CHIR2104 Chiropractic Sciences 4
Week 7a: AC/SC Joint Assessment & Interventions
Michael Swain
Laura Montgomery
michael.swain@mq.edu.au
laura.montgomery@mq.edu.au
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Well-being & information
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“The new normal: the skills you need to stay emotionally strong”
o Stay informed - with the right information!
o Understand history and the course of previous infectious diseases
o Be active, keep exercising
o Balance your thoughts, stay realistic
o Disconnect from all the ‘noise’
o Be kind to yourself!
o Keep looking forward
Professor Nick Titov
https://lighthouse.mq.edu.au/article/march/The-new-normal-the-skills-you-need-to-stay-emotionally-strong
https://mindspot.org.au/assets/pdf/10_Tips_for_Coping_with_Infectious_Diseases.pdf
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1pm-2pm Tutorial
3pm-4pm Tutorial
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LINK TO TUTORIAL QUIZ
Week 7 Tuesday | SC/AC joints
Physical Exam
Observation
Special Test/s
Static Palpation
Sternoclavicular/Acromioclavicular joints: Static palpation
Active RoM
Passive RoM
Sternoclavicular (SC) joint: Motion palpation series
Acromioclavicular (AC) joint: Motion palpation series
Motion Palpation
Muscle Test/s
Diagnosis/Ddx
Management Plan
Manual Techniques
Soft tissue work
Joint Mobilisation
SC: Supine arm raised I Inferior thrust
SC: Supine arm traction I Posterior thrust
AC: Supine, arm raised I Inferior thrust
AC: Sitting inferior pressure I Humeral circumduction
Joint Manipulation
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Section 1
STATIC PALPATION
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Static Palpation | Sternoclavicular joint
Physical Exam
Static Palpation
Bones
Clavicle: Superior, medial & inferior borders
Sternum: Jugular (suprasternal) notch, manubrium sternal angle
1st & 2nd costal cartilage
Ligaments
Anterior sternoclavicular ligament, Costoclavicular ligament,
Interclavicular ligament, Articular disc
Muscles
Sternocleidomastoid, Pectoralis major, Platysma, Subclavius
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Static Palpation | Acromioclavicular joint
Physical Exam
Static Palpation
Bones
Clavicle: Joint space
Scapular: Acromion, Coracoid process
Ligaments
Coracoclavicular, Coracoacromial, Acromioclavicular, Coracohumeral
Muscles
Short head biceps, Upper trapezius, Supraspinatus, Deltoid
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Muscles
AC/SC joints
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Section 2
MOTION PALPATION
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SC joint motion palpation | Elevation & depression
Physical Exam
Motion Palpation
1° Contact
Patient Position:
Sitting
Practitioner Position:
Standing directly behind the patient
Primary Contact:
Contralateral, (opposite) hand palpates the sternoclavicular joint by
approaching from the contralateral side
Secondary Contact:
Homolateral hand grasps the patient's homolateral elbow which is flexed to 90°
and lies by the patient's side
Motion Palpation:
The secondary contact raises and lowers the elbow in a vertical direction along
the line of the humerus. The primary contact feels for joint movement
2° Contact
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SC joint motion palpation | Protraction & retraction
Physical Exam
Motion Palpation
Patient Position:
Sitting
Practitioner Position:
Standing directly behind the patient
Primary Contact:
Contralateral, (opposite) hand palpates the sternoclavicular joint by approaching
from the contralateral side
Secondary Contact:
Homolateral hand grasps the patient's homolateral elbow which is flexed to 90°
and the glenohumeral joint is abducted to 90°
Motion Palpation:
The secondary contact horizontally abducts and adducts the G/H joint (within the
transverse plane). The primary contact feels for joint movement.
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Acromioclavicular joint | Motion Palpation
Physical Exam
Motion Palpation
Patient Position:
Supine
Practitioner Position:
Standing on the homolateral side of the couch facing cephalad
Contacts:
Bilateral index and third finger contacts on the distal superior surface of the clavicle
and bilateral thumb contacts on the distal inferior aspect of the clavicle.
