JOINT MOBILIZATION :

UPPER EXTREMITY

Prepared by :
DR. RICHA MAHAJAN (PT)
GLENOHUMERAL JOINT

Resting position : Shoulder is abducted 55o , horizontally adducted 30o and externally rotated
so that the forearm is in horizontal plane.

Treatment plane : In the glenoid fossa and moves with the scapula.

Stabilization : Fixate the scapula with a belt or have an assistant.

Glenohumeral Joint Traction / Distraction

Subject Position : Supine, with arm in the resting position. Support the forearm between
your trunk and elbow.
Hand Placement : Use the hand nearer the part being treated and place it in the subjects
axilla with your thumb just distal to the joint margin anteriorly and fingers posteriorly.
Your other hand supports the humerus from the lateral surface.
Mobilizing Force : With the hand in the axilla, move the humerus laterally.

Glenohumeral Caudal Glide

Subject Position : Supine, with arm in the resting position. Support the forearm between
your trunk and elbow.
Hand Placement : Place one hand in the subjects axilla to provide a grade I
distractqion. The web space of your other hand is placed just distal to the acromion
process.
Mobilizing Force : With the superiorly placed hand, glide the humerus in an inferior
direction.
Glenohumeral Posterior Glide

Subject Position : Supine, with the arm in resting position.

Therapist Position and Hand Placement : Stand with your back to the subject,
between the subjects trunk and arm. Support the arm against your trunk, grasping the
distal humerus with your lateral hand. This position provides grade I distraction to the
joint. Place the lateral border of your top hand just distal to the anterior margin of the
joint, with your fingers pointing superiorly. This hand gives the mobilizing force.
Mobilizing Force : Glide the humeral head posteriorly by moving the entire arm as you
bend your knees.
Glenohumeral Anterior Glide

Subject Position : Supine, with the arm in resting position over the edge of treatment
table.
Therapist Position and Hand Placement : Stand facing the top of the table with the leg
closer to the table in a forward stride position. Support the subjects arm against your
thigh with your outside hand; the arm positioned on your thigh provides a grade I
distraction. Place the ulnar border of your other hand just distal to the posterior angle of
the acromion process, with your fingers pointing superiorly; this hand gives the
mobilizing force.
Mobilizing Force : Glide the humeral head in an anterior and slightly medial direction.
Bend both knees so the entire arm moves anteriorly.

ELBOW AND FOREARM COMPLEX

HUMEROULNAR JOINT

Resting Position : Elbow is flexed 70o, and forearm is supinated 10o.

Treatment Plane : The treatment plane is in the olecranon fossa, angled approximately 45o
from the long axis of the ulna

Stabilization : Fixate the humerus against the treatment table with a belt or use an assistant
to hold it. The subject may roll onto his or her side and fixate the humerus with the
contralateral hand if muscle relaxation can be maintained around the elbow joint being
mobilized.
Humeroulnar Distraction
Subject Position : Supine, with the elbow over the edge of the treatment table or
supported with padding just proximal to the olecranon process. Rest the subjects wrist
against your shoulder, allowing the elbow to be in resting position for the initial
treatment.
Hand Placement : Place the fingers of your medial hand over the proximal ulna on the
volar surface; reinforce it with your other hand.
Mobilizing Force : Force against the proximal ulna at a 45o angle to the shaft of the bone.

Humeroulnar Distal Glide

Subject Position : Supine, with the elbow over the edge of the treatment table. Begin
with the elbow in resting position. Progress by positioning it at the end range of flexion.
Hand placement : Place the fingers of your medial hand over the proximal ulna on the
volar surface; reinforce it with your other hand.
Mobilizing Force : First apply a distraction force to the joint at a 45o angle to the ulna,
then while maintaining the distraction, direct the force in a distal direction.
Humeroulnar Radial Glide
Subject Position : Side-lying on the arm to be mobilized, with the shoulder laterally
rotated and the humerus supported on the table. Begin with the elbow in resting position;
progress to end-range flexion.
Hand Placement : Place the base of your proximal hand just distal to the elbow; support
the distal forearm with your other hand.
Mobilizing Force : Force against the ulna in a radial direction.

Humeroulnar Ulnar Glide

Subject Position : Same as for radial glide except a block or wedge is placed under the
proximal forearm for stabilization (using distal stabilization). Initially, the elbow is
placed in resting position and is progressed to end-range extension.
Mobilizing Force : Force against the distal humerus in a radial direction, causing the
ulna to glide ulnarly.

