Comprehensive Upper Extremity Range of Motion Techniques

 

Upper Extremity

Shoulder. Flexion and Extension

Placement of the Hand and Process

Using your lower hand, grasp the patient's arm just below the elbow.
Cross over and take hold of the patient's wrist and palm with the top hand.
Raise the arm to the maximum extent and lower it back.

NOTE:

When the shoulder flexes in normal motion, the scapula should be free to rotate upward. When the glenohumeral joint alone needs to move, the scapula is stable.

Shoulder. Extension (Hyperextension)

Place the patient's shoulder to the edge of the bed while they are supine, or place them side-lying, prone, or sitting to achieve extension past zero.

Shoulder: Abduction and Adduction

Placement of the Hand and Process
Move the arm out to the side while maintaining the same hand positioning as with flexion. To facilitate finishing the arc of motion, the elbow can be flexed.

NOTE:

The scapula must rotate upward and the humerus must rotate externally for the whole range of abduction.

Shoulder: Internal (Medial) and External (Lateral) Rotation

The elbow should be flexed to 90°, the arm should be abducted to 90°, and the forearm should be maintained in a neutral position. While the patient's arm can be rotated to the side of the thorax, complete internal rotation is not achievable in this posture.

Hand Placement and Procedure

With your index finger between the patient's thumb and index finger, hold their hand and wrist.
To stabilize the patient's wrist, place your thumb and the remaining digits on either side of the wrist.
Stabilize the elbow with the opposite hand.
Move the forearm in a manner similar to a wheel's spokes to rotate the humerus.

Shoulder: Horizontal Abduction (Extension) and Adduction (Flexion)

The patient's shoulder should be positioned at the table's edge to achieve complete horizontal abduction. Start with the arm at a 90° adduction or abduction.

Hand Placement and Procedure

The same hand positioning applies as with flexion; however, when you move the patient's arm out to the side and then across the body, turn your body to face the patient's head.

Scapula: Elevation/Depression, Protraction/ Retraction, and Upward/Downward Rotation

The patient should be in the prone position, with their arm to the side or side-lying facing you and their arm draping over your lower arm.

Hand Placement and Procedure

Put one hand around the inferior angle of the scapula and cup the top hand over the acromion process. When the scapular motions are aimed at the acromion process, the clavicle also moves for elevation, depression, protraction, and retraction.To produce a force pair turning action during rotation, aim the scapular motions at the inferior angle of the scapula while concurrently pushing the acromion in the opposite direction.

Elbow: Flexion and Extension

Hand Placement and Procedure

With one hand, support the wrist by grabbing the distal forearm. This hand also regulates pronation and supination of the forearm.

Hold the elbow in place with the other hand.

With the forearm both pronated and supinated, flex and extend the elbow.

NOTE:

When the elbow extends, the scapula should not lean forward because this will obscure the actual range.

Stretching of the Two-Joint Biceps Brachii Muscle

If the patient is supine, place their shoulder at the edge of the table; if they are sitting, standing, or lying prone, place their shoulder at zero.

Hand Placement and Procedure

Firstly, extend the elbow while supporting the patient's forearm and pronate it by holding their wrist. Next, stretch (hyperextend) the shoulder until it reaches the anterior arm region's point of tissue resistance. This is the point at which the two-joint muscle has reached its maximum length.

Elongation of Two-Joint Long Head of the Triceps Brachii Muscle

The patient can only access the entire range of motion (ROM) of the triceps brachii muscle when they are seated or standing. For ROM, the supine position can be used, although there will be a noticeable restriction in muscular range.

Hand Placement and Procedure

First, place one hand on the patient's distal forearm and fully flex their elbow.

Next, lift up on the humerus with the other hand beneath the elbow to flex the shoulder.

When posterior arm region pain is felt, the full range of motion is attained.

Forearm: Pronation and Supination

Hand Placement and Procedure

Elbow flexion and extension are both used in pronation and supination. Stabilize the elbow to stop the shoulder from rotating when the elbow is stretched.

Taking hold of the patient's wrist, place the thumb and remaining fingers on either side of the distal forearm, using the index finger to support the hand.

Using the other hand, steady the elbow.

At the distal radius, there is a rolling of the radius around the ulna.

Alternate Hand Placement

Place both hands' palms over the patient's distal forearm.

PRECAUTION:

Instead of twisting your hand to strain your wrist, move your radius around your ulna to manage your pronation and supination motions.

Wrist: Ulnar (Adduction) and Radial (Abduction); Flexion (Palmar Flexion) and Extension (Dorsiflexion) Disturbance

Hand Placement and Procedure

Using one hand to hold the patient's hand slightly distal to the joint while using the other to brace the forearm, do all wrist motions.

NOTE:

If tension is applied to the tendons as they pass into the fingers, the range of the extrinsic muscles to the fingers will impact the range at the wrist. Let your fingers move freely while you move your wrist to achieve the maximum range of motion in your wrist joint.

Hand: Cupping and Flattening the Arch of the Hand at the Carpometacarpal and Intermetacarpal Joints

Hand Placement and Procedure

Face the patient; position your thenar eminences on the posterior aspect of the patient's hand and both of your fingers in its palms. To increase the arch and flatten it, roll the metacarpals palmar ward and dorsal ward.

Alternate Hand Placement

The patient's hand is put on the back, with the thumb and fingers cupping the metacarpals joint.

Joints of the Thumb and Fingers: Flexion and Extension and Abduction and Adduction

The metacarpophalangeal and interphalangeal joints are among the joints found in the thumbs and fingers.

Hand Placement and Procedure

Stabilize the patient's forearm and hand against your body or on the bed or table, depending on their posture. Utilizing the index and thumb fingers of one hand to stabilize the proximal bone and the index and thumb fingers of the other hand to move the distal bone, move each patient's hand joint separately.

Alternate Procedure

Joints can move in multiple directions at once if adequate stability is offered.

Example:

With one hand, support the metacarpals and move all of the proximal phalanges to move all of the metacarpophalangeal joints of digits 2 through 5.

NOTE:

Avoid straining the extrinsic muscles that supply the fingers in order to achieve complete joint range of motion. By adjusting the wrist position while the fingers are moved, tension in the muscles can be released.

Elongation of Extrinsic Muscles of the Wrist and Hand: Flexor and Extensor Digitorum Muscles

General Technique Hand Placement and Procedure

Prior to moving the proximal interphalangeal joint, move and stabilize the distal interphalangeal joint. Place the metacarpophalangeal joint at the end of its range after holding both of these joints at their limits. Start extending the wrist after stabilizing each finger joint. The muscles are fully extended when the patient experiences forearm pain.

NOTE:

To reduce compression on the small joints, movement is started in the distalmost joint of each digit. When the extrinsic muscles are stretched, full range of motion cannot be achieved in the joints.