Alternatively, the index finger of the outside hand palpates over the
acromioclavicular joint
Motion Palpation:
The contacts produce a superior-posterior to inferior-anterior glide of the clavicle
whilst feeling for joint movement
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Section 3
CHIROPRACTIC TECHNIQUE
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Sternoclavicular: supine arm raised | Inferior thrust
Management Plan
Manual Techniques
Joint Manipulation
Mechanics:
Clinical Indications:
Static: Apparent superior shift of the clavicle relative to the sternum
Motion: sternoclavicular joint restriction with elevation of the clavicle, (decrease
inferior movement of medial clavicle)
Soft tissue: prominence and adhesions of sternoclavicular ligaments and joint tissue
capsule superior to the sternoclavicular joint
Clinical Effects:
Direct pressure from the practitioners primary contact creates an inferior pressure
on the medial articulatory surface of the clavicle. This is taken into a more locked
position via elevation of the patients arm which increases the inferior pressure on
the medial clavicle. The sternoclavicular joint is then adjusted with a superior to
inferior shear motion
Patients Position:
Supine, with the head resting near the top of the couch
Practitioners Position:
Supine or crouching at the head of the couch facing caudad
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Sternoclavicular: supine arm raised | Inferior thrust
Management Plan
Manual Techniques
Joint Manipulation
Primacy Contacts:
Hypothenar contact of the pronated opposite hand on the superior edge of the
clavicle just lateral to the sternoclavicular joint
Secondary Contact:
The outer or analogous hand reaches over the top of the patients arm and uses a
palmar grip on the homolateral humerus distally
Pre-adjustment Position:
The primary contact applies inferior pressure with the wrist extended. The fingers
point directly inferiorly and the forearm lies nearly horizontal. Whilst inferior pressure
is maintained via the primary contact, the secondary contact abducts the patients
homolateral arm to a comfortably elevated position. No traction is applied through
the secondary contact
Adjustment:
A sharp non-recoil thrust with the primary contact in an inferior direction while the
secondary contact maintains a counteracting pressure. It is not a scissor action with
the secondary contact
16
https://echo360.org.au/media/b578ca9c-e6b7-48ed-8354-59216f6c173b/public
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Sternoclavicular: supine arm traction | Posterior thrust
Management Plan
Manual Techniques
Joint Manipulation
Mechanics:
Clinical Indications:
Static: Apparent anterior shift of the clavicle relative to the sternum
Motion: Restriction with protraction of the clavicle
Soft-tissue prominence and adhesions of sternoclavicular ligaments and joint
capsule anterior to sternoclavicular joint
Clinical Effects:
Long axis traction is created at the sternoclavicular joint. This is maintained as direct
posterior pressure is applied to the medial clavicle and so creating an anterior to
posterior shear at the joint as well as stretching anterior and posterior ligamentous
and joint capsule structures
Patient Position:
Supine, lying near the homolateral edge of the couch
Practitioner Position:
Standing on the homolateral side of the patient at the level of the thorax and facing
cephalad
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Sternoclavicular: supine arm traction | Posterior thrust
Management Plan
Manual Techniques
Joint Manipulation
Primary Contact:
Hypothenar contact of the inner hand on the anterior surface of the clavicle just
lateral the sternoclavicular joint. The wrist is extended and the fingers point superlaterally
Secondary Contact:
The outer hand uses a palmar grip on the homolateral humerus distally
Pre-adjustment position:
The practitioner stands close to the patients axilla, keeping the patients arm close to
the practitioners outer thigh. Traction is applied to the arm by the practitioner rotating
their body outwards whilst maintaining a firm grip of the arm. The primary contact
then applies light posterior pressure with the practitioners arm remaining straight
Adjustment:
A firm, non-recoil thrust in a posterior direction by the primary contact while the
secondary contact maintains forced distraction of the arm
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https://echo360.org.au/media/aae3eda4-45e3-4f2d-961f-f3bcbe420084/public
