PERIPHERAL Joint Mobilization
PERIPHERAL JOINT MOBILIZATION
TECHNIQUES
Shoulder Girdle Complex
Glenohumeral Joint
• The concave glenoid
fossa receives the
convex humeral head
Resting Position
• The shoulder is
abducted 55,
horizontally adducted
30, and rotated so the
forearm is in the
horizontal plane
Shoulder Girdle Complex
Treatment Plane
• The treatment plane is
in the glenoid fossa and
moves with the scapula
Stabilization
• Fixate the scapula with
a belt or have an
assistant help.
Shoulder Girdle Complex
• Glenohumeral Distraction
Indications
• Testing
• Initial Treatment
(sustained grade II)
• Pain control
(grade I or II oscillations)
• General mobility
(sustained grade III).
Shoulder Girdle Complex
• Glenohumeral Caudal Glide, Resting Position
Indications
• To increase abduction (sustained grade III); to
reposition the humeral head if superiorly
positioned
CAUDAL GLIDE
Glenohumeral joint: caudal
glide in the resting position.
Note that the distraction
force is applied by the hand
in the axilla, and the caudal
glide force is from the hand
superior to the humeral
head.
Glenohumeral Elevation Progression
INDICATION
• To increase elevation
beyond 90 of abduction
Glenohumeral joint: elevation progression in
the sitting position. This is used when the
range is greater than 90. Note the externally
rotated position of the humerus; pressure
against the head of the humerus is toward the
axilla
Glenohumeral Posterior Glide,
• Resting Position
Indications
• To increase flexion; to
increase internal
rotation
Glenohumeral joint: posterior glide in the
resting position
Glenohumeral Posterior Glide
Progression
• Indications
• To increase posterior
gliding when flexion
approaches 90; to
increase horizontal
adduction
Glenohumeral joint: posterior glide
progression. One hand (A)
or a belt
Glenohumeral Posterior Glide
Progression
• Indications
• To increase posterior
gliding when flexion
approaches 90; to
increase horizontal
adduction.
Glenohumeral joint: posterior glide
progression is used to exert a grade 1
distraction force
Glenohumeral Anterior Glide,
Resting Position
Indications
• To increase extension;
to increase external
rotation
Glenohumeral joint: anterior glide in the
resting position
Glenohumeral External Rotation
Progressions
Indication
• To increase external
rotation
Glenohumeral joint: distraction for
external rotation progression. Note that
the humerus is positioned in the resting
position with maximum external
rotation prior to the application of
distraction
Acromioclavicular Joint: Anterior
Glide
• Indication
• To increase mobility of
the joint.
Acromioclavicular joint: anterior glide
Sternoclavicular Joint
• The proximal articulating
surface of the clavicle is
convex superiorly/inferiorly
and concave
anteriorly/posteriorly
Patient Position and
Stabilization
• Supine; the thorax provides
stability to the sternum.
Sternoclavicular Posterior Glide
and Superior Glide
Indications
• Posterior glide to increase
retraction
• superior glide to increase
depression of the clavicle
Sternoclavicular joint: posterior and superior
glides. (A) Press down with the thumb for
posterior glide. (B) Press upward with the index
finger for superior glide
Sternoclavicular Anterior Glide
and Caudal (Inferior) Glide
Indications
• Anterior glide to
increase protraction
• caudal glide to increase
elevation of the clavicle.
Sternoclavicular joint: anterior and inferior
glides. (A) Pull the clavicle upward for an
anterior glide. (B) Press caudalward with the
curled fingers for an inferior glide
Scapulothoracic Mobilization
• The scapulothoracic
articulation is not a true
joint, but the soft tissue is
stretched to obtain normal
shoulder girdle Mobility
Indications
• To increase scapular
motions of elevation,
depression, protraction,
retraction, rotation,
Scapulothoracic articulation: elevation,
upward and downward
depression, protraction, retraction, upward and
downward rotations, and winging
rotations, and winging
Elbow and Forearm Complex
• The elbow and forearm
complex consists of four
joints:
–
–
–
–
Humeroulnar
Humeroradial
Proximal radioulnar
Distal radioulnar
• For full elbow flexion and
extension, accessory motions
of varus and valgus (with
radial and ulnar glides) are
necessary.
