** in transverse diameter; with **exhalation**, the **lateral margin** of the rib moves **inferior and medial** and there is a **decrease** in transverse diameter. **All ribs (1-10)** exhibit both pump-handle and bucket-handle mechanics. However, the predominant motion of the upper ribs (1-3) is **pump-handle motion**, while the predominant motion of the lower ribs (7-10) is **bucket-handle motion**. Ribs 4-6 exhibit a **balance** between the two types of motion. Ribs also exhibit a physiological type of motion called **caliper motion**. This motion is found predominantly in ribs 11 and 12 and is motion in the **transverse plane**. It is best palpated 3-5 cm lateral to the transverse processes. The axis of motion is along a **vertical line** (cephalad-pedad). With **inhalation**, the rib moves **posteriorly** while the tip of the rib moves **superiorly**; with **exhalation**, the rib moves **anteriorly** while the tip of the rib moves **inferiorly**. For **predominantly pump-handle inhalation rib dysfunctions**, the **anterior** portion of the dysfunctional rib does not move as much **inferiorly** as the non-dysfunctional complementary rib when the patient **exhales**. The **posterior** rib angle moves easier in a **posterior and inferior** direction, thus **increasing** the A-P diameter of the rib cage. For **predominantly bucket-handle inhalation rib dysfunctions**, the **lateral portion** of the dysfunctional rib does not move as much in the **inferomedial direction** as the non-dysfunctional complementary rib when the patient **exhales**, thus **increasing** the transverse diameter of the rib cage. For **predominantly pump-handle exhalation rib dysfunctions**, the **anterior** portion of the dysfunctional rib does not move as much in the **superior** direction when the patient **inhales**. The **posterior** rib angle moves easier in an **anterior and superior direction**, **decreasing** the A-P diameter of the rib cage. For **predominantly bucket-handle exhalation rib dysfunctions**, the **lateral portion** of the dysfunction rib does not move as much in the **superolateral direction** when the patient **inhales**, thus **decreasing** the transverse diameter of the rib cage. In **inhalation** somatic dysfunction, the key rib is at the **bottom** of the group. In **exhalation** somatic dysfunction, the key rib is at the **top** of the group.  *Rib Somatic Dysfunction Diagnosis and Treatment* In a **supine approach and a seated-posterior approach**, the **thumbs** are placed on the h**ead of the rib** while the **fingers** are placed on the **anterior shaft of the rib**, inferior and superior to the clavicle. In a **seated-anterior approach**, the **fingers** are on the **head of the rib** while the **thumb** is placed on the **anterior shaft of the rib** inferior to the clavicle. An additional component to cervicothoracic somatic dysfunction that is also associated with the first rib positioning is the rotational aspect that is found at the anterior first rib attachment with the manubrium. The shaft of the 1^st^ rib should be located with the thumb or finger, and then its position should be assessed: - - - The ribs themselves do not attach to the sternum, but the cartilaginous attachments at the costosternal border are still referred to as the "ribs." **Rib 1** is attached to the upper portion of the manubrium. **Rib 2** is attached to the Angle of Louis. **Ribs 3 to 6** are all attached to the sternum; these ribs are most easily identified by finding rib 2, then putting your fingers into the intercostal spaces and continuing down the ribs. **Ribs 7-10** are identified by the little notches that are created when the cartilage of one rib connects to the rib above; run your fingers along the costal margin down from the xiphoid and around, until you palpate the tip of the 11^th^ rib in the mid-axillary line. **Rib 7** is the 1^st^ notch palpable inferolateral to the xiphoid. **Rib 8** is level with the medial 1/3 of the clavicle, roughly halfway between ribs 7 and 9. **Rib 9** is located in the mid-clavicular line. **Rib 10** is level with the lateral 1/3 of the clavicle. **Rib 11** is free-floating, with the tip palpable in the mid-axillary line. To perform active motion testing of **ribs 2-6**: 1. 2. 3. 4. 5. To perform active motion testing of **ribs 7-10**: 1. 2. 3. 4. 5. 6. If you feel asymmetry that indicates motion restriction in either exhalation or inhalation, it is necessary to also perform **passive motion testing**. Put your hands in contact with the ribs to gently spring from anterior to posterior in ribs 2-6 and lateral to medial in ribs 7-10. Springing is only confirmation of a restriction in the region; you still have to find the key rib in that region. Use the above methods for finding general areas of restriction of motion of the ribs and the thoracic cage. They can either be left- or right-sided pump handle dysfunctions in ribs 1-5 or left- or right-sided bucket handle dysfunctions in ribs 6-10. Performing a spring test on the rib area where motion asymmetry is noted is used to determine the dysfunctional side, which will have less spring than the non-restricted side. Once these general areas have been identified, you must find the key rib, which is done by assessing movement of the individual rib (in associated with the ribs above and below) with inhalation and exhalation. To treat **ribs 1 and 2 exhalation dysfunction** (uses joint mobilization using muscle force with post isometric relaxation and respiratory assist): 1. 2. 3. 4. 5. 6. 7. 8. 9. To treat **ribs 3-5 exhalation dysfunction** (uses joint mobilization using muscle force of **pectoralis minor** with post-isometric relaxation and respiratory assist): 1. 2. 3. 4. 5. 6. To treat rib **6-10 exhalation dysfunction** (uses joint mobilization using muscle force of **serratus anterior and latissimus dorsi**) with post-isometric relaxation and respiratory assist): 1. 2. 3. 4. 5. 6. 7. 8. To treat **inhalation somatic dysfunction**, the physician pushes the dysfunctional rib toward **exhalation** when the patient **exhales** and **resists inhalation motion** when the patient **inhales**. To treat **exhalation somatic dysfunction**, the physician **makes use of anatomic** attachment of muscles and **has the patient contract appropriate muscles to move the ribs into inhalation motion**. To treat **rib 1 inhalation dysfunction** (uses respiratory assistance): 1. 2. 3. 4. 5. 6. To treat ribs 2**-6 inhalation dysfunction** (uses respiratory assistance): 1. 2. 3. 4. 5. 6. 7. 8. 9. To treat ribs **7-10 inhalation dysfunction** (uses respiratory dysfunction): 1. 2. 3. 4. 5. 6. 7. To treat **ribs 11 and 12 inhalation dysfunction** (uses joint mobilization using **quadratus lumborum**, reciprocal inhibition, and respiratory assist): 1. 2. 3. 4. 5. 6. To treat **rib 11 and 12 exhalation dysfunction** (uses post-isometric relaxation of **quadratus lumborum** and respiratory assist): 1. 2. 3. 4. 5. To perform **rib raising**: 1. 2. 3. 4. 5. 6. 7.