Glenohumeral Lab 1 PDF

*Thumb web/axilla with knee extension; long-axis distrac on (Figure 6-48) DP: Ipsilateral to lis ng with pa ent’s arm slightly aBducted and doctor straddling the pa ent’s leg so that the doctor’s slightly bent knees can grasp the pa ent’s distal humerus just proximal to the epicondyles if possible O...

*Thumb web/axilla with knee extension; long-axis distrac on (Figure 6-48) DP: Ipsilateral to lis ng with pa ent’s arm slightly aBducted and doctor straddling the pa ent’s leg so that the doctor’s slightly bent knees can grasp the pa ent’s distal humerus just proximal to the epicondyles if possible OR grasp pa ent’s forearm above the wrist with your knees. It is VERY important to de-ar fact (remove all jewelry, etc.) PP: Supine with involved arm slightly aBducted guarding breast ssue. Scapula should be on the table (if broad shoulders may need to reposi on pt.) with the g-h joint off the edge of the table. Pt posi oned with thumb poin ng toward the ceiling for comfort. CP: With inside (inferior) hand, establish web contact with back of the hand towards the breast ssue. The outside hand will be along the back of the humerus pressing the scapula into the table. The picture in the book is wrong. IH: Suppor ng the pa ents posterior humerus SCP: anterior glenohumeral joint Vector/LOD: LAD P: While maintaining the scapula against the table and applying slight superior pressure with the CP, deliver a quick “bunny hop” movement by extending both knees and drawing the humerus into long axis distrac on. Bimanual thumb thenar grasp/proximal humerus with knee extension; anterior-to-posterior glide (Figure 6-49) DP: Ipsilateral to lis ng with pa ent’s arm slightly aBducted and doctor straddling the pa ent’s leg so that the doctor’s slightly bent knees can grasp the pa ent’s distal humerus just proximal to the epicondyles if possible OR grasp pa ent’s forearm above the wrist. It is VERY important to dear fact (remove all jewelry, etc.) PP: Supine with involved arm slightly aBducted guarding breast ssue. G-h joint needs to be posi oned off the edge of the table. CP: Bilateral Thumb and thenar together SCP: Proximal Humerus Vector/LOD: A-P P: Apply distrac on above the pts wrist and impulse A-P Interlaced digital/proximal humerus; superior-to-inferior glide in flexion (Figure 6-50) DP: Ipsilateral to lis ng with pa ent’s arm flexed, can slightly aBduct the shoulder to make contact then bring back to neutral in flexion. Doctor is facing cephalad in a lunge posi on on the involved side while straddling the pa ent’s leg so that the doctor’s slightly bent knees can grasp the pa ent’s distal humerus just proximal to the epicondyles if possible OR grasp pa ent’s forearm above the wrist. It is VERY important to de-ar fact (remove all jewelry, etc.) PP: Supine with involved arm in 90 degrees flexion with elbow flexed so that the hand rests on the doctor’s inside shoulder. Pa ent MUST guard breast ssue. CP: Interlaced fingers over superior glenohumeral joint SCP: Anterior Proximal Humerus Vector/LOD: A-P (anatomical posi on) towards the pa ents feet causing the humeral head to go S-I. P: Using the pa ent’s elbow on your shoulder as a pivot point, apply S-I joint distrac on with both hands, finishing with an A-P impulse towards the pa ent’s feet. Index/proximal humerus; superior-to-inferior glide in abduc on (Figure 6-51) DP: Involved side HOT facing caudal drop elbow down (this enables the correct LOD) before thrust PP: Supine (guarding breast ssue if you are contac ng near it) with involved arm aBducted 90 degrees. CP: MCP 2nd digit IH: Use caudal hand to grasp the distal humerus for stabiliza on. SCP: Lateral aspect proximal humerus Vector/LOD: L-M (anatomical posi on) towards the pa ent’s feet causing the humeral head to go S-I. P: IH serves as a pivot point, stabilizing distal humerus and elbow, apply S-I joint distrac on with both hands, finishing with an L-M impulse towards the pa ent’s feet. *Bimanual thumb thenar grasp/proximal humerus with knee extension; internal or external rota on (Figures 6-52 and 6-39) DP: Ipsilateral to lis ng with pa ent’s arm slightly aBducted and doctor facing the HOT straddling the pa ent’s leg so that the doctor’s slightly bent knees can grasp the pa ent’s distal humerus just proximal to the epicondyles if possible OR grasp pa ent’s forearm above the wrist. It is VERY important for the doctor AND pa ent to de-ar fact (remove all jewelry, etc.) PP: Supine with involved arm slightly aBducted guarding breast ssue. Pre-load in the direc on of correc on CP: Interlaced fingers SCP: Proximal Humerus Vector/LOD: Rota onal internal rota on OR external rota on P: Use both hands to preload the humerus into internal or external rota on while you simultaneously straighten both knees to create a long axis distrac on at the glenohumeral joint. Bimanual thumb thenar grasp/proximal humerus; mobiliza on with distrac on (Figure 6-53) DP: Lunge (do NOT stand between the pa ent’s arm and body) on involved side facing the head of the table trapping the pa ent’s forearm against your thoracic cage. It is VERY important for the doctor AND pa ent to de-ar fact (remove all jewelry, etc.) PP: Supine with involved arm aBducted up to 90 degrees guarding breast ssue. CP’s: Grasping the pa ent’s humerus with a bilateral palmar contact SCP: Proximal humerus Vector/LOD: Circumduc on and distrac on P: Use body weight to assist in producing a mild distrac on and circumduc on movement in all direc ons Bimanual grasp/hand; pendular abduc on mobiliza on (Figure 6-54): Ist lab needs to prac ce this one & notes corrected DP: Stand at the side of the table on the involved side facing the pa ent. PP: Supine with involved arm flexed 90 degrees and aBducted up to the restric on (guarding breast ssue op onal). CP’s: Grasping the pa ent’s hand with bilateral palmar contact. Use inferior hand to grasp the pa ent’s thumb and then reinforce with the other hand. SCP: Pa ent’s thumb and hand Vector/LOD: S-I with passive rocking. P: Abduct pa ent’s arm with elbow flexed 90 degrees un l you feel restric on and passively rock pa ent’s hand back and forth to induce a pendulum mo on at the elbow. Pa ent MUST be relaxed. Elbow should be swinging.