HUMERORADIAL JOINT

Resting Position : Elbow is extended, and forearm is supinated to the end of the available
range.

Treatment Plane : The treatment plane is in the concave radial head perpendicular
to the long axis of the radius.

Stabilization : Fixate the humerus with one of your hands.

Humeroradial Distraction
Subject Position : Supine or sitting, with the arm resting on the treatment table.
Therapist Position and Hand Placement : Position yourself on the ulnar side of the
subjects forearm so you are between the subjects hip and upper extremity. Stabilize the
subjects humerus with your superior hand. Grasp around the distal radius with the fingers
and thenar eminence of your inferior hand. Be sure your are not grasping around the distal
ulna.
Mobilizing Force : Pull the radius distally (long-axis traction causes joint traction).
Humeroradial Dorsal / Volar Glides
Subject Position : Supine or sitting with the elbow extended and supinated to the end of
the available range.
Hand Placement : Stabilize the humerus with your hand that is on the medial side of the
subjects arm. Place the palmar surface of your lateral hand on the volar aspect and your
fingers on the dorsal aspect of the radial head.
Mobilizing Force : Move the radial head dorsally with the palm of your hand or volarly
with your fingers.

Humeroradial Compression
Subject Position : Sitting or supine.
Hand Placement : Approach the subject right hand to right hand, or left hand to left hand.
Place your thenar eminence against the subjects thenar eminence (locking thumbs).
Mobilizing Force : Simultaneously, extend the subjects wrist, push against the thenar
eminence, and compress the long axis of the radius while supinating the forearm.
PROXIMAL RADIOULNAR JOINT

Resting Position : The elbow is flexed 70o and the forearm supinated 35o.

Treatment Plane : The treatment plane is in the radial notch of the ulna, parallel to the long
axis of the ulna.

Stabilization : Proximal ulna.

Dorsal/Volar Glides
Subject Position : Sitting or supine, with the elbow and forearm in resting position.
Progress by placing the forearm at the limit of the range of pronation prior to
administering the dorsal glide or at the limit of the range of supination prior to
administering the volar glide.
Hand Placement : Fixate the ulna with your medial hand around the medial aspect of the
forearm. Place your other hand around the head of the radius with the fingers on the volar
surface and the palm on the dorsal surface.
Mobilizing Force : Force the radial head volarly by pushing with your palm or dorsally by
pulling with your fingers.

DISTAL RADIOULNAR JOINT

Resting Position : The resting position is with the forearm supinated 10o.

Treatment Plane : The treatment plane is the articulating surface of the radius, parallel to the
long axis of the radius.

Stabilization : Distal ulna.

Dorsal/Volar Glides
Subject Position : Sitting, with the forearm on the treatment table. Begin in the resting
position and progress to end-range pronation or supination.
Hand Placement : Stabilize the distal ulna by placing the fingers of one hand on the dorsal
surface and the thenar eminence and thumb on the volar surface. Place your other hand in
the same manner around the distal radius.
Mobilizing Force : Glide the distal radius dorsally or volarly parallel to the ulna.

WRIST COMPLEX

RADIOCARPAL JOINT

Resting Position : The resting position is a straight line through the radius and third
metacarpal with slight ulnar deviation.

Treatment Plane : The treatment plane is in the articulating surface of the

radius perpendicular to the long axis of the radius.

Stabilization : Distal radius and ulna.

Radiocarpal Distraction
Subject Position : Sitting, with the forearm supported on the treatment table, wrist over
the edge of the table.
Hand Placement : With the hand closest to the subject, grasp around the styloid processes
and fixate the radius and ulna against the table. Grasp around the distal row of carpals
with your other hand.
Mobilizing Force : Pull in a distal direction with respect to the arm.
Radiocarpal Joint General Glides
Dorsal glide to increase flexion ; volar glide to increase extension ; radial glide to increase
ulnar deviation; ulnar glide to increase radial deviation.
Subject Position and Hand Placement : Sitting with forearm resting on the table in
pronation for the dorsal and volar techniques and in mid-range position for the radial and
ulnar techniques.
Mobilizing Force : The mobilizing force comes from the hand around the distal row of
carpals.
Progression : Progress by moving the wrist to the end of the available range and glide in
the defined direction. Specific carpal gliding techniques described in the next sections
are used to increase mobility at isolated articulations.

Dorsal glide
Volar glide

Ulnar glide