SHOULDER
Apleys: The patient is asked to make a fist with
the hands and stretch out the thumbs. The
hands are placed behind the neck or the back.
- Neck: tests for external rotation
and abduction of the shoulder
- Back: tests for internal rotation,
extension, and adduction of the
shoulder
Drop arm Test: Supraspinatus muscle
Painful Arc: Subacromial impingement
With the patient in either sitting or standing the patient
should be instructed to abduct the arm in the scapular
plane. This test is considered to be positive if the patient
experiences pain between 60 and 120 degrees of
abduction which reduces once past 120 degrees of
abduction
Adsons: TOS
The arm of the standing (or seated) patient is abducted 30
degrees at the shoulder and maximally extended.
The radial pulse is palpated and the examiner grasps the
patient's wrist.
The patient then extends neck and turns the head toward
the symptomatic shoulder and is asked to take a deep
breath and hold it
The test is positive if there is a marked decrease, or
disappearance, of the radial pulse. It is important to check the patient's radial pulse on the
other arm to recognize the patient's normal pulse
Roos: TOS (Elevated Arm Stress Test)
The patient has both arms in the 90° abductionexternal rotation position. Shoulders and elbows
are in the frontal plane of the chest. The patient is
to open and close the hands slowly over a 3minute period.
Speed’s Test: Bicipital Tendonitis
Patient seated, forearm is extended & supinated (arm at
side), patient actively flexes arm to 20°, and examiner
applies resistance to this motion while palpating the
bicipital groove
Yergason Test: Bicipital Tendonitis
The patient should be seated or standing,
with the humerus in neutral position and the
elbow in 90 degrees of flexion. The patient is
asked to externally rotate and supinate their
arm against the manual resistance of the
therapist. Yergason's Test is considered
positive if pain is reproduced in the bicipital
groove during the test
Empty Can Test: Supraspinatus
The patient's upper arm should be
passively abducted (∼ 90°) and flexed horizontally
with the elbow extended.
The arm is internally rotated (thumb pointing
downwards)
Check the patient's ability to maintain the arm in
this position
If the patient is able to maintain this position, the
examiner applies pressure to the patient's arm and the patient is asked to resist.
Findings and significance: Positive Jobe's test: pain or the inability to maintain the arm's
position against resistance → functional disorder of the supraspinatus muscle(e.g., tendon
rupture, tendinopathy, or subacromial bursitis)
Hawkins/Kennedy: Subacromial
Impingement
The examiner places the patient's arm
shoulder in 90 degrees of shoulder flexion
with the elbow flexed to 90 degrees and
then internally rotates the arm. The test is
considered to be positive if the patient
experiences pain with internal rotation
Neer’s Test: Subacromial Impingement
The examiner should stabilize the patient's scapula with
one hand, while passively flexing the arm while it is
internally rotated. If the patient reports pain in this
position, then the result of the test is considered to be
positive.
Load and Shift: Glenohumeral Stability
Patient seated with arm in dependent position. Examiner
applies pressure over humerus to “load” the GH joint
while stabilizing shoulder, examiner then moves the
shoulder anterior, posterior & anterior
Crossed Arm Adduction: AC Joint Injury
With the arm to be tested in 90 degrees of elbow
flexion and 90 degrees of shoulder flexion (forward
elevation), the patient then cross adducts /
horizontally adducts, resting the hand on top of the
opposite shoulder
The examiner pushes the arm into further cross /
horizontal adduction. The position and movement
mimics throwing a ‘scarf’ over the shoulder, hence the name of the test
Anterior Apprehension: Anterior Glenohumeral Joint
Instability
The patient should be position in supine. The
therapist will flex the patient's elbow to 90 degrees
and abducts the patient's shoulder to 90 degrees,
maintaining neutral rotation. The examiner then
slowly applies an external rotation force to the arm
to 90 degrees while carefully monitoring the
patient. Patient apprehension from this manoeuvre,
not pain, is considered a positive test
Posterior Apprehension: Posterior Glenohumeral Joint Instability
Patient supine seated, shoulder flexed 90° & internally rotated,
elbow flexed 90°. Examiner applies A→P pressure over elbow while
palpating glenohumeral joint.
