For a patient who appears to prefer pronation of the arm, how should HVLA be applied to treat the radial head?

• A. Supinate the Arm to the Restrictive Barrier and Thrust Through It
• B. Pronate the Arm to the Restrictive Barrier and Thrust Through It
• C. Extend the Elbow and Apply Traction
• D. Abduct the Shoulder and Twist the Forearm

Answer: (A)

When treating a radial head dysfunction with HVLA, you apply a thrust toward the restrictive barrier in the direction that corrects the abnormal motion. If the patient shows a preference for pronation, that signals the restriction is in supination, so you take the forearm into supination up to the barrier and deliver a brief, high-velocity thrust through that barrier to release the radial head. The other approaches don’t address the radial head in the corrective direction: moving into pronation or using elbow extension with traction or shoulder abduction with a twist would not target the radial head’s articulation or provide the needed impulse to reset it.