Shouler Rehablitation Flashcards
shoudler actions ROM
- sagittal flexion 180
- sagittal extension 60
- cross flexion 135
- cross extension 45
- abduction 180
- external rotation 90
- internal rotation 70
5 paired shoulder girdle actions and respective muscles
- ant/post tilt: pec minor/serratus ant + lower traps
- sup/inf rot: serratus ant + rhomboids/levator scapulae + lower traps
- retract/protract: rhomboids + middle traps/serratus ant + pec minor
- depress/elevate: lower traps + serratus ant + pec minor (little)/upper traps + levator scapulae (little)
- winging: winging is due to lack of muscular control not because of muscles that are too strong; anti-wining muscles are serratus ant + rhomboids
8 muscles for GH control
- rotator cuff: infraspinatus, subscapularis, teres minor, supraspinatus (only non-rotator) stabilize and center humerus in GH fossa, prevent sup translation of humerus, ext rot prevent post translation, int rot prevent ant translation
- biceps long head inserts into GH fossa
- axillary muscles pairs pec major + coracobrachialis and lats + teres major int rot and adduct shoulder
- continuous with trapezius
thoracic spine and shoulder action partners
1. thoracic flexion
2. thoracic extension
3. thoracic lateral flexion
4. thoracic rotation
- protraction + ant tilt, extension
- retraction + post tilt, flexion
- abduction
- in horizontal plane, protract/retract, cross flexion/extension
shoulder actions and matching scapular actions
1. abduction
2. flexion
3. cross flexion
4. cross extension
- sup rot, elevation
- sup rot, post tilt, elevation
- protraction
- retraction
conmon shoulder conditions
1. AC joint instability
2. GH joint instability
3. Impingement
- due to sprain or separation, related to clavicle fracture and SC joint inj; difficulty with cross flex/ext bc compresssion and raising arm overhead since it req coordination between scapula and clavicle
- subluxation or dislocation, related to rotator cuff tears and dmg to labrum
- SAI (supraspinatus, supraspinatus bursa, tendon long head BB) and PII (infraspinatus, supraspinatus, labrum), related to subacromial bursitis and tendiopathy (ECC promote healing)
4 cyclic motion for shoudler
work within pain free ROM to maintain current ROM
1. rock the baby, support with other arm, standing abduction or leaning circumduction
2. codman’s pendulum with therapy ball
3. table slides with towel
4. dowel assisted movement
PNF target muscle for shoulder girdle elevation
UFT bc people who shrug a lot likely do not superiorly rotate well, rely on elevation to raise arm
hold-relax PNF techique
same as CRAC but no agonist contraction
1. take target muscle to point of stretch
2. isometric contraction at 10-30% 1RM for 5-10 sec
3. passively take joint into new available range
static stretch and SMR for pec major and minor
- target to increase abduction, extension, external rotation, and retraction for posture
- SS: wall or corner stretch, assisted executive in sitting or supine hands behind head and therapist can gently pull arms back, standing TRX strap or dowel chest opener, foam roller lean back supine with roller along length of spine, hands behind head and lean back to stretch; stretching pec can put GH joint in vulnerable position if anteriorly unstable so consider keeping arm in a lowered position
- SMR: foam roller on floor at 45 deg to midline to roll along fibres or across ball on wall, only use if client is comfortable
static stretch and SMR for lats
- target to increase abduction, ext rotation, and flexion; big muscle also controlling lumbar spine and pelvis
- SS: chair or wall lat stretch or elevated prayer, thumbs up and sink down by hinging at the hips; lat lean back from TRX strap or pole; modify child’s pose by adding lat flexion by walking hands out to one side, top hand with palm up to int rot and push hip to opp side to open lats
- SMR: foam roller in side lying, top leg over bottom to drive, thumb up int rot to activate lat
static stretch and SMR for long head biceps
- target to increase shoulder extension and lengthen tendinopathy
- SS: also target BB with wall/doorway pec stretch but differentiate by pronation and extended elbow; half kneeling rear reach with pronated forearm; scootch stretch on floor, lift sternum, ext rot GH with finger pointing post, slide hips forward along floor to deepen stretch
static stretch and SMR for post GH capsule
- target to increase space posteriorly to allow for anteriorly translated humerus to be centered; anchor the scapula to min its motion and max motion of humerus
- SS: modified sleeper bypasses impingement pos that non-mod puts shoulder into; (mod) cross-body stretch cross flex at GH joint only, no protraction to open post GH, can combine with SMR with lacrosse ball between spine of scapula and spine for greater release of retractors when cross body stretch not enough
- SMR: lacrosse or golf ball on wall to open infraspinatus and teres minor
3 shoulder stretches/exercises from lab 1
- levator scapulae/UFT stretch
- thoracic extension on foam roller or cobra
- thoracic rotation with archer or seated rotation
3 components to shoulder resistance program
- improving base position of cervical or thoracic spine and scapula
- GH joint exercises for rotator cuff and long head BB
- shoulder girdle emphasis on improving retractionm posterior tile, superior rotiation, and anti-winging
shoulder resistance: address base position
- set spine and shoulder girdle foundation for arm
- coach patient awareness of undesirable pos for shoulder esp scapula since have limited kiinesethetic feedback
- cue corrections using verabal cues (instruction and imagery), visual cues (demostration for mirror observation), and physical cue (use hands to move their body into position, how the exercises feels internally, sight or feel of a wall)
shoudler resistance: rotator cuff emphasis
- compress humerus into GH foss for stability, centre, and rebuild pathological tendon
- int rot to prevent ant translation ext rot to prevent post translation of humerus, work on abd in plane of scapula (30 deg cross flex) to optimize supraspinatus motion
- key modifiers are form of contraction (ISO for high weakness or recent immobilization/surgery), progress to CON/ECC), body positioin (supine requires less scapular anchoring, side lying, upright), position of arm elevation (progress sup rot with higher elevation)
shoudler resistance: ISO for GH?