Clunk Test: Labral Tear
Have the patient lie down in supine. Place one hand on the posterior aspect of the shoulder
over the humeral head. Place the other hand on the humerus above the elbow. Fully abduct
the arm over the patient’s head, and then push anteriorly with the hand over the humeral
head while the other hand rotates the humerus into external
rotation. A clunk or grinding sound is a positive test, and can
indicate a tear of the labrum
O’Brien’s: SLAP
The arm to be tested should be in 90 degrees of flexion and
about 10 degrees of adduction. The patient then internally
rotates the arm, pronating at the elbow and essentially
pointing the thumb to the ground. The examiner provides a
downward force distally on the arm while the patient resists
with an upward force.
ADJUSTMENTS
GLENOHUMERAL
Thumb web/axilla with knee extension; long-axis distraction
• IND: Loss of long-axis accessory movement, superior misalignment of the humerus.
• PP: The patient is supine, with the involved arm along the body.
• DP: Stand on the involved side, bring the patient’s arm into slight abduction, and
straddle the arm so that your slightly bent knees can grasp the patient’s distal
humerus just proximal to the epicondyles.
• SCP: The patient’s axilla.
• CP: With your inside hand, establish a thumb web contact in the patient’s axilla while
applying downward pressure with your fingers on the shoulder girdle to stabilize it
against the table.
• IH: With your outside hand, use a digital
contact over the lateral aspect of the joint
to monitor for movement.
• VEC: Long-axis distraction.
• P: While maintaining the shoulder girdle
against the table and applying slight
superior pressure with the CP, make a quick
“bunny hop” movement by extending both
knees and drawing the humerus into longaxis distraction.
Bimanual thumb thenar grasp/proximal humerus with knee extension; anterior-to-posterior
glide
• IND: Loss of A-P accessory movement, anterior misalignment of the humerus.
• PP: The patient lies in the supine position, with the involved arm in slight abduction
and the glenohumeral joint positioned off the edge of the table.
• DP: Stand at the side of the table and straddle the affected arm so that the patient’s
epicondyles are held between your knees.
• SCP: Proximal humerus.
• CP: With both hands, grasp the proximal
humerus with thumbs / thenars together in
the midline.
• VEC: A-P.
• P: With your knees, provide slight distraction
while applying an impulse thrust anteriorly to
posteriorly with both hands.
Interlaced Digital/Proximal Humerus; Superior-to-Inferior Glide in Flexion
• IND: Loss of accessory movements in inferior glide in
flexion, superior misalignment of the humerus.
• PP: The patient is supine, with the involved arm
raised to 90 degrees flexion and the elbow bent so
that the hand rests on the shoulder.
• DP: Stand on the involved side in a lunge position,
facing cephalad and allowing the patient’s elbow to
rest against your shoulder.
• SCP: Proximal humerus.
• CP: Grasp the proximal humerus with both hands,
using interlaced fingers over the superior aspect of
the glenohumeral joint.
• VEC: S-I.
• P: Using the patient’s elbow on your shoulder as a
pivot point, apply S-I joint distraction with both
hands, finishing with an S-I impulse thrust.
Index/Proximal Humerus; Superior-to-Inferior Glide in Abduction
• IND: Loss of accessory movements in inferior glide in abduction, superior
misalignment of the humerus.
• PP: The patient is supine, with the involved arm abducted to 90 degrees.
• DP: Stand on the involved side at the head of the
table, facing caudal.
• SCP: Superior aspect of the proximal humerus.
• CP: Establish a web contact over the superior aspect
of the proximal humerus with the cephalic hand.
• IH: With your caudal hand, grasp the distal aspect of
the patient’s humerus.
• VEC: S-I.
• P: Your IH serves as a pivot point, stabilizing the distal
humerus and elbow, and your cephalic hand removes
articular slack, finishing with an impulse-type thrust in
an S-I direction.
Bimanual Thumb Thenar Grasp/Proximal Humerus with Knee Extension; Internal Rotation
• IND: Restricted internal rotation accessory joint movement, external rotation
misalignment of the humerus.