.
Bones and joints of the elbow complex
Humeroulnar Articulation
• The convex trochlea
articulates with the
concave olecranon fossa.
Resting Position
• Elbow is flexed 70, and
forearm is supinated 10
Bones and joints of the elbow complex
Humeroulnar Articulation
Treatment Plane
• The treatment plane is in the
olecranon fossa, angled
approximately 45 from the long axis
of the ulna
Stabilization
• Fixate the humerus against the treatment table
with a belt or use an assistant to hold it.
• The patient may roll onto his or her side and
fixate the humerus with the contralateral hand
if muscle relaxation can be maintained around
the elbow joint being mobilized.
Humeroulnar Distraction and
Progression
Indications
• Testing
• Initial Treatment
(sustained grade II)
• Pain control
(grade I or II oscillation)
• To increase flexion or
extension
(grade III or IV).
Humeroulnar joint: Distraction
Humeroulnar Distal Glide
Indication
• To increase flexion.
distraction with distal glide (scoop motion).
Humeroulnar Radial Glide
Indication
• To increase varus.
– An accessory motion of
the joint that
accompanies elbow
flexion
• used to progress flexion
• Mobilizing Force against
the ulna in a radial
direction.
Humeroulnar Ulnar Glide
• Indication
• To increase valgus.
– an accessory motion of the
joint that accompanies
elbow extension
• used to progress extension
• Mobilizing Force
applied against the
distal humerus in a
radial direction, causing
the ulna to glide ulnarly.
Humeroradial Articulation
• The convex capitulum articulates
with the concave radial head
Resting Position
• Elbow is extended, and forearm
is supinated to the end of the
available range.
Treatment Plane
• The treatment plane is in the
concave radial head
perpendicular to the long axis of
the radius.
Stabilization
• Fixate the humerus with one of
your hands.
Bones and joints of the elbow complex
Humeroradial Distraction
Indications
• To increase mobility of the
humeroradial joint; to
manipulate a pushed
elbow (proximal
displacement of the radius
Humeroradial joint: distraction
Humeroradial Dorsal/Volar Glides
• Indications
• Dorsal glide head of
the radius to
increase elbow
extension;
• volar glide to
increase flexion.
Humeroradial joint: dorsal and volar glides.
This may also be done sitting, as in Figure
5.32, with the elbow positioned in extension
and the humerus stabilized by the proximal
hand (rather than the ulna).
Humeroradial Dorsal/Volar Glides
(in sitting)
Humeroradial joint: dorsal and volar glides
Humeroradial Compression
Indication
• To reduce a pulled
elbow subluxation
Humeroradial joint: compression
manipulation. This is a quick
thrust with simultaneous supination and
compression of the radius
Proximal Radioulnar Joint,
Dorsal/Volar Glides
• The convex rim of the radial
head articulates with the
concave radial notch on the
ulna
Resting Position
• The elbow is flexed 70 and
the forearm supinated 35.
Treatment Plane
• The treatment plane is in the
radial notch of the ulna,
parallel to the long axis of the
ulna.
Stabilization
• Proximal ulna is stabilized
Bones and joints of the elbow complex
Proximal Radioulnar Joint,
Dorsal/Volar Glides
• Indications
• Dorsal glide to increase
pronation; volar glide to
increase supination
Proximal radioulnar joint: dorsal and volar
glides.
Distal Radioulnar Joint, Dorsal/Volar
Glides
• The concave ulnar notch of
the radius articulates with
the convex head of the ulna.
Resting Position
• The resting position is with
the forearm supinated 10.
Treatment Plane
The treatment plane is the
articulating surface of the
radius, parallel to the long
axis of the radius.
Stabilization
• Distal ulna.
Bones and joints of the elbow complex
Distal Radioulnar Joint, Dorsal/Volar
Glides
• Indications
• Dorsal glide to increase
supination; volar glide
to increase pronation
Distal radioulnar joint: dorsal and volar glides