Upper Extremity Flashcards
What are Wand Exercises used for in shoulder mobility?
Wand exercises help maintain and increase shoulder joint mobility. They can be used as PROM or AAROM exercises. AAROM exercises assist in neurological communication and movement pattern development in the CNS.
What is the purpose of Codman’s Pendulum exercise?
Codman’s Pendulum is used to:
Decrease pain and increase circulation
Relax surrounding muscles
Increase ROM of the GH joint
How is Codman’s Pendulum exercise performed?
- Bend/lean forward or lie prone with the shoulder passively flexed forward and dangling.
- Use gravity or a weight in hand to allow joint distraction.
- Use body weight and momentum to create large circular motions (clockwise and counterclockwise).
- Ensure movement comes from body weight, not shoulder muscle strength.
What is the Sleeper Stretch, and what is it used for?
The Sleeper Stretch is used for posterior capsule issues and Frozen Shoulder. In sidelying, the affected shoulder is fixed by the body while the contralateral arm passively moves it into internal rotation as much as possible.
What is SCAPULAR AF exercise and its purpose?
SCAPULAR AF exercise involves movements of the scapula, which guide GH movement. Strengthening and stabilizing the scapula may help improve limited GH ROM.
How is the Ball-Wall Exercise performed, and how can it be progressed?
• Lean body weight slightly against a ball on the wall.
• Move the ball in circular motions or draw the alphabet.
• Easier: Stand with feet further apart.
• Harder: Stand farther from the wall.
What is the Arm Bar exercise, and what muscles does it engage?
• Performed in supine/hooklying with scapula resting on the ground.
• Hold a kettlebell/dumbbell at 90° shoulder flexion, elbow extended.
• Ensures traps are not overly engaged while activating serratus anterior.
• Progression: Press movement → Sidelying position with shoulder abduction.
• Purpose: Engages shoulder stabilizers and can be challenged in multiple directions.
How are Wall Slides/Wall Angels performed?
- Stand against a wall with a neutral spine, maintaining three points of contact (head, shoulder blades, sacrum).
- Start with shoulders and elbows at 90/90°.
- Maintain hand and elbow contact with the wall and slide arms up.
- Engages scapular retractors and improves thoracic mobility.
What compensations might occur during Wall Slides/Wall Angels?
• Excessive lumbar extension (arching back).
• Loss of head, shoulder blade, or sacrum contact with the wall.
• Overuse of upper traps instead of scapular retractors.
What are the primary muscles involved in scapular retraction?
Rhomboids and Middle Trapezius.
How is a passive stretch for scapular retractors performed?
• Position: Prone, Sidelying, or Standing.
• Therapist’s technique:
1. Hook one hand on the patient’s medial scapular border.
2. Support the anterior shoulder with the other hand.
3. Gently pull the scapula laterally to stretch the rhomboids and middle traps.
How is a self-stretch for scapular retractors performed?
• Position: Quadruped (on all fours) or Standing.
• Technique:
1. Patient pushes up from the ground, rounding/hunching the thoracic spine.
2. Focus on scapular protraction.
3. This movement is also known as Cat Pose (angry cat stretch).
How is isometric strengthening of scapular retractors performed in supine, standing, or seated positions?
• Position: Supine, Standing, or Seated.
• Technique:
1. Place a towel roll along the spine, between the shoulder blades.
2. Arms can rest at the sides or be abducted to 90° with elbows bent.
3. Action: Squeeze shoulder blades together into the towel, using the wall or floor for resistance.
4. Joint angle can be changed by adjusting the size of the towel roll.
How is isometric strengthening of scapular retractors performed in prone Y(T)I’s?
• Position: Prone.
• Technique:
1. Arms abducted to 90° or less.
2. Towel bolsters or pillows placed under the arms to modify joint angle.
3. Action: Isometric contraction, squeezing shoulder blades together.
How is isotonic strengthening of scapular retractors performed in a long-seated position?
- Wrap a theraband around the feet.
- Rest arms at sides with elbows bent at 90° (seated row position).
- Action: Squeeze shoulder blades together. Important:
• Keep the movement subtle.
• Avoid shoulder extension (to prevent lat recruitment).
• Avoid tension in upper traps. - Isometric alternative: Use a belt or strap instead of a theraband.