• PP: The patient is supine, with the affected arm
abducted slightly away from the patient’s body
and the edge of the table in internal rotation.
• DP: Stand on the involved side, facing cephalad
and straddling the patient’s affected arm so that
your knees can squeeze the distal humerus just
above the epicondyles.
• SCP: Proximal humerus.
• CP: Grasp the patient’s proximal humerus with
interlaced fingers of both hands.
• VEC: Rotational-internal rotation.
• P: Your hand contacts first turn the humerus into
internal rotation, removing articular slack.
Simultaneously straighten both knees, applying a long-axis distraction to the
glenohumeral joint.
Bimanual Thumb Thenar Grasp/Proximal Humerus with Knee Extension; External Rotation
• IND: Restricted external rotation accessory joint movement, internal rotation
misalignment of the humerus.
• PP: The patient is 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.
• DP: Stand on the involved side, facing cephalad and straddling the patient’s affected
arm so that your knees can squeeze the distal humerus just above the epicondyles.
• SCP: Proximal humerus.
• CP: With your hand, grasp the patient’s proximal humerus with interlaced fingers.
• VEC: Rotational-external rotation.
• P: Use both hands to turn the humerus into external rotation.
• Simultaneously straighten both knees to create a long-axis distraction to the
glenohumeral joint.
Bimanual Thumb Thenar Grasp/Proximal Humerus Grasp; Mobilization with Distraction
• IND: Intracapsular adhesions in the glenohumeral joint and mobilization of the
shoulder.
• PP: The patient is supine, with the affected arm
outstretched.
• DP: Stand in a lunge position on the affected side, facing the
head of the table.
• SCP: Humerus.
• CP: With your inside hand, grasp the patient’s arm to hold
the patient’s forearm against your thoracic cage.
• IH: With your outside hand, make a palmar contact on the
posterior aspect of the shoulder and scapula to provide
support and lift during the mobilization.
• VEC: Circumduction and distraction.
• P: Use your body weight to assist in producing a mild
distraction and circumduction movement of the shoulder in
all directions.
Bimanual Grasp/Hand; Pendular Abduction Mobilization
• IND: Intracapsular adhesions in the glenohumeral joint, mobilization of the shoulder,
and adhesive capsulitis.
• PP: The patient is supine, with the affected arm slightly abducted and the forearm
flexed to 90 degrees, pointing upward.
• DP: Stand at the side of the table on the involved side,
facing the patient.
• SCP: The hand.
• CP: With both hands, grasp the patient’s hand.
• VEC: S-I with passive rocking.
• P: Instruct the patient to relax the arm as much as
possible. Raise the arm away from the table so that it
can swing freely. Induce a pendular motion in the
glenohumeral joint by rocking the forearm cephalad
and caudal, increasing the arc of abduction motion as
tolerated.
Prone: Bimanual Thumb Thenar Grasp/Proximal Humerus with Knee Extension; Posterior-toAnterior Glide
• IND: Loss of P-A accessory movements; or posterior misalignment of the humerus.
• PP: The patient lies in the prone position, with the involved arm in slight abduction
and the glenohumeral joint positioned
off the edge of the table.
• DP: Stand at the side of the table and
straddle the patient’s affected arm,
with the epicondyles held between your
knees.
• SCP: Proximal humerus.
• CP: With both of your hands, grasp the
proximal humerus with thumbs
together in the midline.
• VEC: P-A.
• P: With your knees, provide slight
distraction while applying
Bimanual Thumb Thenar Grasp/Proximal Humerus;Mobilization with Distraction
• IND: Intercapsular adhesions and mobilization of the shoulder.
• PP: The patient lies prone, with the affected arm hanging down and off the side of the
table.
• DP: Kneel at the side of the table, facing the patient.
• SCP: Proximal humerus.
• CP: Grasp the patient’s proximal humerus with
both hands, with your thumbs together on the
posterior aspect of the humerus while your
fingers wrap around and into the axilla on the
underside of the humerus.
• VEC: Circumduction.
• P: Using both hands, first distract the
glenohumeral joint in the long axis of the
humerus, and then move the humerus toward
and away from you, cephalad and caudal, in a
figure-8 motion.