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Acromioclavicular: supine arm raised | Inferior thrust
Management Plan
Manual Techniques
Joint Manipulation
Mechanics:
Clinical Indications:
Static: Apparent superior shift of clavicle relative to acromion
Motion: Acromioclavicular joint restriction with inferior glide restriction of clavicle
Soft-tissue: Adhesions of ligaments and joint capsule superior to the
acromioclavicular joint
Clinical Effects:
Direct inferior pressure on the lateral aspect of the clavicle creates a superior to
inferior shear at the acromioclavicular joint. Elevation of the patients homolateral
arm maximises the inferior shear of the laterally articulating clavicle
Patient Position:
Supine, with the head resting near the top of the couch
Practitioner Position:
Sitting or crouching at the head of the couch facing caudad
Primary Contact:
Crooked thenar contact of the inner (opposite) hand on the superior edge of the
clavicle medial to the acromioclavicular joint
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Acromioclavicular: supine arm raised | Inferior thrust
Management Plan
Manual Techniques
Joint Manipulation
Secondary Contact:
The outer hand (analogous) reaching over the top of the patients arm with a palmar
grip on the homolateral humerus distally
Pre-adjustment Position:
The primary contact applies inferior pressure with the wrist extended. The fingers
point directly inferiorly and the forearm lies nearly horizontal. Whilst inferior
pressure is maintained via the primary contact, the secondary contact abducts the
patients homolateral arm to a comfortably elevated position. No traction is applied
through the secondary contact
Adjustments:
A sharp non-recoil thrust with the primary contact in an inferior direction while the
secondary contact maintains a counteracting pressure. It is not a scissor action with
the secondary contact
22
https://echo360.org.au/media/a59bafd5-54d9-4f3e-aff9-ba2c6cb32fec/public
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Acromioclavicular: sitting inferior pressure | Humeral circumduction
Management Plan
Manual Techniques
Joint Mobilisation
Mechanics:
Clinical Indications:
Static: Apparent superior shift of clavicle relative to acromion
Motion: Acromioclavicular joint restriction with inferior glide restriction of clavicle
Soft-tissue: Adhesions of ligaments and joint capsule superior to the
acromioclavicular joint
Clinical Effects:
Direct inferior pressure on the lateral aspect of the clavicle creates a superior to
inferior shear at the acromioclavicular joint. Elevation of the patients homolateral
arm maximises the inferior shear of the laterally articulating clavicle
Patient Position:
Supine, with the head resting near the top of the couch
Practitioner Position:
Sitting or crouching at the head of the couch facing caudad
Primary Contact:
Crooked thenar contact of the inner (opposite) hand on the superior edge of the
clavicle medial to the acromioclavicular joint
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Acromioclavicular: sitting inferior pressure | Humeral circumduction
Management Plan
Manual Techniques
Joint Mobilisation
Secondary Contact:
Palmar contact of the analogous (outer) hand grips under the homolateral humerus
distally
Pre-adjustment Position:
Pressure is applied directly inferior by the primary contact. The secondary contact
raises the homolateral humerus by 60 °. The forearm is allowed to hang naturally
Adjustment:
A firm inferior pressure is maintained by the primary contact while the secondary
contact repeatedly circumducts the humerus in a backstroke direction. The
circumduction starts small and then gradually increases in size making sure, as they
get larger, that the arm is raised above the horizontal at the upper limit of the
movements
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https://echo360.org.au/media/a689ed8f-9da3-4422-8b67-dde1b5d27c83/public
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References
Manual of Spinal Technique, Esposito & Philipson - 1st Ed. March 2005
Oatis, Carol A. Kinesiology: the mechanics and pathomechanics of human movement. 2nd Edition. Baltimore: Lippincott
Williams & Wilkins, 2009.
Magee D.J. (2008). Orthopaedic Physical Assessment. 5th Edition. W.D Saunders, Philadelphia
Manual of Spinal Technique, Esposito & Philipson - 1st Ed. March 2005
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Thank you
END