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ForwardFrom Theory to Practice: Manual Therapy Techniques for the Shoulder, Elbow, Forearm, Wrist, and Hand
Maggie Malecha, MS, OTR/L, CHT and Ben Dobson, PT, DPT, MBA
This course is for Mayo Clinic Personnel only
September 9 - 10, 2023 - Mayo Clinic - Rochester, Minnesota
Attend this two-day course to sharpen your skills to address joint limitations in the upper extremity! This course covers manual therapy techniques for the elbow, forearm, wrist, and thumb carpometacarpal (CMC) joint with clinical applications for use in the clinic on Monday morning. In addition, this course includes proximal screening for thoracic outlet syndrome (TOS) and mobilization techniques for the 1st rib and posterior shoulder. Provocative testing for nerve compression syndromes for the elbow and forearm, and instruction in elastic taping techniques will also be covered.
Target Audience
Occupational therapists, occupational therapy assistants, physical therapists, and physical therapist assistants.
Learning Objectives
Upon completion of this activity, participants should be able to:
1. Identify key bony structures at the wrist and thumb CMC joint, needed for testing and treatment.
2. Demonstrate techniques to address limitations at both the radiocarpal and midcarpal joints to improve wrist motion following trauma.
3. Describe specific joint mobilization techniques to address a capsular pattern at the thumb CMC joint.
4. Perform joint mobilization techniques to address limitations at the proximal radioulnar joint to improve forearm rotation and humeroulnar joint to maximize elbow flexion and extension.
5. Execute proximal screening for the cervical spine and clinical examination for TOS involving the following special tests: Roos test (Elevated Arm Stress Test), Cyriax release test, and cervical rotation lateral flexion test.
6. Demonstrate ability to test and treat first rib limitations to improve neural mobility in the upper extremity.
7. Perform assessment and treatment of posterior glenohumeral capsule limitations which occur in both TOS patients as well as with those presenting with shoulder impingement/subacromial pain syndrome.
8. Select provocative tests to classify nerve compressions at the elbow and forearm that can cause impairment in occupations.
Attendance at any Mayo Clinic course does not indicate or guarantee competence or proficiency in the skills, knowledge or performance of any care or procedure(s) which may be discussed or taught in this course.
Saturday September 9, 2023
Time | Topic |
7:30-7:50 am (CST) | Continental breakfast |
7:50-8:00 am | Welcome to day 1 |
8:00-10:15 am | Bony surface anatomy of the wrist to determine landmarks for wrist and thumb mobilization techniques |
10:15-10:30 am | Break |
10:30-12:30 pm | Joint-specific treatment to address a capsular pattern at the wrist: row techniques to improve flexion and extension at the radiocarpal joint (RCJ) and radial column techniques to improve midcarpal joint (MCJ) motion |
12:30-1:00 pm | Lunch |
1:00-2:15 pm | Joint-specific techniques to address a capsular pattern at the thumb carpometacarpal (CMC) joint: traction, radial glides, volar glides |
2:15-2:45 pm | Forearm rotation limitations: testing for the distal radioulnar joint (DRUJ) |
2:45-3:00 pm | Break |
3:00-4:00 pm | Forearm rotation limitations: treatment for the proximal radioulnar joint (PRUJ) |
4:00-5:30 pm | Joint-specific techniques for the elbow: addressing flexion and extension limitations at the humeroulnar joint (HUJ) |
5:30 pm | Adjourn |
Sunday September 10, 2023
Time | Topic |
7:30-7:55 am (CST) | Continental breakfast |
7:55-8:00 am (CST) | Welcome to day 2 |
8:00-9:15 am | TOS evaluation: Cervical spine screen, Elevated Arm Stress test, Cyriax Release test, and Cervical Rotation Lateral Flexion test |
9:15-10:15 am | Addressing 1st rib limitations: soft tissue techniques followed by joint mobilization techniques |
10:15-10:30 am | Break |
10:30-11:00 am | Complete 1st rib mobilization with home program |
11:00-11:30 am | Scapular taping (using McConnell tape) to promote scapular retraction with elevation |
11:30-12:30 pm | Glenohumeral joint (GHJ) mobilization techniques to address posterior shoulder tightness for TOS and shoulder impingement/subacromial pain syndrome |
12:30-1:00 pm | Lunch |
1:00-1:00 pm | Complete GHJ posterior mobilizations with home program |
1:30-2:30 pm | Nerve compression testing for the elbow and forearm followed by elastic taping techniques for radial tunnel, cubital tunnel, and Wartenberg’s Syndrome |
2:30-3:00 pm | Wrap-up and adjourn |
All travel and lodging expenses are the sole responsibility of the individual registrant.
Ann Porretto-Loehrke, PT, DPT, CHT, COMT, CMTPT - Dr. Porretto-Loehrke is a skilled clinician with a passion for teaching and clinical treatment of upper extremity disorders. She has been practicing for 28 years and teaching continuing education courses for the past 18. She is the Clinical Development Coordinator at the Hand to Shoulder Center in Appleton, Wisconsin. Ann is a Certified Hand Therapist (CHT) and a Certified Orthopedic Manual Therapist (COMT) for treatment of the upper quadrant through the International Academy of Orthopedic Medicine (IAOM). Ann received a bachelor’s degree in physical therapy from Marquette University in 1994 and completed a post-professional Doctorate in Physical Therapy (DPT) degree from Drexel University with a specialty in hand and upper quarter rehabilitation in 2007. She is also certified in dry needling through Myopain Seminars, as a Certified Myofascial Trigger Point Therapist (CMTPT). Ann is a lead instructor who co-developed the Hand & Upper Extremity Track through IAOM, a set of 6 manual therapy courses designed specifically for hand and upper extremity specialists. She co-authored a chapter in Rehabilitation of the Hand & Upper Extremity on nerve compression syndromes of the elbow and forearm, as well as published two peer-reviewed articles entitled “Clinical Manual Assessment of the Wrist” and “Taping Techniques for the Wrist” in the 2016 Journal of Hand Therapy’s special edition of the wrist. Ann serves as the planning committee chair for the Wisconsin Hand Experience conference and has presented at American Society of Hand Therapists (ASHT) annual conferences, Canadian Society of Hand Therapist Annual Conference, Philadelphia meeting, TRIA Hand Conference, and Teton Hand Conferences. She also teaches online courses for MedBridge education.
Available Credit
- 14.25 AOTA Contact Hours
- 14.25 PT
Commitment to Equity, Diversity and Inclusion
Mayo Clinic School of Continuous Professional Development (MCSCPD) strives to foster a learning environment in which individual differences are valued, allowing all to achieve their fullest potential.
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