Joint Mobilization

Joint Mobilization

THE UPPER EXTREMITY

Glenohumeral Joint

-Convex head of humerus on a proximal concave glenoid fossa of scapula.

A. Loose-packed position: 55 degs abduction, 30 degs horizontal adduction

B. Close-packed position: Full abduction and external rotation

C. Capsular pattern: External rotation, abduction, internal rotation

D. Glides: * Inferior glide to increase abduction * Anterior glide to improve extension and external rotation * Posterior glide to improve flexion and internal rotation

Acromioclavicular Joint

-Concave clavicle on convex acromion process.

A. Loose-packed position: Arm resting at side

B. Close-packed position: 90 degs of shoulder abduction

C. Capsular pattern: Maximal elevation * Anterior glide to improve overall joint mobility

Sternoclavicular Joint

-Convex clavicle on concave sternum superior and inferiorly; Concave clavicle on a convex sternum anterior and posteriorly.

A. Loose-packed position: Arm resting at side

B. Close-packed position: Shoulder maximally elevated

C. Capsular pattern: Maximal elevation * Superior glide to increase depression * Inferior glide to increase elevation * Anterior glide to increase protraction * Posterior glide to increase retraction

Scapulothoracic Joint

-Not a true joint but permits scapular motions of retraction, protraction, elevation, depression, tipping, and winging. * Postion patient in side-lying and perform scapular movements to increase scapular mobility.

Humeroulnar Joint

-Concave olecranon fossa of humerus on a convex humerus.

A. Loose-packed position: 70 degs elbow flexion, 10 degs supination

B. Close-packed position: Full elbow extension and supination

C. Capsular pattern: Elbow flexion then extension * Distal glide to increase elbow flexion

Humeroradial Joint

-Concave radial head on a convex humerus

A. Loose-packed position: Full elbow extension and supination

B. Close-packed position: 90 degs flexion, 5 degs supination

C. Capsular pattern: Flexion then extension * Dorsal glide to increase extension * Ventral glide to increase flexion

Proximal radioulnar joint

-Convex radial head on a concave ulna.

A. Loose-packed position: 70 degs flexion, 35 degs supination

B. Close-packed position: Full extension, 5 degs supination

C. Capsular pattern: Elbow supination and pronation equally limited * Dorsal glide to increase pronation * Ventral glide to increase supination

Distal Radioulnar Joint

-Concave radius on a convex ulna.

A. Loose-packed position: 10 degs supination

B. Close-packed position: 5 degs supination

C. Capsular pattern: Supination and pronation equally limited * Dorsal glide to increase supination * Ventral glide to increase pronation

Radiocarpal Joint

-Convex proximal carpal row on concave radius and ulna

-Proximal carpal row is made up of the scaphoid, lunate, triquetrum

-Distal carpal row is made up of the trapezium, trapezoid, capitate, and hamate.

A. Loose-packed position: Slight ulnar deviation

B. Close-packed position: Full wrist extension and radial deviation

C. Capsular pattern: Wrist flexion and extension equally limited * Ventral glise to increase wrist extension * Dorsal glide to increase wrist flexion * Radial glide to increase ulnar deviation * Ulnar deviation to increase radial deviation

-Scaphoid convex on a concave radius * Glide radius on fixed scaphoid ventrally to increase flexion * Glide scaphoid on a fixed radius ventrally to increase extension

-Lunate convex on a concave radius * Glide radius on a fixed lunate ventrally to increase flexion

-Scaphoid convex on concave trapezii

-Capitate convex on concave lunate

Carpometacarpal, Metacarpophalangeal, and Interphalangeal Joints of fingers 2-5

-All are concave on a convex proxiaml surface

A. Loose-packed position: CMC=midway between all ranges; MCP=slight flexion with ulnar deviation; PIP=10 degs flexion; DIP=30 degs flexion