Interventions for Shoulder common impairments Flashcards
Tendonitis/Tendinopathy common interventions:
- pain/inflammation management
- focus on regaining strength, endurance, and flexibility
- be sure to address any kinetic chain impairments which may have led to excess strain at tendon
- cross friction massage to tendon
- eccentrics preferred for strengthening
Decreased mobility interventions
- joints mobs
- soft tissue mobs
- stretching (helps with guarding)
- strengthening/stabilization
As ROM increases, likely will need to strengthen and improve coordination in new _______
available ranges
What grade joint mobilization will help if decreased mobility is due to joint hypomobility?
Grades 3 and 4
What grade joint mobilization will help if normal mobility, but painful?
Grades 1 and 2
What joint mobs will help with hypomobility and pain
start with grades 1 and 2, progress to 3 and 4
What is the primary direction joint mobilization of the humerus on the glenoid that you should perform to improve flexion ROM?
posterior
What is the primary direction joint mobilization of the humerus on the glenoid that you should perform to improve abduction ROM?
inferior
What is the primary direction joint mobilization of the humerus on the glenoid that you should perform to improve ER ROM?
anterior
What is the primary direction joint mobilization of the humerus on the glenoid that you should perform to improve IR ROM?
posterior
Scapular mobility is important and often forgotten when trying to improve _______
shoulder mobility
____ and ____ joint mobility contribute to shoulder movements, be sure to check these joints especially if hitting roadblock with ROM progression and/or if limitations are at end range of shoulder elevation
AC and SC
Soft tissue mobs: If lack of ROM is due to muscle pain, trigger point, or guarding soft tissue mobilization is appropriate, what is something you could check before and after to determine your effectiveness?
ROM and pain
Why might you pick passive stretching versus active stretching?
pt tolerance or safe positioning
What does it indicate to you if they are able to stretch themselves farther actively than you can passively?
pt does not trust you–> try to have them relax
-if they still don’t trust you, make all ROM AROM or AAROM
What muscles are commonly tight and may contribute to rounded shoulders?
Pecs and Lats
Shoulder mobility exercises
- Pulley
- Pendulum
- Stretches
- Wall slides
Shoulder mobility exercises with external assistance
- can use a table or stick for elevation
- can use a stick behind back for IR or a towel
- can use a stick or doorward for ER
Adhesive Capsulitis Interventions- Joint mobs
directed to the GH joint to reduce pain and increase motion and function
Adhesive Capsulitis Interventions- modalities
diathermy, ultrasound, or e-stim combined with mobility and stretching exercises to reduce pain and improve shoulder ROM
Adhesive Capsulitis Interventions- corticosteroid injections
Combined with shoulder mobility and stretching exercises are more effective in providing short-term (4-6 weeks) pain relief and improved function
Adhesive Capsulitis Interventions- translational manipulation
doctors do this under anesthesia
Adhesive Capsulitis Interventions- patient education
- describe the natural course of the disease
- promotes activity modification to encourage functional, pain-free ROM
- matches the intensity of stretching to the pts current level of irritability
Adhesive Capsulitis Interventions- stretching exercises
- upper trap
- pecs
- levator
- posterior joint capsule
How will you know if your interventions for adhesive capsulitis are being effective?
- test-retest
- reduced pain and improved ROM
If someone has pain that increases with stretching in adhesive capsulitis, what kind of stretching should you choose?
cyclic because you move in and out of it
Hypermobility: without surgery, the goal is to improve the ______ and ______ of the joint
support and stability
What do you strengthen in those that are hypermobile?
-muscles that attach to the area that can help stabilize (even if already 5/5)
If SC/AC joint hypermobility, strengthen….
deltoid, pecs, traps, SCM
Why is proprioceptive training beneficial to those that are hypermobile?
to teach the body to sense the humerus when it goes too far so that it can contract its muscle and pull it back in place before injury occurs
Progressions of proprioceptive training of the hypermobile shoulder
- Blocked vs random
- Slow vs fast
- Mid range vs more provoking positions
- verbal vs nonverbal cues
- supported vs unsupported (sitting vs standing)
Should we do joint mobs for hypermobile individuals?
not unless they have pain then grades 1 and 2 are okay
Should we work on ROM and/or stretching for hypermobile individuals?
Maintain ROM and make it pain free
Bracing and taping benefits for hypermobile shoulder
- gives pt tactile feedback if they start to dislocate
- reduce sulcus
- anterior instability to draw humeral head backwards
Pain interventions
- modalities
- soft tissue mobs
- pendulums
- joint mobs grades 1 and 2
- correcting muscle imbalances contributing to poor posture
How decide whether to pick soft tissue mobilizations versus joint mobilizations versus both for pain?
- Assess joint mobs and if hypomobile (work on it) but if normal/hyper with pain (grades 1 and 2)
- If normal and no pain with joint mobs, palpate areas and wherever causes pain, do soft tissue mobs
Myofascial pain syndrome common interventions
- soft tissue mobs (trigger point release)
- stretching of involved muscles
- correcting muscle imbalances which may be contributing to trigger points
- dry needling
