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MSK 1 > 9/27 - RC Nonop Therex Considerations > Flashcards

9/27 - RC Nonop Therex Considerations Flashcards

1
Q

what are the goals of therex when treating RC (5)

A
  • joint compression
  • dynamic ligament tension
  • NM control
  • ST control
  • mobility&raquo_space; stability&raquo_space; controlled mobility&raquo_space; skill
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2
Q

what is an important concept to consider when treating pts when RCs

A

mobility
> stability
» controlled mobility
»> skill

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3
Q

what other ms should be considered when prescribing therex for RC

A

delt, upper trap, pec minor

think ab exercises that would be good for RC without activating those ms

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4
Q

how can you prescribe therex for RC without overwhelming the pt

A

couple exercises that will minimize other ms group activation

exercises that target multiple ms groups

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5
Q

empty vs full can motion

A

empty can - thumb down, elevation, IR
full can - thumb up, depression, ER

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6
Q

which can is more irritating for impingement

A

empty
- IR - greater tub isn’t clearing acromion

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7
Q

what path is sidelying ER therex great for

A

posterior RC

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8
Q

what are the 2 ways that ER therex can be set up? what are the pros/cons of each?

A
  1. arm at side - stable environment
  2. arm up - challenging
    - scap musculature need to work harder to stabilize
    - more functional
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9
Q

what is a general rule for how to make stability exercises more difficult

A

as gets further away from body

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10
Q

what ms are specifically activated in sidelying ER

A

infra & teres minor (aka posterior cuff)

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11
Q

how does adding a towel roll to sidelying ER change the exercise

A

inc infra activity
- keeps motion in scap plane

improves the form by keeping arm at side

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12
Q

how is ER at 90deg ABD more functional than when arm is at side

A

more functional for overhead athletes/workers

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13
Q

when should ER at 90deg ABD be avoided and/or why with caution

A

avoid in early stage of rehab

caution - inc strain on capsule in 90-90 position

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14
Q

where & how should force be applied for manual resistance in ER

A

at medial border of inferior scap angle and at arm

work to get concentric and eccentric contractions thru whole motion

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15
Q

what is a characteristic of subscap ms fibers that should be considered for therex

A

upper and lower fibers act independently

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16
Q

what therex motions had the greates subscap activity

A

pushup plus
diagonal exercises (ie tennis forehand)

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17
Q

what position is not ideal for optimal subscap activation and why

A

IR at 0deg
d/t co-contraction of:
- ant delt
- pec major
- lats

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18
Q

what is a consideration of upper vs middle vs lower trap when determining therex

A

upper almost always strong
- will compensate for middle & lower trap weakness

want to prevent upper trap involvement when prescribing middle and lower trap exercises

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19
Q

optimal exercises for upper, middle, and lower traps

A

upper - unilateral shrug
middle - prone elevation & H - ext (“T”)
lower - prone elevation (“Y”)

20
Q

how do T vs Y motions change the activation of middle vs lower traps

A

changes alignment of fibers
- T = middle
- Y = lower

21
Q

what is a consideration of ms activation for unilateral scap retractions

A

see more upper trap than lower trap activation

22
Q

what exercises minimize upper trap while activating lower trap

A

SL flex
SL ER
prone H-ABD in ER

23
Q

what exercises minimize upper trap while activating middle trap

A

SL flex
SL ER
prone ext

24
Q

what is the difference in sidelying flex compared to sitting or standing flex

A

sitting or standing, prime position for UT to work

sidelying limits mechanical advantage to use UT

25
Q

in what positions elicit the greatest the upper trap activation and what positions elicit the least

A

greatest - standing
- highest in 60-120deg range

least - prone, SL, supine

26
Q

what determines serratus anterior activation

A

position of scapula
- activated first when scapula retracted (ie low row, inferior glide)

serratus anterior activated last when scapula protracted
- ex: lawnmower and robbery

27
Q

what is an optimal exercise to activate serratus anterior while minimizing the upper trap

A

standard push-up plus

when on wall, highest upper trap activation

28
Q

what is something w pushup plus exercises that can inc RC activation

A

open hand

29
Q

what are serratus anteiror exercises (5)

A

serratus punch
wall slide (@ >90deg elevation)
push up plus
elevation in scapular plane
elevation w ER and Tband

30
Q

what exercise is best for serratus w least pec minor involvement

A

serratus punch

31
Q

progression and regression for serratus anterior wall slides

A

progression - band around arms
- activates ER also

regression - foam roll b/w wall to roll up

32
Q

what ms are we trying to minimize in exercises targeting RC and serratus

A

UT
delt
pec minor

33
Q

what serratus ms exercise do you see UT activation in

A

scaption

34
Q

what serratus ms exercise do you see middle and lower trap activation in

A

elevation & ER

35
Q

what serratus ms exercise do you see pec minor activation in

A

wall slide

36
Q

what are RC exercises that facilitate neuromuscular control

A

reactive drills
sport-specific positions
perturbation @end range
concentric & eccentric resistance
- 90-90 ER

37
Q

what are some plyometric exercises for RC

A

all one hand progressions:
- ball drop
- catch from a toss behind
- wall dribbles - stationary or semi-circular
- small wall circles (inc infraspinatus)

38
Q

prognosis for a non-op RC tear rehabed by PT

A

do well early on in first 2 years

after that decline d/t fatty infiltration
- changes quality of tissue
- if repaired, fat already there will stay there

39
Q

what patients is PT not the first intervention for a RC tear

A

small-medium tears in younger active patients
- know it will get worse over time
- plenty of time for fatty infiltration
- higher demands

40
Q

what is a super important thing to advocate for if a pt has a RC tear when you are forming your POC

A

advanced imagery asap
- see how much fatty infiltration already

41
Q

POC for a traumatic full thickness RC tear

A

referral
delayed surgery = (-) outcomes

42
Q

what type of RC full thickness tears are most common

A

chronic/degenerative

43
Q

what is seen in chronic/degenerative full thickness RC tears

A

RC atrophy
fatty infiltration (via MRI)

44
Q

what is a consideration of chronic/degenerative fullthickness RC tears that should be noted when deciding POC

A

tear size, atrophy, and fatty infiltration all may progress over time (5-10yrs)
- even tho may acutely improve in PT

45
Q

what is a characteristic of fatty infiltrate

A

once it is present, won’t be removed by PT or surgery

MSK 1 (31 decks)

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