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Liz, a 40-year-old musician, is being treated in the inpatient rehabilitation unit for a right proximal humeral fracture. For comfort and support, Liz uses a sling, and she is permitted to perform supervised passive and active wrist and finger movements. During one of her sessions, the OTR® notices edema in Liz’s right hand, which she will treat using retrograde massage. How should the OTR® position Liz’s arm and what massage technique should the therapist use to BEST manage the edema?

A. Position the right arm completely outstretched on a table with the hand placed palm
down while massaging the fingers to the wrist distal-to-proximal
B. Position the right arm completely outstretched on a table with the hand placed palm
down while massaging the wrist to the fingers proximal-to-distal
C. Maintain scapular stability, humeral adduction and elevate the forearm with the hand
above the heart while massaging the fingers to the wrist, distal-to-proximal
D. Maintain scapular stability, humeral adduction and elevate the forearm with the hand
above the heart while massaging the wrist to the fingers, proximal-to-distal

C. Maintain scapular stability, humeral adduction and elevate the forearm with the hand above the heart while massaging the fingers to the wrist, distal-to-proximal.
This position protects the shoulder and humerus and allows fluid to move toward the elbow when the hand is above the heart. Retrograde massage is a common technique used by occupational therapists to reduce swelling, particularly in the hand. The massage consists of manually moving fluid from the tips of the fingers back toward the heart to be reabsorbed into the bloodstream.
A and B. These are contraindicated for the shoulder and humerus and does not allow optimal position of the hand.
D. This is incorrect because the direction of the massage occurs distal-to-proximal, not proximal-to-distal.
Keogh, J., Sain, S.; and Roller, C. (2012). Kinesiology for the Occupational Therapy Assistant: Essential Components of Function and Movement. Thorofare, NJ: SLACK Incorporated, pp 264.

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