Shoulder Unit- Hypomobility

Question 1

Related diagnosis

Answer 1

-RA/OA
-Traumatic arthritis
>Occurs in response to fall or blow to the shoulder or to micro trauma from faulty mechanics or overuse
-Post immobilization arthritis or stiff shoulder
-Idiopathic frozen shoulder

Question 2

Clinical symptoms of acute joint problems:

Answer 2

-Pain and muscle guarding limit motion

>Pain frequently radiates below elbow and may disturb sleep

Question 3

Clinical symptoms of Subacute joint problems

Answer 3

-Capsular tightness
>Limited motion – capsular pattern
>Pain at the end of motion
>Limited arthrokinematics

Question 4

Clinical symptoms of Chronic joint problems

Answer 4

-Progressive restriction of glenohumeral joint capsule
>Significant loss of function
>Aching localized to deltoid region

Question 5

Common Impairments

Answer 5

• Night pain and disturbed sleep
• Pain with motion and often at rest during acute flares
• Decreased joint play and ROM
• Postural compensations
• General muscle weakness and poor endurance in the glenohumeral muscles

Question 6

What are the postural compensations?

Answer 6

Protracted and anteriorly tipped scapula, rounded shoulders and elevated and protected shoulder

Question 7

What is involved with the muscle weakness and poor endurance of GH muscles?

Answer 7

Overuse of the scapular muscles leading to pain in the trapezius and posterior cervical muscles

Question 8

Common Functional Limitations

Answer 8

-Inability to reach overhead, behind head, out to the side and behind back
>Trouble dressing, reaching hand into back pocket, reaching out of car window, self grooming
>Difficulty lifting weighted objects
>Limited ability to sustain repetitive activities

Question 9

GH Joint Management – Goals Maximum Protection Phase

Answer 9

1. Control pain, edema and muscle guarding
2. Maintain soft tissue and joint integrity and mobility
3. Maintain integrity and function of associated areas

Question 10

Maintain integrity and function of associated areas: involves?

Answer 10

-Patient education
  >Keep joints distal to injured site mobile
   >>Keep hand mobile with exercise
  >>Manage edema
  >>* risk of RSD (IMPORTANT)

Question 11

Goals Controlled Motion Phase

Answer 11

1. Control pain, edema and joint effusion
2. Progressively increase soft tissue and joint mobility
3. Correct faulty mechanics
4. Progressively increase strength

Question 12

Controlled Motion Phase-Correct faulty mechanics:

Answer 12

• Avoid compensations
• Reposition head of humerus caudally before proceeding with shoulder exercises> Gentle joint oscillation techniques
  Sustained caudal glide
  Train external rotators to help depress the head of the humerus as the arm abducts

Question 13

Return to Function Phase

Answer 13

-Progressively increase flexibility and strength

>Progress stretching and strengthening as joint tissue tolerates

Question 14

What is the emphasis of treatment in Return to Function Phase?

Answer 14

correct mechanics, safe progression of exercise for return to function