Adjustment for inferior glide in flexion of the right glenohumeral joint in the standing
position
• IND: Loss of accessory movements in inferior glide in flexion; superior misalignment
of the humerus.
• PP: The patient stands, with feet spread at least shoulder-distance apart (or farther if
the patient is taller than the doctor). The involved arm is flexed to 90 degrees, and
the elbow is flexed so that the hand rests on the patient’s shoulder.
• DP: Stand in front of the patient and to the affected side. Your legs should be spread
appropriately for balance, as well as to align to the patient’s height.
• SCP: Proximal humerus.
• CP: First place the patient’s elbow on
your shoulder, then, using both hands,
grasp the proximal humerus with your
fingers interlaced on the superior aspect
of the joint capsule while your thumbs
wrap into the axilla.
• VEC: S-I.
• P: First draw away from the patient,
creating a joint separation, and then
apply a downward pressure to remove
articular slack. Give a thrust in the S-I
direction.
Interlaced Digital/Proximal Humerus; Superior-to-Inferior Glide in Abduction
• IND: Loss of accessory movements in inferior glide in abduction; superior
misalignment of the humerus.
• PP: The patient stands with legs at least shoulder-distance apart, with the involved
arm abducted to 90 degrees and the elbow flexed so that the hand rests on the
patient’s shoulder.
• DP: Stand with legs apart so that the
patient’s elbow can rest on your
shoulder.
• SCP: Proximal humerus.
• CP: Grasp the proximal humerus,
with interlaced fingers on the
superior aspect and thumbs in the
axilla.
• VEC: S-I.
• P: Back away from the patient to
distract the joint while applying a
downward pressure with the hands
to remove articular slack. Give an
impulse thrust in the S-I direction.
Sitting: Reinforced Palmar/Olecranon; Anterior-to-Posterior Glide
• IND: Loss of A-P accessory movement, anterior misalignment of the humerus.
• PP: The patient sits with the arm in forward flexion, the elbow bent, and the hand
resting on the opposite shoulder if
internal rotation is also desired or on the
same shoulder if external rotation is also
desired.
• DP: Stand behind the patient, slightly to
the side of involvement, stabilizing the
patient’s shoulder girdle against the
torso.
• SCP: The olecranon process.
• CP: With your ipsilateral hand, use a
palmar contact to cup the patient’s
elbow.
• IH: With your other hand, reinforce the
CP.
• VEC: A-P.
• P: Using both hands, remove the
articular slack and give a very quick and
shallow thrust primarily in the axis of the
humerus.
ACROMIOCLAVICULAR
Index/Distal Clavicle; Superior-to-Inferior Glide
• IND: Restricted S-I accessory movement of the distal clavicle, superior misalignment
of the distal clavicle.
• PP: The patient is supine, with the affected arm abducted to 90 degrees.
• DP: Stand at the head of the table, facing caudal, to the side of the affected arm.
• SCP: Superior aspect of the distal clavicle.
• CP: Establish an index contact with the
inside hand over the superior aspect of the
distal clavicle.
• IH: With your outside hand, grasp the
humerus at midshaft.
• VEC: S-I
• P: As your IH draws the humerus into longaxis distraction and abduction, apply an S-I
impulse thrust with your contact hand
Covered thumb/distal clavicle; inferior-to-superior glide
• IND: Loss of I-S accessory joint movement of the distal clavicle, inferior misalignment
of the distal clavicle.
• PP: The patient is supine, with the affected arm straight and slightly abducted.
• DP: Stand at the side of the table,
straddling the patient’s affected arm so
that your knees can grasp the distal
humerus above the patient’s epicondyles.
• SCP: Inferior aspect of the distal clavicle.
• CP: With your outside hand, apply a thumb
• IH: With your inside hand, place a pisiform
contact over the thumbnail of the contact
hand.
• VEC: I-S.
• P: As you straighten your knees to create a
long-axis distraction of the shoulder joint,
use both
Hypothenar/Distal Clavicle with Distraction; Anterior to-Posterior Glide
• IND: Restricted A-P accessory joint movement of the distal clavicle, anterior
misalignment of the distal clavicle.
