Loose shoulder management

Question 1

2 categories of instability

Answer 1

unidirectional
> tubs
> more appropriate for surgery
> traumatic
> best outcomes post-op

multidirectional
> frequent dislocations
> hypermobility
> AMBRI

Question 2

The problems:

Answer 2

Cuff doesn’t fire

Cuff doesn’t control joint translation

Muscle sequencing

Proprioceptive deficits

Postural control

Central considerations (Pain sensitivity)

Question 3

Focus on:

Answer 3

Cuff strength, muscle balance, eccentric endurance

Normalize rotation ROM

Scapular stabilizers – if associated

Sport-specific loading progression

Question 4

Poor Outcomes Associated with:

Answer 4

Reduced IR/ER ROM

Reduced IR/ER Strength

Proprioceptive Deficits

Question 5

Our job is to treat impairments to restore function

Answer 5

Every treatment we select targets a specific impairment that has been objectively identified during the examination process

The impairment must be linked to a functional, measurable goal

A physician gives a prescription for a specific documented reason, so do we!

Question 6

Assess & Address the chain

Answer 6

Thoracic Spine

Scapulothoracic

Glenohumeral
> Prime Movers
> Dynamic Stabilizers

Elbow/Wrist

Question 7

Exercise Selection:

Answer 7

There are an infinite number of ways to get your patient from Point A to Point B

The correct treatment is the one that gets your patient better!

Clinical Practice Guidelines

Awareness of surgical procedure

Question 8

Sets and Reps:

Answer 8

The goal of your exercise dictates how you prescribe sets and reps

> Power
Strength/ Hypertrophy
Endurance

Question 9

soreness during warm-up that continues =

Answer 9

2 days off

drop down 1 level

Question 10

soreness during warm-up that goes away =

Answer 10

stay at level that led to soreness

Question 11

soreness during warm-up that goes away but redevelops during session =

Answer 11

2 days off

drop down 1 level

Question 12

soreness the day after lifting (not muscle soreness) =

Answer 12

1 day off

do not advance program to next level

Question 13

no soreness =

Answer 13

advance 1 level per week or as instructed by healthcare professional

Question 14

Strengthening/Control:

Answer 14

Straight planes -> Multiplanar

Isometric -> Isotonic -> Plyometric

Question 15

Protection Phase:

Answer 15

Negative pressure lost during dislocation = About a week to restore

Sling

Goals:
> Don’t allow another dislocation
> Reduce pain & Inflammation
> Restore Cuff Neuromuscular Activity = Sub-max isometrics

Question 16

Intermediate Phase:

Answer 16

Restore normal kinematics (cautious with high 5 position)

Restore proprioception

Restore neuromuscular control

Progress closed-chain to open-chain

Goals:
> Don’t allow another dislocation
> Regain scapula thoracic and scapulohumeral rythym
> Increase strength, emphasis on control uniplanar

Question 17

Late Phase:

Answer 17

Restore normal kinematics (cautious with high 5 position)

Restore proprioception

Restore neuromuscular control

Goals:
> Don’t allow another dislocation
> Increase strength, emphasis on control multiplanar
> Sport/activity specific

Question 18

UE proprioceptive and NM control exercises

Answer 18

> Rhythmic Stabilization
PNF (Proprioceptive Neuromuscular Facilitation)
Ball on Wall