743 UE Accessory Motion

open pack position for glenohumeral joint

55° abduction, 30° horizontal adduction

closed pack position for glenohumeral joint

abduction with full lateral rotation

open pack position for sternoclavicular

anatomical position

closed pack position for sternoclavicular

maximum shoulder elevation

open pack position for acromioclavicular

anatomical position

closed pack position for acromioclavicular

abduction 90°

open pack position for elbow: humeroulnar

70° flexion, 10° supination

closed pack position for elbow: humeroulnar

extension

open pack position for elbow:humeroradial

full extension, full supination

closed pack position for elbow: humeroradial

90° flexion, 5° supination

openpack position for elbow: proximal radioulnar

70° flexion, 35° supination

closed pack position for elbow: proximal radioulnar

5° supination

open pack position for wrist: distal radioulnar

10° supination

closed pack position for wrist: distal radioulnar

5° supination

open pack position for wrist: radiocarpal

neutral with slight ulnar deviation

closed pack position for wrist: radiocarpal

full extension with radial deviation

open pack position for wrist: intercarpal

neutral

closed pack position for wrist: intercarpal

full extension

glenohumeral anterior to posterior (AP) glide hand placement

stabilizing hand: inferior hand supports arm at the elbow

mobilizing hand: thenar eminence contacts humeral head

glenohumeral anterior to posterior (AP) glide direction of force

posterior glide of the humeral head on the glenoid

glenohumeral anterior to posterior (AP) glide associated physiologic motion

flexion, medial rotation, horizontal adduction

scapulothoracic abduction/protraction direction of force

lateral (towards PT) glide of the scapula on the thorax

scapulothoracic abduction/protraction associated physiologic motion

potentially all motions, necessary for arm elevation

scapulothoracic adduction/retraction direction of force

medial (towards table) glide of the scapula on the thorax, using your trunk and upper extremities

scapulothoracic adduction/retraction associated physiologic motion

potentially all motions, necessary for shoulder extension

scapulothoracic elevation direction of force

superior glide (towards the head) of the scapula on the thorax

scapulothoracic depression direction of force

inferior glide (towards the feet) of the scapula on the thorax

scapulothoracic elevation and depression associated physiologic motion

potentially all motion

scapulothoracic upward rotation direction of force

inferior angle of scapula up towards ceiling

scapulothoracic downward rotation direction of force

inferior angle of scapula down towards the floor

scapulothoracic upward and downward rotation associated physiologic motion

potentially all motions, upward rotation particularly important for any arm elevation

humeroradial joint anterior to posterior (AP) glide hand placements

stabilizing hand: towel stabilizes humerus, inferior hand supports wrist

mobilizing hand: superior hand thenar eminence contacts anterior radial head

humeroradial joint anterior to posterior (AP) glide direction of force

posterior glide of radius on humerus

humeroradial joint anterior to posterior (AP) glide associated physiologic motions

extension, supination

humeroradial joint posterior to anterior (PA) glide hand placement

stabilizing hand: superior hand holds the patients distal humerus

mobilizing hand: inferior hand thumb contacts posterior radial head, fingers rest on anterior radial head

humeroradial joint posterior to anterior (PA) glide direction of force

anterior glide of the radius on humerus

humeroradial joint posterior to anterior (PA) glide associated physiologic motions

flexion, pronation

humeroulnar joint anterior to posterior (AP) glide hand placement

stabilizing hand: superior hand grasps distal humerus

mobilizing hand: inferior hand thenar eminence on posterior* proximal ulna

humeroulnar joint anterior to posterior (AP) glide direction of force

posterior (perpendicular to ulna) glide of ulna on distal humerus

humeroulnar joint anterior to posterior (AP) glide associated physiologic motion

extension

humeroulnar joint posterior to anterior (PA) glide hand placement

stabilizing hand: superior hand grasps distal humerus

mobilizing hand: inferior hand thenar eminence on posterior proximal ulna, fingers wrap around to anterior proximal ulna

humeroulnar joint posterior to anterior (PA) glide direction of force

anterior (perpendicular to ulna) glide of the ulna on the humerus

humeroulnar joint posterior to anterior (PA) glide associated physiologic motion

flexion

radiocarpal joint distraction glide hand placement

stabilizing hand: superior hand holds proximal radius and ulna

mobilizing hand: inferior hand grasps around proximal carpal row

radiocarpal joint distraction glide direction of force

distraction of carpal bones from radius

radiocarpal joint distraction glide associated physiologic motions

all motions

radiocarpal joint anterior to posterior (AP) glide hand placement

stabilizing hand: superior hand grasps posterior distal ulna and radius (close to joint line)

mobilizing hand: inferior hand grasps proximal row of carpal bones; palm to palm

radiocarpal joint anterior to posterior (AP) glide direction of force

posterior glide of proximal carpal row on radius

radiocarpal joint anterior to posterior (AP) glide associated physiologic motion

flexion

radiocarpal joint posterior to anterior (PA) glide hand placement

stabilizing hand: superior hand grasps anterior distal ulna and radius

mobilizing hand: inferior hand grasps proximal row of carpal bones; palm to dorsum

radiocarpal joint posterior to anterior (PA) glide direction of force

anterior glide of proximal carpal row on radius

radiocarpal joint posterior to anterior (PA) glide associated physiologic motion

extension

indications for assessing accessory motion/joint play

• limited active or passive physiologic motion

• excessive physiologic motion

• normal physiologic motion with abnormal end feel

• pain with motion

• patient perceived stiffness in a joint

• poor joint mechanics are observed

contraindications/precautions for joint accessory motion assessment

• evidence of vascular compromise or insufficiency

• patient on blood thinners including aspirin

• evidence of instability such as fracture or dislocation

• patient with acute nerve issues

• evidence of decreased bone density, such as osteoporosis

• caution with children

• any condition that is worsening