Shoulder joint

The movements are flexion, extension, abduction, adduction, medial rotation, lateral rotation and circumduction.

Figure 9.18 Flexion and extension of the elbow.

This is a complex ball and socket joint with many planes of movement. The arm can be taken through flexion into elevation, i.e. taken above the head. It may also be taken from abduction across the body into horizontal flexion. Perform these movements yourself until you are confident of each direction. When including passive movements for relaxation purposes it is easier to maintain rhythm and continuity by limiting shoulder movements to abduction, adduction, flexion/elevation and extension. However, for mobilisation all movements must be included.

PROCEDURE FOR ABDUCTION AND ADDUCTION

Hold the arm behind the elbow, with the other hand at the wrist; or place one hand over the shoulder to stabilise it, thumb in front and fingers behind. Grasp the client's upper arm just above the elbow allowing her/his forearm

Adduction

Abduction

Figure 9.19

Abduction and adduction of the shoulder joint.

Adduction

Abduction

Figure 9.19

Abduction and adduction of the shoulder joint.

and hand to rest across the therapist's forearm. Keep the arm level with the body and move it away from the body by 90° into abduction, then return it to the side of the body into adduction.

PROCEDURE FOR ELEVATION THROUGH FLEXION AND EXTENSION

Hold the client's arm just above the elbow and hold the wrist with the other hand; rotate the arm laterally and lift it upwards above the client's head, then bring it down into extension. This movement will be limited by the bed unless the client is lying along the edge of the bed. It is not desirable to move the client if these movements are part of a treatment when limited extension is acceptable, but the client should be moved if the purpose is mobilisation.

PROCEDURE FOR HORIZONTAL FLEXION AND EXTENSION

Hold the client's arm just above the elbow and hold the wrist with the other hand as shown. Abduct the arm to 90°, then take it across the body (at chest level) into flexion and bring it back as far as possible into extension (in the abducted position).

PROCEDURE FOR MEDIAL AND LATERAL ROTATION

Grasp the client's arm just above the elbow with one hand and hold the wrist with the other. The upper arm can rest on the bed. Take the client's arm into abduction, then rotate it backwards into lateral rotation and then forwards into medial rotation.

Figure 9.21 Horizontal flexion and extension.

Medial rotation

Medial rotation

Lateral rotation

Figure 9.22 Medial and lateral rotation of the shoulder joint.

Lateral rotation

Figure 9.22 Medial and lateral rotation of the shoulder joint.

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