Passive Stretching of the Upper Limb

A- Glenohumeral Joint:

Movement Flexion Hyperextension Abduction Adduction

Indication Increase flexion of the shoulder (stretch the Increase hyperextension of the shoulder (stretch Increase abduction of the shoulder (stretch the To increase adduction of the
shoulder extensors) the shoulder flexors). adductors). shoulder (stretch the abductors)

Position ■ Supine. ■ Prone. ■ Elbow flexed to 90°, grasp the distal ■ It is rare when a patient is
and Hand ■ Grasp Posterior aspect of the distal ■ Support the forearm and grasp the distal humerus. unable to adduct the shoulder
Placement
humerus. humerus. ■ Stabilize the axillary border of the scapula. fully to 0° because of the
■ Stabilize: ■ Stabilize the scapula. ■ Move the patient into full shoulder constant pull of gravity
 Iliac crest to stretch latissimus ■ Move the patient’s arm into full abduction. elongates the shoulder
dorsi. hyperextension. abductors.

 Scapula to stretch teres major.

Application

Movement External Rotation Internal Rotation Horizontal Abduction

Indication Increase external rotation of the shoulder (stretch the Increase internal rotation of the shoulder (stretch the external Increase horizontal abduction of the shoulder (stretch
internal rotators) rotators). the pectoralis muscles).

Position ■ Abduct the shoulder to a comfortable position— ■ Abduct the shoulder to a comfortable position that allows ■ To reach full horizontal abduction in the supine
and Hand initially 30° or 45° and later to 90° if the glenohumoral internal rotation to occur without the thorax blocking the position, the patient’s shoulder must be at the
Placement (GH) joint is stable—or place the arm at the patient’s motion (initially to 45° and eventually to 90°). edge of the table. Begin with the shoulder in 60°
side. to 90° of abduction. The patient’s elbow may also
‫ لو بيشنت عنده ديسلوكاشن ببقا حذر جدا فالتعامل‬:‫معلومة عالجية‬ ■ Flex the elbow to 90°, grasp the dorsal surface of the be flexed.
x‫ درجة او في المدى الخالي من األلم‬90 ‫ بيكون لحد‬[Link]‫وال‬ forearm with one hand, and stabilize the anterior aspect of ■ ‫؟‬noitctdba‫ تفتكر بتفرق درجة ال‬:‫سؤال‬
■ Flex the elbow to 90° so the forearm can be used as a the shoulder and support the elbow with your other forearm ■ Grasp the of the distal humerus.
lever. and hand.
■ Stabilize the anterior aspect of the shoulder.
■ Grasp the forearm with one hand. ■ Internally rotate the patient’s shoulder. ■ Move the patient’s arm below the edge of the table
■ Externally rotate the patient’s shoulder. into full horizontal abduction.
 Application

Notes ■ Be sure the elbow joint is stable and pain-free. In ■ Stretching techniques can be applied bilaterally by the therapist.
addition, keep the intensity of the stretch force very low,
particularly in patients with osteoporosis.

B- Elbow Joint:

Movement Flexion Extenion Forearm Pronation and Supination

Indication Increase elbow flexion (stretch the one-joint elbow To increase elbow extension (stretch the elbow flexors) Increase supination or pronation of the forearm.
extensors).
(stretch the long head of the triceps)
Position ■ Flex the patient’s elbow to lengthen the elbow extensors. ■ With the patient lying supine close to the side of the table, ■ With the patient’s humerus supported on the table and
and Hand stabilize the anterior aspect of the shoulder, Pronate the the elbow flexed to 90°, grasp the distal forearm.
Placement ■ Flex the patient’s shoulder as far as possible. forearm, extend the elbow, and then extend the shoulder.
■ While maintaining shoulder flexion, grasp the distal ■ NOTE: Be sure to do this with the forearm in supination, ■ Supinate or pronate the forearm just beyond the point
forearm and flex the elbow as far as possible. pronation, and neutral position to stretch each of the of tissue resistance.
elbow flexors. ■ Do not twist the hand, thereby avoiding stress to the
wrist articulations.

Application
C- Wrist Joint:

Movement Flexion Extenion Radial & Ulnar Deviation

Indication Increase wrist flexion. (stretch wrist extensors) Increase wrist extension. (stretch wrist flexors) Increase Radial & Ulnar deviation.

