Traction of shoulder sidelying Fix the

patient's forearm between your flexed wrist and biceps and keep the elbow well flexed so that as you lean back, the forearm and upper arm is carried into traction. Apply the other hand just below the acromium to produce a traction and distraction force at the shoulder. Varied degrees of abduction and rotation and flexion, extension can be induced to maximize the effectiveness and reach different parts of the capsule.

Tips: Most useful where rotation in traction is indicated rather than pure rotation. Least useful where there is any dysfunction in the elbow or wrist. Extra considerations: Try applying the traction with alternating hands.

25.8 • (bottom left) Articulation of shoulder sitting The sitting position allows you to treat the shoulder by your body movement while the shoulder is held still rather than the shoulder being moved on the body. Fix the scapula to your sternum and rotate or sidebend yourself, thereby influencing different parts of the shoulder joint complex. You must maintain a firm grip so that you and the patient move as a unit.

Tips: Most useful where the long muscles affecting the shoulder interiorly are involved. Least useful in very mobile subjects. Extra considerations: Take care to avoid the patient's trachea.

25.10 • Traction to shoulder sitting Place your interlocked fingers just below the acromium and apply a traction and distraction force. While this force is maintained take the shoulder through a variety of movements while the body is torqued into the opposite directions. This will have the effect of influencing the shoulder directly and the long muscles acting on it.

Tips: Most useful where for any reason the recumbent position may be a problem and where good abduction range is possible. Least useful in very flexible subjects where spinal movement will absorb the levers. Extra considerations: An initial force applied diagonally toward the opposite hip first, before the traction, is useful.

25.9 • (see facing page, bottom right) Traction and articulation to shoulder sidelying Place your interlocked fingers just under the acromium and apply a force toward the axilla so that you produce a distraction and traction to the joint. Some variation of angles of rotation can be introduced to affect different parts of the capsule.

Tips: Most useful where it is necessary to avoid putting forces through the elbow or wrist. Extra considerations: Firm pressure toward the table is an essential component.

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