2. A. Upper Extremity Diagonal Patterns
1. D1Flexion:
a) Starting Position (Fig. 6.33A)
• shoulder extension, abduction, and internal
rotation;
• elbow extension;
• forearm pronation;
• wrist and finger extension with the hand
about 8 to 12 inches from the hip.
3. b) Hand Placement:
• Place the index and middle fingers of your (R) hand in the palm of
the patient’s hand and your left (L) hand on the volar surface of the
distal forearm or at the cubital fossa of the elbow.
c) Verbal Commands
• As you apply a quick stretch to the wrist and finger flexors, tell the
patient “Squeeze my fingers, turn your palm up; pull your arm up
and across your face,” as you resist the pattern.
d) Ending Position (Fig. 6.33B)
• Complete the pattern with the arm across the face in shoulder
flexion, adduction, external rotation; partial elbow flexion; forearm
supination; and wrist and finger flexion.
4.
5. 2. D1Extension
a) Starting Position (Fig. 6.34A)
• Begin as described for completion of D1Flexion.
b) Hand Placements
• Grasp the dorsal surface of the patient’s hand and
fingers with your (R) hand using a lumbrical grip. Place
your (L) hand on the extensor surface of the arm just
proximal to the elbow.
c) Verbal Commands
• As you apply a quick stretch to the wrist and finger
extensors, tell the patient, “Open your hand” (or “Wrist
and fingers up”); then “Push your arm down and out.”
6. d) Ending Position (Fig. 6.34B)
• Finish the pattern in shoulder extension,
abduction, internal rotation; elbow extension;
forearm pronation; and wrist and finger
extension.
7.
8. 3. D2Flexion
a) Starting Position (Fig. 6.35A)
• Position the upper extremity in shoulder extension,
adduction, and internal rotation; elbow extension;
forearm pronation; and wrist and finger flexion. The
forearm should lie across the umbilicus.
b) Hand Placement
• Grasp the dorsum of the patient’s hand with your (L)
hand using a lumbrical grip. Grasp the dorsal surface of
the patient’s forearm close to the elbow with your (R)
hand.
9. c) Verbal Commands
• As you apply a quick stretch to the wrist and
finger extensors, tell the patient, “Open your
hand and turn it to your face”; “Lift your arm up
and out”; “Point your thumb out.”
d) Ending Position (Fig. 6.35B)
• Finish the pattern in shoulder flexion, abduction,
and external rotation; elbow extension; forearm
supination; and wrist and finger extension. The
arm should be 8 to 10 inches from the ear; the
thumb should be pointing to the floor.
10.
11. 4. D2Extension
a) Starting Position (Fig. 6.36A)
• Begin as described for completion of D2
Flexion.
b) Hand Placement
• Place the index and middle fingers of your (R)
hand in the palm of the patient’s hand and
your (L) hand on the volar surface of the
forearm or distal humerus.
12. c) Verbal Commands
• As you apply a quick stretch to the wrist and
finger flexors, tell the patient, “Squeeze my
fingers and pull down and across your chest.”
d) Ending Position (Fig. 6.36B)
• Complete the pattern in shoulder extension,
adduction, and internal rotation; elbow
extension; forearm pronation; and wrist and
finger flexion. The forearm should cross the
umbilicus.
