‌

Other upper limb treatments

‌‌
‌‌
‌
‌
‌‌‌‌‌‌‌‌‌‌

Notes

Upper limb

Other upper limb treatments

Author: Arman Israelyan, OMS-III
Editor: Matt Lipinski, DO
Editor: Robyn Hughes, MScBMC
Below are several techniques that are less commonly taught at osteopathic schools and / or rarely tested on the COMLEX® exams. These lists are not fully inclusive but are meant to highlight some of the most common or useful applications of each technique. The exception to this is the Spencer technique of the shoulder, which is frequently used in practice and tested on examinations.
ARTICULATORY
The Spencer technique is the most common articulatory technique of the upper limb. Please see the “Upper limb muscle energy treatment” learn page for details on the Spencer technique.
BALANCED LIGAMENTOUS TENSION

Glenohumeral restriction (e.g., adhesive capsulitis)

  1. With the patient in the lateral recumbent position with the dysfunctional shoulder facing up, stand behind the patient
  2. With your caudad hand, grasp the olecranon process of the patient’s gently flexed elbow
  3. With your cephalad hand, grasp the patient’s shoulder
  4. Add gentle compression through the olecranon toward the glenoid fossa, then gently flex and extend the shoulder to find a balanced tension
  5. While maintaining gentle compression through the olecranon, gently abduct and adduct the shoulder to find a balanced tension
  6. Once a point of total balance is achieved, hold this position until a release is palpated
SOFT TISSUE

Levator scapulae hypertonicity, direct inhibition emphasis

  1. Stand behind the seated patient on the side of their dysfunction
  2. Locate the inferior portion of the levator scapulae near the superomedial border of the scapula
  3. Place your thumb or olecranon process at the musculotendinous portion of the muscle, immediately cephalad to its insertion on the scapula
  4. Start with a gentle, perpendicular pressure and meet the barrier by altering your force inferiorly, medially or laterally
  5. Maintain a steady pressure until a release is palpated

Teres minor hypertonicity, direct inhibition emphasis

  1. With the patient in the lateral recumbent position with the dysfunctional side up, stand behind the patient
  2. Locate the teres minor at the posterior axillary fold
  3. Place both thumb pads parallel to the teres minor at the point of maximum hypertonicity
  4. Maintain a steady pressure superiorly, medially, and slightly anteriorly until a release is palpated

Midhumeral contralateral traction

Right-sided example
  1. With the patient lying supine and the right arm abducted to 60–90º, stand at their right side, facing their axilla
  2. Place your right palm over the humerus (near the deltoid insertion) and grasp the patient’s right forearm / wrist with your left hand
  3. Flex the patient’s elbow and slowly externally rotate their upper limb while compressing the insertion of the deltoid muscle
  4. Once the restrictive fascial barrier is met, slowly release the tension by internally rotating the patient’s shoulder to relax the compression on the right humerus
  5. Repeat steps three and four in a slow, rhythmic fashion for up to 2–5 minutes