Lecture 12 - Shoulder rehab Flashcards
Imbalance between ___ and ___ and ___ often see in individuals with GH injuries
UFT
MFT
SA
Functionally, the ___ and ___ provide the moment arm for upward rotation
UFT and SA
___ provides stability and compression to the inferior angle of the scapula against the thorax
LFT
3 stages of muscle performance deficits
- Conscious muscle control
- Muscle control and strength necessary for ADL
- Advanced control during sports movements
Shown to improve dynamic GH stability through stimulation of proprioceptors and enhance co-contraction of RC muscles
closed kinetic chain exercises
Which exercise has a greater UFT activation ratio, but is not recommended if want to work more on MFT,LFT, and SA?
Bow and arrow
Which exercise is recommended to minimize UFT while activating MFT, LFT, and SA?
External rotation with scapular squeeze
Lawn mover
Which exercise has more UFT activation than lawn mower?
Robbery
Goal of progression when athlete is in a sling?
Establishing conscious control - minimal RC activity
Flexibility deficits are common to lead to mispositioning such as anterior tilt or downward rotation of scapula, T or F
TRUE
Scapular muscles affected by flexibility
Pec minor
Levator scapulae
GH muscles affected by flexibility
Lats
Rotator cuff/posterior capsule
See slide 18
Scapular rehab algorithm
50% decrease in rotator cuff force leads to what?
Increases anterior/posterior humeral displacement by 40%
Rotator cuff muscles line of pull (2)
- compression of humerus into glenoid cavity
- inferior pull
Is there a difference for eccentric ex. vs concentric-eccentric ex. for rotator cuff tendinopathy rehab?
No significant
__ if preffered over 1-2
3
Exercise programs for RC tendinopathy should provide clinically relevant outcomes within how much time?
12 weeks
Common findings with impingement syndrome (3)
- Diminished posterior tilting (10d)
- Increased superior translation of humerus (2cm) - weakness in RC m.
- Poor posture
See slide 25
AC joint rehabilitiation
Other name for idiopathic adhesive capsulitis
Frozen shoulder
Early mobilization is recommenced for what injury?
Frozen shoulder
read slide 26
Frozen shoulder
With a GH instability, 1st time dislocations are typically treated (surgery or not?)
Non-operatively
GH instability - Phase 1 goals (4)
- Reduce pain/inflammation/mm guarding
- Protect healing tissue and avoid further injuries to capsule
- Minimize effects of immobilization
- Re-establish dynamic joint ability and proprioception
3 categories of exercises for acute phase 1 of GH instability
- Early passive ROM - protect injury
- Submaximal strengthening
- Proprioception
2 Milestones of intermediate phase 2 for GH instability
Must have near full PROM and AROM
Flexion and ER/IR exercises can be initiate at 90d of ABD
What can be done in phase 2 of GH instability with isotonic strengthening?
- Side-lying ER, prone rowing
- Push up introduced + core strengthening
- Address underlying scapular dyskenisis
4 milestones of phase 3 advanced strengthening of GH instability
- Minimal to no pain
- Full shoulder ROM and capsular mobility
- Good strength (4/5 MMT)
- Endurance, and dynamic stability of scapulothoracic and UE
Progression of isotonic exercises in phase 3 of GH instability
- Functional positions for sports
- Low resistance and high reps to improve neuromuscular control and fatigue
- Bench press, seated row, lat pull downs resistance progressed
- Plyometric exercises - two hand throwing drills, chest pass, progress to one hand
Causes of biceps tendinopathy (4)
- Postural issues
- RC weakness/injury
- Overuse of the biceps tendon without proper strength and conditioning
- SLAP lesions?
RTP criteria for biceps tendinopathy
No sport-specific pain or weakness
RTP for shoulder injuries (8)
No specific criteria
Little/no pain, near normal ROM and strength
Functional ability and sport specific skills
Scapular dyskinesis - symmetry in scapular muscle strength (for non throwing athletes)
10% increased strength on dominant side in unilateral OH athletes
Less than 20d difference from side to side in IR
Also fatigue tests - high performance plyometric tests or eccentric RC
Examples of proprioception type of exercises
CKC or OKC exercises
WB vs NWB
Rhythmic stabilizations
Reaction exercises
Coordination exercises
Main components that need to be worked on in shoulder rehab (3 main)
- Rotator cuff muscles
- Posture
- Scapular motion
2 examples of PROM of shoulder tools
T-bar (cane)
Pendulums
2 examples of A-AROM of shoulder tools
Pully system
T-bar (cane)
2 examples of AROM of shoulder tools
Table bows
Wall washes
