The final position for this technique is shown here. The operator has applied an external rotation, flexion and traction to the patient's shoulder while firmly holding back on the clavicle so that forces accumulate at the acromio-clavicular joint. As a preliminary the patient's arm is taken from a position with the back of her hand facing forwards at, or behind her waist and then thrust out sharply forwards while supinating her forearm. This puts a gapping force on the acromio-clavicular joint.
Tips: Least useful in very flexible subjects as the force will tend to dissipate. Extra considerations: Try using different phases of respiration and varying the flexion angle of the shoulder.
24.6 • Thrust to acromio-clavicular joint supine Start with the patient's arm by the side and firmly fix the distal third of the clavicle with the pad of your thumb. Bring the patient's arm into elevation and rotate it gently until tension accumulates at the acromio-clavicular joint. An articulatory force can be used, or if tension is suitable, a small thrust can aid in breaking fixation in the joint. Care must be taken to apply the thumb to the plateau on the top of the clavicle to keep the discomfort of the pressure to a minimum.
Tips: Least useful where there is gleno-humeral dysfunction making this range of movement impossible. Extra considerations: Try sandwiching the patient's wrist between your hand and forearm and then moving your whole body and arms together.
24.7 • Articulation of sterno-clavicular joint sitting Hold tension with both hands in opposite directions and fix the patient's scapula with your thorax, then twist into rotation both ways to produce a mobilizing force on the sterno-clavicular articulation and first rib anteriorly.
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