Position and Hand ■ The forearm may be supinated, in mid position, or ■ Pronate the forearm or place it in mid position, and grasp ■ Hold the wrist in midposition.
Placement pronated. the patient at the palmar aspect of the hand.
■ Stabilize the forearm.
■ Stabilize the forearm against the table and grasp the ■ Stabilize the forearm against the table.
dorsal aspect of the patient’s hand. ■ Radially deviate the wrist to lengthen the ulnar
■ To lengthen the wrist flexors, extend the patient’s wrist. deviators of the wrist.
■ To elongate the wrist extensors, flex the patient’s wrist
■ To further elongate the wrist extensors, extend the ■ Ulnarly deviate the wrist to lengthen the radial
patient’s elbow. deviators.
Application

D- Fingers

Movement Fingers Flexion Fingers Extenion

Indication Increase fingers flexion. (stretch finger extensors) Increase fingers extension (stretch finger flexors)
Position and Hand ■ First, move the distal interphalangeal joint and stabilize then move the proximal interphalangeal
Placement joint.

■ Hold both these joints at the end of their range; then move the metacarpophalangeal joint to the end
of the available range.
xx‫ملخص الحتة دي اني ببدأ من فوق لتحت يعني‬
NOTE: Motion is initiated in the distal-most joint of each digit in order to minimize compression of the
small joints. Full joint ROM will not be possible when the extrinsic muscles are elongated.
ynssdcR dast dcdRacp‫تفتكر بسبب ايه ؟ علشان‬ Finger Fexion Finger Extenion
 Self-Stretching of the Upper Limb
Glenohumeral Joint Capsular Stretches: (mohem awy)

Stretch A. Anterior GHJ Capsular Stretch B. Posterior GHJ Capsular Stretch C. Superior GHJ Capsular Stretch D. Inferior GHJ Capsular Stretch

Indication Gain horizontal extension and lateral rotation. Gain medial rotation and horizontal Increase superior capsule mobility and To improve shoulder elevation.
flexion shoulder extension.
.

Procedure  The patient stands in the middle of a doorway  The patient positions the involved arm at  In standing, the patient places a rolled  The patient positions the elbow
with the elbows and forearms on either side of the shoulder level and grasps the elbow with towel under the axilla and positions the overhead and flexed with the forearm
doorjamb. the opposite hand. elbow next to his or her side. behind the head and the arm next to the
ipsilateral ear.
 With one foot placed in front of the other, lean
through the doorway.
Application

A. Shoulders, Back, And Chest

Stretch 1. Above head stretch 2. Parallel arm chest stretch 3. Reverse Shoulder Stretch 4. Assisted Reverse Shoulder Stretch

Procedure 1. Stand upright and interlock your fingers. 1. Hold on to an immovable object. 1. Stand upright and clasp your 1. Stand upright with your back towards a table or bench.
2. Place your hands on top of your head. 2. Turn your shoulders and body hands together behind your 2. place your hands on the edge of the table or bench.
3. Contract your back muscles, and pull away from your outstretched arm. back. 3. Keep your arms straight and slowly lower your entire
your elbows back toward each other. 2. Slowly lift your hands upward. body.

Application
Stretch 5. Bent Arm Shoulder Stretch 6. Wrap Around Shoulder Stretch 7. Shoulder Adductor and Extensor Stretch 8. Shoulder External Rotators
Stretch

Procedure  Stand upright and place one arm across  Stand upright and wrap your arms around 1. Squat while facing a doorway. Place one hand behind your back
your body. your shoulders as if hugging yourself. 2. Stick the right arm through the doorway. Grab the and then try to reach up between
 Bend your arm at 90 degrees inside of the doorjamb at shoulder level with the right your shoulder blades.
 Pull your elbow towards your opposite hand.
shoulder. 3. While keeping the right arm straight and the feet
firmly planted, lower the buttocks toward the floor.
Application

B. Arms, Forearms, Wrists and Fingers.

Stretch 1. Triceps Stretch 2. Triceps Alternative 3. Wrist Flexors Stretch 4. Wrist Extensor 5. Beginner Wrist Flexors
Stretches. Stretch Stretch

Procedure  Reach behind your head with both  Stand with your hand behind your  Hold onto your fingers and turn  Hold on to your fingers while  Interlock your fingers, with the
hands with elbows pointing upwards. neck and your elbow pointing your palms outwards. straightening your arm. palms pointing out away from the
upwards. body.
 Then reach down your back with  Straighten your arm and pull your  Pull your fingers towards
your hands.  Then use your other hand (or a fingers back using your other your body.  Straighten your elbows and push
rope or towel) to pull your elbow hand. your palms out away from the
down. body as far as you can.
Application
Stretch 6. Forearm Pronator with dumbbells stretch 7. Wrist Flexors Stretch 8. Finger Flexors Stretch 9. Thumb Stretch

Procedure  Grasp a light dumbbell with a weight plate attached  Grasp a light dumbbell with a weight plate attached  Place the tips of your fingers  Start with your fingers pointing
to one end only, with the weighted end sticking out to one end only, with the weighted end sticking out together. up and your thumb out to one
past the thumb. past the thumb. side, then use your other
hand to pull your thumb
 Push your palms towards
down.
 Hyper-supinate the forearm so that the weighted  Pronate the forearm so that the weighted end of each other.
end of the dumbbell points toward the floor. the dumbbell points toward the floor.