• PP: The patient is supine, with the affected arm
straight and forward flexed to approximately 60
degrees.
• DP: Stand at the side of the table, opposite the
involved side.
• SCP: Anterior aspect of the distal clavicle.
• CP: With your cephalic hand, establish a pisiform
hypothenar contact over the anterior aspect of the
distal clavicle.
• IH: With your IH, grasp the outer aspect of the distal
forearm.
• VEC: A-P.
• P: As you distract the shoulder anteriorly and
inferiorly with your IH, apply an A-P impulse thrust
to the distal clavicle with your contact hand.
Digital/Distal Clavicle with Distraction; Posterior-to-Anterior Glide
•
•
•
•
•
•
•
•
IND: Restricted P-A accessory joint movement of the distal clavicle, posterior
misalignment of the distal clavicle.
PP: The patient is supine, with the affected arm
straight, flexed to approximately 60 degrees, and
slightly abducted.
DP: Stand at the side of the table on the affected
side, facing cephalad, between the patient’s
affected arm and the table.
SCP: Posterosuperior aspect of the distal clavicle.
CP: With your inside hand, place the digital
contact of the index and middle fingers over the
posterosuperior aspect of the distal clavicle.
IH: With your outer hand, grasp the patient’s
distal forearm.
VEC: P-A.
P: With your IH, distract the shoulder anteriorly
and while maintaining distraction, flex the arm,
raising it past 90 degrees. As the articular slack is
taken out, use your contact hand to deliver a very
quick and shallow P-A impulse thrust to the distal clavicle (lifting the distal clavicle).
Sitting: Web/Distal Clavicle; Superior-to-Inferior Glide
• IND: Restricted S-I accessory movement of the distal clavicle, superior misalignment
of the distal clavicle.
• PP: The patient sits, with the affected arm abducted.
• DP: Stand behind the patient and to the side of the affected arm.
• SCP: Superior aspect of the distal clavicle.
• CP: With your inside hand, apply a web contact over the superior aspect of the distal
clavicle.
• IH: With your outside hand, grasp the patient’s distal forearm.
• VEC: S-I.
• P: While your IH uses the patient’s
forearm as a lever to distract and
abduct the shoulder joint, deliver an S-I
impulse thrust with your contact hand
STERNOCLAVICULAR
Sternoclavicular Joint, Supine: Hypothenar/Proximal Clavicle with Distraction; Anterior to
Posterior Glide
• IND: Restricted A-P accessory movement of the proximal clavicle, anterior
misalignment of the proximal clavicle.
• PP: The patient is supine, with the
involved arm flexed forward to
approximately 60 degrees.
• DP: Stand on the side of the table
on the side of involvement, facing
cephalad.
• SCP: Anterior aspect of the
proximal clavicle.
• CP: Use your inside hand to apply a
pisiform-hypothenar contact over
the anterior aspect of the proximal
clavicle.
• IH: With your outside hand, grasp
the outer aspect of the distal
humerus at the epicondyles.
• VEC: A-P.
• P: With your IH, distract the
shoulder anteriorly, raising the
shoulder and scapula off the
adjusting table. As the articular
slack is removed, deliver an A-P impulse thrust over the proximal clavicle with the
contact hand.
Covered Thumb/Proximal Clavicle; Superior-to-Inferior Glide
• IND: Loss of S-I accessory motion of the proximal clavicle, superior misalignment of
the proximal clavicle.
• PP: The patient is supine, with the involved arm abducted to 90 degrees and the hand
placed under the head.
• DP: Stand at the head of the table,
facing caudal.
• SCP: Superior aspect of the proximal
clavicle.
• CP: With your ipsilateral hand, place a
thumb contact on the superior aspect of
the proximal clavicle.
• IH: With your contralateral hand, place a
pisiform-hypothenar contact over the
thumb contact.
• VEC: S-I.
• P: Deliver an impulse thrust with both
hands in an S-I direction on the proximal clavicle.
