Stretching the Upper Limb

Drs. Adnan Wshah & Zaid Modhi

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Stretching Shoulder Flexors
• It’s used to increase shoulder extension and hyperextension ROM
• Target muscles:
• Ant. Deltoid
• Biceps brachii
• Coracobrachialis
• Pec. Major

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Hand Placement and Stabilization

Place the patient in a prone position

Support the forearm and grasp the distal
humerus
Stabilize the posterior aspect of the
scapula to prevent substitute movements
Move the patient’s arm into full
hyperextension of the shoulder to elongate the shoulder flexors

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Hand Placement and Stabilization
For the pec. Major muscle:
To reach full horizontal abduction in the supine position, the patient’s
shoulder must be at the edge of the table. Begin with the shoulder in
60° to 90° of abduction. The patient’s elbow may also be flexed.

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Stretching Shoulder Extensors
• It’s used to increase shoulder flexion ROM
• Target muscles:
• Triceps brachii
• Lattimus dorsi
• Teres major

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Hand Placement and Stabilization
Grasp the posterior aspect of the distal humerus, just above the
elbow.
■ Stabilize the axillary border of the scapula to stretch the teres major,
or stabilize the lateral aspect of the thorax and superior aspect of the
pelvis to stretch the latissimus dorsi.
■ Move the patient’s arm into full shoulder flexion to elongate the
shoulder extensors.

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Hand Placement and Stabilization

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Hand Placement and Stabilization
For the triceps muscle:
■ With the patient sitting or lying supine with the
arm at the edge of the table, flex the patient’s
shoulder as far as possible
■ While maintaining shoulder flexion, grasp the
distal forearm and flex the elbow as far as possible

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Stretching Shoulder Adductors
• It’s used to increase shoulder abduction ROM
• Target muscles:
• Pec. Major
• Lattismus dorsi
• Teres major

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Hand Placement and Stabilization
■ With the elbow flexed to 90°, grasp the distal
humerus
■ Stabilize the axillary border of the scapula
■ Move the patient into full shoulder abduction
to lengthen the adductors of the shoulder

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Stretching Shoulder Abductors
• It is rare when a patient is unable to adduct the shoulder
fully to 0° (so the upper arm is at the patient’s side).

• Even if a patient has worn an abduction splint after a soft

tissue or joint injury of the shoulder, when he or she is
upright the constant pull of gravity elongates the shoulder
abductors so the patient can adduct to a neutral position

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Stretching Shoulder Internal Rotators
• It’s used to increase shoulder external rotation ROM
• Target muscle:
• Subscapularis

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Hand Placement and Stabilization
• Shoulder position (slightly abducted and flexed) and hand placement
at the mid to proximal forearm to increase external rotation of the
shoulder. A folded towel is placed under the distal humerus to
maintain the shoulder in slight flexion. The table stabilizes the
scapula.
• Make sure the elbow is pain-free

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Stretching Shoulder External Rotators
• It’s used to increase shoulder internal rotation ROM
• Target muscles:
• Infraspinatus
• Teres minor

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Hand Placement and Stabilization
■ Abduct the shoulder to a comfortable position that allows internal
rotation to occur without the thorax blocking the motion
■ Grasp the dorsal surface of the midforearm
with one hand, and stabilize the anterior
aspect of the shoulder and support the
elbow with your other forearm and hand.

■ Move the patient’s arm into internal rotation

to lengthen the external rotators of the shoulder.
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Stretching Elbow Flexors
• It’s done to increase elbow extension
• Target muscles:
• Biceps brachii
• Brachialis
• Brachioradialis

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Hand Placement and Stabilization
■ Grasp the distal forearm.
■ With the upper arm at the patient’s side supported on the table,
stabilize the scapula and anterior aspect of the proximal humerus.
■ Extend the elbow just past the point of tissue resistance to lengthen
the elbow flexors.

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Stretching Elbow Extensors
• It’s done to increase elbow flexion
• Target muscles:
• Triceps brachii
• Anconeus

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Stretching Forearm Pronators and Supinators
• It’s used to increase forearm pronation (stretching supinators) and to
increase supination (stretching the pronators)
• Target muscles:
• Supination: biceps brachii and supinator
• Pronation: pronator teres and quadratus

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Hand Placement and Stabilization
■ With the patient’s humerus supported on the table and the elbow
flexed to 90°, grasp the distal forearm.
■ Stabilize the humerus.
■ Supinate or pronate the forearm just beyond the point of tissue
resistance.

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Stretching Wrist Flexors
• It’s used to increase wrist extension ROM
• Target muscles:
• Flexor carpi ulnaris
• Flexor carpi radialis
• Palmaris longus

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Hand Placement and Stabilization
■ Pronate the forearm or place it in midposition, and grasp the patient
at the palmar aspect of the hand. If there is a severe wrist flexion
contracture, it may be necessary to place the patient’s hand over the
edge of the treatment table.
■ Stabilize the forearm against the table.
■ To lengthen the wrist flexors, extend
the patient’s wrist, allowing the fingers
to flex passively

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Stretching Wrist Extensors
• It’s done to increase wrist flexion ROM
• Target muscles:
• Extensor carpi radialis longus and brevis
• Extensor carpi ulnaris
• Extensor digitorum

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Hand Placement and Stabilization
■ Pronate the forearm or place it in midposition, and grasp the patient
at the palmar aspect of the hand.
■ Stabilize the forearm against the table.
■ To lengthen the wrist extensors, flex
the patient’s wrist, allowing the fingers
to extend passively

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Stretching Digits (fingers)
• You can apply stretching techniques to increase finger flexion and
extension

• Apply similar mechanics as mentioned in previous joints

• Make sure to work on all joints of the fingers (metacarpophalangeal

joints, proximal, and distal interphalangeal joints)

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Thank You!

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