Application

C. Different Upper limb Stretches:

Stretch 1. Kneeling Forearm Stretch 2. Wall-Assisted Finger Flexor Stretch 3. Corner Stretch 4. Rhomboid Stretch

Procedure  While crouching on your knees with your  Turn the body so that the shoulder is  Place both hands on the wall  Patient stands facing the edge of an open
forearms facing forward and hands pointing perpendicular to the wall. and lean toward the corner to door, with the feet placed on either side of the
backwards, slowly move rearward. stretch pectoralis major. door and the hands on the doorknobs.
 Reach out and place the fingertips on the
wall then lean towards the wall.  patient pushes his hip backward and leans
backward from the door

Application
 Muscle Energy Techniques of the Upper Limb
Stretch 1. Pectoralis Major

A. Supine B. Setting C. Prone

Procedure 1. Sternal Fibers:  The patient is asked to place their arm  The patient is prone, arm is abducted to 90°, elbow flexed
& in 90 degrees of abduction and elbow to 90° and palm down.
 The arm is taken away from the body into the scapular plane to flexion.  The therapist Stabilizes the patient’s scapula area to
Application
induce a lengthening of the sternal fibers of the pectoralis major,  Horizontally flex against a resistance prevent trunk rotation
to the point of the resistance. (After the contraction the therapist  The therapist eases the patient's arm into extension at the
encourages horizontal extension. shoulder until point of resistance from pectoralis.
 Then the patient is asked to pull their arm across the body
 The patient is asked, using no more than 20%of strength, to
(horizontal flexion) to induce a contraction of the right pectoralis
attempt to the arm towards the floor.
major for 10 seconds.
 After 7-10 second isometric contraction, the arm is taken
into greater extension, with the patient's assistance, and held
 Then The therapist slowly takes the shoulder further away into
at stretch for not less than 20 seconds.
the scapular plane.

2. Clavicular Fibers

 The patient's arm is gently taken from approximately 90 degrees of 2. Pectoralis Minor
abduction and taken away from the midline to induce a bind of the
clavicular fibers of the right pectoralis major. From the point of  The patient in a side-lying position.
resistance, the patient is asked to lift their arm against a resistance  The therapist cradles the right scapula, the patient is asked to protract the right scapula against the
applied by the therapist. resistance.
 After the 10-second contraction, the therapist gently encourages the right scapula into a retracted
 After a 10-second contraction, the clavicular fibers are then taken to position which will inducre lengthening of the right pectoralis minor.
their new point of resistance.
Stretch 3&4. Latissimus dorsi & Teres Major

A. Side Line B. Setting

Procedure  The patient lies on their side and the therapist interlocks their hand through the patient's arm.  The patient is asked to place their arms together in horizontal flexion and to
& rotate to the opposite side of the muscle until they feel resistance.
Application  The patient is asked to adduct their right arm to the lumbar spine
 The patient is asked to resist thoracic rotation to the same side of the muscle .

 After the contraction, the therapist encourages further thoracic rotation to the
left.

 The therapist applies pressure to the patient's iliac crest and after the contraction takes the
patient's arm into further abduction; this will lengthen the shortened latissimus dorsi.

Stretch 5. Subscapularis 6&7. Infraspinatus & Teres Minor

 The therapist takes the patient's shoulder into external rotation until a bind is felt, and  The therapist takes the shoulder into internal rotation until the point of bind is felt and
from this position, the patient is asked to contract the subscapularis by internally from this position, the patient is asked to externally rotate the shoulder, which will
rotating their shoulder. activate the infraspinatus.

 After 10 seconds and on the relaxation phase, the therapist applies traction to the  After the 10-second contraction, the therapist applies traction to the shoulder and slowly
shoulder joint (to prevent an impingement) and slowly encourages the shoulder into encourages the shoulder into further internal rotation
further external rotation.
Stretch 8. Biceps Brachii 9. Forearm Flexors

Procedure  Treatment of biceps brachii involves the affected arm being held in extension at the easy  The patient is seated facing the therapist, with flexed elbow supported by the therapist’s
barrier.
fingers. The patient's hand is dorsiflexed at the wrist, so that the palm is upwards.

 The therapist holds the patient's wrist in order to restrain a light effort to flex the elbow  The therapist guides the wrist into greater flexion to an easy barrier.
for 7-10 seconds
 The patient attempts to gently flex hand against resistance for 7-10 seconds.

 After relaxation of the effort, the arm is extended to the new resistance barrier.  After relaxation dorsiflexion is increased to the new barrier.

Application

Ahmed Hany Elsaeed

– PT STUDENT AT SINAI UNIVERSITY GRADE 3

DRD