Covered Thumb/Proximal Clavicle with Knee Extension; Inferior-to-Superior Glide
• IND: Loss of I-S accessory joint movement of the proximal clavicle, inferior
misalignment of the proximal clavicle.
• PP: The patient is supine, with the affected arm slightly abducted.
• DP: Stand on the affected side, straddling the
patient’s arm and grasping the distal humerus
between your knees.
• SCP: Inferior aspect of the proximal clavicle.
• CP: With your outside hand, place a thumb
contact on the inferior aspect of the proximal
clavicle.
• IH: With your inside hand, place a pisiformhypothenar contact over the thumb contact for
reinforcement.
• VEC: I-S.
• P: Use your knee contact on the patient’s distal
humerus to distract the shoulder girdle caudally.
When articular slack has been removed, apply an
impulse thrust through both hands in an I-S
direction on the proximal clavicle.
Digital/Proximal Clavicle with Distraction; Posterior-to-Anterior Glide
• IND: Loss of P-A accessory joint movement of the proximal clavicle, posterior
misalignment of the proximal end of the clavicle.
• PP: The patient is supine.
• DP: Stand at the side of the table on the affected
side, facing cephalad.
• SCP: Posterosuperior aspect of the proximal
clavicle.
• CP: With your inside hand, apply the digital contact
of the index and middle fingers over the
posterosuperior aspect of the proximal clavicle.
• IH: Grasp the patient’s distal forearm with your
outer hand.
• VEC: P-A.
• P: With your IH, distract the shoulder anteriorly and
while maintaining distraction, flex the arm, raising it
past 90 degrees. As the articular slack is taken out,
use your contact hand to deliver a very quick and
shallow P-A impulse thrust to the proximal clavicle
(lifting the proximal clavicle).
Thenar/Distal Clavicle, Thenar/Manubrium; Long-Axis Distraction
• IND: Generalized decrease in movement of the sternoclavicular joint, and
displacement of the intraarticular meniscus.
• PP: The patient is supine, with a rolled towel or small cylindrical pillow placed under
the upper thoracic spine. The affected arm is abducted to approximately 90 degrees.
• DP: Stand on the affected side in a lunge position, facing cephalad.
• SCP: Distal clavicle.
• CP: With your outside hand, place a thenar contact over the distal clavicle and grasp
the deltoid area.
• IH: With your inside hand, place a thenar
contact over the manubrium of the sternum,
with the thumb pointing cephalad and the
fingers pointing laterally across the
contralateral clavicle.
• VEC: Distraction.
• P: With your IH, stabilize the patient’s
manubrium and opposite shoulder against
the table, applying a downward pressure. The
pillow or rolled towel serves as a fulcrum as
you apply a shallow impulse thrust to the distal clavicle and shoulder to distract the
proximal clavicle from the manubrium. Alternatively, the clinician can use crossed
arms, applying hypothenar knife-edge contacts on the clavicle and manubrium
Sitting: Reinforced Thenar/Proximal Clavicle; Inferior-to-Superior Glide
• IND: Loss of I-S accessory joint movement of the proximal clavicle, inferior
misalignment of the proximal clavicle.
• PP: The patient sits, with arms relaxed.
• DP: Stand behind the patient.
• SCP: Inferior aspect of the proximal clavicle.
• CP: With your contralateral hand, establish a
thenar contact on the inferior aspect of the
proximal clavicle.
• IH: With your ipsilateral hand, take a calcaneal
contact over the thenar contact for reinforcement.
• VEC: I-S.
• P: Stabilize the patient’s torso against the back of
the chair or your body. Deliver an impulse thrust
with both hands in an I-S direction.
Digital Proximal/Clavicle, Thenar/Manubrium; Long-Axis Distraction
• IND: Generalized decrease in movement of the sternoclavicular joint, and
displacement of the intra-articular meniscus.
• PP: The patient sits, with the affected arm abducted to approximately 90 degrees.
• DP: Stand behind the patient and slightly to the side of involvement.
• SCP: Proximal clavicle.
• CH: With your ipsilateral hand, reach under the patient’s affected arm to support the
patient’s arm on your forearm. Make digital contact with the index and middle fingers
on the proximal end of the clavicle.
