In the upper extremity patterns certain combinations of motions are fixed. The shoulder and forearm rotate in the same direction, supination occurs with external rotation and pronation with internal rotation. Extension of the hand and wrist is combined with shoulder abduction, flexion of the hand and wrist with shoulder adduction. The elbow is free to move in any direction or maintain its position.
The thrust combinations are associated with shoulder adduction. The fingers, the wrist and the elbow extend. The shoulder and forearm rotate in opposite directions from each other.
Thrust reversal (withdrawal) combinations are associated with shoulder abduction. The fingers, the wrist and the elbow flex. The shoulder and forearm rotate in opposite directions from each other.
Use these combinations when they are stronger than the normal pattern or to emphasize variability and selective motions of the forearm and hand.
Use ulnar withdrawal to strengthen shoulder extension and scapular posterior depression when elbow flexion with supination is stronger than elbow flexion or extension with pronation.
Shoulder flexion-adduction with elbow extension is a good combination to facilitate rolling over from
7.6 • Thrust and Withdrawal Combinations supine to prone. Use the ulnar thrust when elbow extension with pronation is more effective than forearm supination.
The therapist's position remains in the line of the motion. Because of the "pushing" and "pulling" motions of the thrust-withdrawal diagonals, an effective position is at the opposite side of the patient. This position is illustrated with both thrust diagonals.
The distal and proximal grips are those used to resist the same distal and proximal pattern movements.
The sequencing of the movements is the same as it is in the patterns. The hand and wrist complete their motion, and then the elbow, shoulder and scapula move through their ranges together.
The thrust and withdrawal variations are always exercised as a unit. Do the variations singly or in combinations. Lock in the strong arm to reinforce the work of the weaker arm. Combination of Isotonics and Dynamic Reversals (Slow Reversals) work well with these patterns.
7.6.1 Ulnar Thrust and Withdrawal Ulnar Thrust (O Fig. 7.15)
The wrist and fingers extend with ulnar deviation and the elbow extends with forearm pronation. The shoulder moves into flexion-adduction-external rotation with scapular anterior elevation.
Withdrawal from Ulnar Thrust (O Fig. 7.16) The wrist and fingers flex with radial deviation and the elbow flexes with forearm supination. The shoulder moves into extension-abduction-internal rotation with scapular posterior depression.
Radial Thrust (O Fig. 7.17) The wrist and fingers extend with radial deviation and the elbow extends with forearm supination. The shoulder moves into extension-adduction-internal rotation with scapular anterior depression.
Fig. 7.16a,b. Withdrawal from ulnar thrust
Fig. 7.16a,b. Withdrawal from ulnar thrust a
Fig. 7.17a,b. Radial thrust
Fig. 7.17a,b. Radial thrust
Withdrawal from Radial Thrust (O Fig. 7.18) The wrist and fingers flex with ulnar deviation and the elbow flexes with forearm pronation. The shoulder moves into flexion-abduction-external rotation with scapular posterior elevation.
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