- emphasize MU recruitment without putting stress of moving joint
- joint angle specific gains
- stability > mobility emphasis
- rec: 70-75% MVC, 3-30 sec/rep, total 80-150 sec/set
shoudler resistance: biceps emphasis
- ISO to ECC emphasis to lengthen tendon
- focus on lowering from front raise for ECC in supine or upright
- CON in lengthed pos, forward pull from behind, BW or band/cabel
- biceps curls from incline/extended shoulder pos
- look to limit ant tilt in lengthen bicep pos
shoudler resistance: retraction and post tilt emphasis
`1. W for rhomboid retraction
2. T for middle traps retraction with less sup rot
3. Y for lower traps predom post tilt and some retract
4. key modifier is body pos; progress from supine, upright, 45 deg lean, prone
shoudler resistance: superior rotation emphasis
- overhead press-based exercises, no matter position of arm (abd, flex, cross) req sup rot
- front facing wall slides for flexion based
- back to wall angels for abd based
- key modification: amount fo elevation of shoulder, less elevation easier
shoulder resistance: anti winging emphasis
focus on serratus ant activaiton
1. front facing wall slides for protract and sup rot
2. serratus scapular pushup from tabletop (easier, less arm and core activation) or kneeling plank
3. serratus elbow scoop, band over back, cupping elbows, raise elbows up for sup rot and protraction
shoulder resistance: general direction
- start with simple isolated movments progressing into complex and integrated movements
- scapula focused exercise sneed scapular cueing
- variables: form of contraciton, body pos, level fo ROM
dowel shoudler ROM
- use opp arm to take inj arm through ROM, starting small, progressing through ROM without pain
- supine or upright, look for compensation using spinal movement
- flexion, extension, abd: inj arm with palm on the end of the dowel, hold the other hand in middle of dowel
- ext rot: use dowel to push into ext rot, can progress to active using 90 deg and
- int rot: push arm without dowel
GH rotators resistance
check shoulder instabilty first
1. body pos (supine, side lying, seated) determines how hard due to gravity
2. progress with increasing GH control, start at side 0 deg to 45 deg to 90 deg
3. progress with resistance bands/cable
scaption resistance
- emphasis on suprapsinatus by abducting along plane of scapula (30-40 deg cross flex) with thumb up (full can), stop at 90 deg abduction since supraspinatus loses traction with after
- can progress with res bands, stepping on band in half kneel with same side foot
scapular retraction resistance
stay neutral through spine, watch for rotation of spine when doing single arm
1. W postiion with 45 deg of abd with thumbs facing post, squeese shoulder blades together to target rhomboid with a bit of sup rot
2. T position with 90 deg and with thumbs forward to prevent impingement, targeting mid traps
3. progress with prone and resistance bands
scapular tilt/sup rot resistance
watch for compensation with thoracic extension and elevation of shoulder
1. Y position with 120-150 deg abd, thumbs post to emphasize post tilt and retraction while in sup rot, challenge serratus ant and lower traps upright progress to prone and resistance
2. forearm wall slides facing wall with ulnar sides of forearms against wall and lean into wall, ext elbows, for sup rot and post tilt through flexion into full Y pos to challenge serratus ant
3. wall angels with head, thoracic spine, and sacrum flush with wall in partial squat, elbows at 90 deg flex, GH abduction 45-60 deg, bring arms back into wall, retract scapulae and sup rot, stopping where shoulder begins elevation; progress with more up right, flush, and sup rot
shoudler press
superior rotation resistance, seated, half kneeling, look for thoracic ext
1. flexion: starting with 90 deg elbow flexion and fully extend while flex shoulder
2. abduct: starting with 90 deg elbow flexion and fully extend while flex shoulder
2. progress with greater ROM and resistance band/cable, weight
neuromuscular skills: shoulder
challenge the proprioception and neuromuscular connection for stability, stable/unstable surface, eyes open/closed, noise, other task req concentration, neck rotation
1. four point kneeling on foam, add shoulder taps
2. tripod hold with target arm on ground
3. shoulder taps with full plank