• IH: With your contralateral hand, make a thenar contact over the manubrium of the
sternum, with the forearm lying across the contralateral clavicle.
• VEC: Distraction.
• P: With your IH, stabilize the
manubrium and opposite shoulder
girdle against the back of the chair or
your body while your contact hand
draws the affected clavicle medially to
laterally and your arm draws the
patient’s affected shoulder slightly
anteriorly to posteriorly. When articular
slack is removed, give a quick and
shallow impulse thrust, separating the
proximal clavicle from the manubrium.
Scapulocostal Articulation Side posture: Bilateral Thumb Thenar/Lateral Scapula; Lateral-toMedial Glide
• IND: Loss of L-M glide movement of the scapulocostal articulation, dysfunctional
scapulohumeral rhythm, subscapular adhesions.
• PP: The patient is in a side-lying position, with the affected side up and the arm
resting on the side.
• DP: Stand at the side of the table, facing
the patient.
• SCP: Lateral border of the scapula.
• CP: With both hands, establish a thumb,
thenar, and calcaneal contact over the
axillary (lateral) border of the scapula, with
the fingers pointing toward the spine.
• VEC: L-M.
• P: Draw the scapula laterally to medially,
and when the end of passive movement is
reached, give an L-M impulse thrust.
Crossed Bilateral Mid-Hypothenar (Knife-Edge)/Medial Scapula; Medial-to-Lateral Glide
• IND: Loss of medial-to-lateral glide movement of the scapulocostal articulation,
dysfunctional scapulohumeral rhythm, subscapular Adhesions
• PP: The patient is in a side-lying position, with the affected arm hanging forward in
front of the table.
• DP: Stand at the side of the table and to the front of the patient in a lunge position
(fencer stance), facing cephalad.
• SCP: Medial (vertebral) border of the scapula.
• CP: Use your caudal hand to apply a metacarpophalangeal (MP) (knife-edge) contact
over the vertebral (medial) border of the
affected scapula, with the fingers over
the spine and body of the scapula.
• IH: With your cephalic hand, establish a
calcaneal contact over the vertebral
border of the other scapula, with the
fingers over the body of the scapula.
• VEC: M-L.
• P: Use both hands in opposing directions
to draw passive movement medially to
laterally and administer an impulse thrust
primarily through the contact hand
medially to laterally.
Bimanual Digital Thenar Grasp/Scapula; Rotation—Inferior Angle Lateral to Medial
• IND: Loss of rotational movement of the scapulocostal articulation, dysfunctional
scapulohumeral rhythm, subscapular adhesions.
• PP: The patient is in a side-lying position, with the affected side up and the affected
arm placed behind the back, with the fist in the small of the back.
• DP: Stand at the side of the table, facing the patient.
• SCP: Lateral aspect of the inferior angle of the scapula.
• CP: With your caudal hand, apply a thenar contact on the lateral aspect of the inferior
angle of the scapula, with the
fingers lying across the scapula and
pointing toward the spine.
• IH: With your cephalic hand, place a
thenar contact on the superior
aspect of the spine of the scapula,
with the fingers pointing toward
the inferior angle.
• VEC: Rotational.
• P: Use both hands to induce a
rotational, twisting action, using an
impulse-type thrust to drive the
inferior angle of the scapula
laterally to medially.
Bimanual Digital Thenar Grasp/Scapula; Rotation—Inferior Angle Medial to Lateral
• IND: Loss of rotational movement of the scapulocostal articulation, dysfunctional
scapulohumeral rhythm, subscapular adhesions.
• PP: The patient is in a side-lying position, with the affected side up and the affected
arm abducted, with the hand behind the head.
• DP: Stand at the side of the table, facing the patient.
• SCP: Medial aspect of the inferior angle of the scapula.
• CH: With your caudal hand, establish a pisiform-hypothenar contact on the medial
aspect of the inferior angle of the scapula, with the fingers pointing toward the axilla.
• IH: With your cephalic hand, grasp
the spine of the scapula.
• VEC: Rotational.
• P: Use both hands to create a
rotational, twisting action, using an
impulse-type thrust to drive the
inferior angle medially to laterally.