Shoulder Manual Therapy and Exercise Flashcards
What are the indications for cromioclavicular joint mobilization?
OA-reduce pain
Restore mobility at the AC
Improve terminal flexion or ABD
What considerations are there for cervicothoracic manipulation when dealing with shoulder injuries?
Reduce shoulder pain
Improve Shoulder AROM
Improve muscle activation for middle trapezius
What criteria was correlated with better outcomes with manual therapy for patients with shoulder injuries?
- pain free shoulder flexion up to 127 deg.
- shoulder internal rotation under 53 deg. at 90 deg. of abduction
- negative neer test
- not taking medications for their shoulder pain
- symptoms less than 90 days
True or False: Patients with shoulder pain and injuries can benefit immediately from cervicothoracic mobilizations/manipulations.
True, depending on the indications and diagnosis
How would tightness of the pectoral muscles affect shoulder flexibility?
What about tightness of the posterior-inferior G-H Capsule?
Tightness of Lat. Dorsi and Teres Major?
assoc. w/ excessive scapular protraction and downward rotation, both disturbing optimal glenohumeral mechanics
assoc. w/ impingement syndrome and SLAP tears
assoc. w/ resistance to UE elevation
What are the essential elements for dynamic stability of the shoulder complex?
- adequate compressive forces
- scapular base
- proprioception and nueromuscular control of the entire kinetic chain
- muscular endurance
What are the proven interventions for the scapula?
- serratus anterior strengthening or retraining
- upper trapezius activation reduction
- pectoralis minor stretching
- thoracic extension posture and exercise
- posterior shoulder stretching
What exercises have been shown to be good for targeting the supraspinatus?
Infraspinatus and teres minor?
subscapularis?
- full can
- prone full can
- side lying ER
- prone ER at 90 deg. abduction
- ER w/ towel roll
- IR at 0 deg. abduction
- IR at 90 deg. abduction
- IR diagonal exercise
What exercises have been shown to be good for targeting the lower trapezius?
Middle Trap?
Upper Trap?
- prone full can
- Prone ER at 90* abd
- Prone horiz. abd at 90* with ER
- bilateral ER
- Prone Row
- Prone horiz. abd at 90* w/ ER
- shrug
- prone row
- prone horiz. abd at 90* with ER
What exercises can target the middle and lower trap while minimizing upper trap activity?
- sidelying ER
- sidelying forward flexion
- prone horiz. abduction at 90* ER
- prone extension
What exercises are recommended for targeting the Serratus Anterior?
Rhomboids and Levator Scap?
- push up w/ plus
- dynamic hug
- serratus punch 120*
- prone row
- prone horiz. abd at 90* w/ ER
- prone ext. w/ ER
True or False: Dumbbells are better than Elastic resistance for muscle activation.
False, there is no difference
True or False: We should limit the amount of resistance used when strengthening the shoulder girdle due to the risk of larger compensatory muscles preventing us from strengthening the intended musculature.
False, EMG analysis has shown that the small muscles will activate just as much as the larger muscles with increased resistance
What are the general guidelines for shoulder girdle exercise during the acute phase?
Sub-acute phase/proliferation phase?
Maturation or remodeling phase?
pain control, edema reduction, gentle P/AROM, address functional limits w/ education and modifications as needed
progress A/PROM as tolerated, initiate strengthening and continue to address functional limits
Progress strengthening, agility, dynamic stabilization, and sport-specific exercises
Is exercise effective for subacromial impingement?
Yes, a supervised strength program has been shown to lead to greater short-term improvements in pain and disability as well as long term function and short term mental health
What is the goal of exercise for impingement syndrome?
improve scapular motion and clear subacromial space via:
- correct posture awareness; as needed
- strengthen shoulder girdle stabilizers (serratus ant., mid and low trap, rhomboids)
- strengthen rotator cuff
- stretch shortened muscles
What is a group 1 patient with rotator cuff disease? What treatment should they receive?
- all patients w/ chronic full thickness tears in an older age group (over 60)
- irreparable tears (based on tear size, retraction, muscle quality, and migration)
Initial conservative treatment
What is a group 2 patient with rotator cuff disease? What treatment should they receive?
- all acute tears over 1 cm
- all chronic full thickness tears for pts. under 60
early surgical repair
What is a group 3 patient with rotator cuff disease? What treatment should they receive?
- tendinopathy
- partial thickness tears
- small tears (under 1 cm full thickness)
prolonged conservative treatment
What strengthening exercise is probably a good starting point for patients with higher irritability?
Isometrics