How is isotonic strengthening performed in prone Y(T)I’s with weights?
• Position: Prone.
• Technique:
1. Arms abducted to 90° or less.
2. Hold weights in hands.
3. Action: Contract and squeeze shoulder blades together, retracting against resistance.
What muscles are responsible for scapular upward rotation?
Upper and Lower Trapezius (Note: Serratus Anterior is listed under protractors).
What muscles are responsible for scapular upward rotation?
Upper and Lower Trapezius (Note: Serratus Anterior is listed under protractors).
How is isometric/isotonic strengthening for the upper trapezius (shrugs) performed?
• Position: Standing with arms at the sides.
• Isometric: Stand on a strap and attempt to elevate the shoulder with an isometric contraction.
• Isotonic: Use a resistance band or handheld weight to perform the shrug.
How is isometric/isotonic strengthening for lower trapezius (prone Y(T)I’s) performed?
• Position: Prone.
• Isometric:
1. Arms abducted to 120°.
2. Place towel bolster/pillows under the arms to adjust joint angle.
3. Squeeze shoulder blades together (down and in) with isometric contraction.
• Isotonic: Use handheld weights to perform the same contraction with movement.
What muscles are responsible for scapular protraction?
Serratus Anterior and Pectoralis Minor.
How is a passive stretch for pectoralis minor (hooklying position) performed?
• Position: Hooklying.
• Therapist’s technique:
1. Position the shoulder off the side of the table.
2. Therapist cradles the scapula with one hand and forward flexes the arm to about 45° with elbow flexed.
3. Therapist applies posterior pressure at an oblique angle.
4. Client may exhale fully to increase stretch sensation.
How is a self-stretch for serratus anterior (push-up with a minus) performed?
• Position: Quadruped or Standing.
• Technique:
1. Client stands facing the wall, performs a push-up with elbows extended.
2. As the client exhales, allow the torso to “sag” forward between the arms, focusing on scapular retraction.
How is isometric strengthening for scapular protractors (pectoralis minor, serratus anterior) performed?
• Position: Supine or Seated.
• Technique:
1. Secure a belt to a stable object behind you, flex the shoulder to 90° with elbows extended.
2. Perform protraction against the resistance of the belt (or weight in supine).
3. Use bolsters under the scapula to change the degree of protraction.
How is isotonic strengthening for scapular protractors (pectoralis minor, serratus anterior) performed?
• Position: Supine or Seated.
• Technique:
1. Secure a theraband to a stable object or anchor it under the foot.
2. Flex the shoulder to 90° with elbows extended.
3. Perform protraction with the resistance of the theraband (or weight in supine).
How is isotonic strengthening for serratus anterior (push-up with a plus) performed?
• Position: Quadruped or against a wall.
• Technique:
1. Adopt a similar position to the “Cat Pose” (elbows extended, shoulder flexed).
2. Perform a push-up while protracting the scapula.
3. To increase intensity, change to a traditional plank/push-up position.
What muscles make up the rotator cuff, and what are their functions?
• Supraspinatus: Abduction of the shoulder.
• Infraspinatus and Teres Minor: External rotation.
• Subscapularis: Internal rotation and stabilization of the scapula.
Function: The rotator cuff stabilizes the glenohumeral joint by compressing the humeral head against the glenoid during dynamic movement.
How is a passive stretch for the supraspinatus (adduction of the GH joint) performed?
• Position: Standing or Seated.
• Technique:
1. Place a towel roll in the axilla to create slight joint distraction.
2. Internally rotate the shoulder with the arm behind or in front of the body.
3. Use the contralateral arm to pull the ipsilateral arm into adduction.
4. To increase the stretch, add a chin tuck and contralateral neck flexion.
How is isometric strengthening for the supraspinatus (scaption) performed?
• Position: Standing or Seated beside a wall or stationary object.
• Technique:
1. Place a towel pad between the hand and the wall.
2. Abduct the arm into resistance from the wall (maintain elbow extension).
3. The abduction should not go beyond 90°; joint angle can be modified by varying the arm height.
How is isometric strengthening for the supraspinatus (scaption with resistance band) performed?
• Position: Standing or Seated.
• Technique:
1. Tie a belt or non-elastic band to an immovable object or anchor it under the foot.
2. Abduct the arm against the resistance of the band, maintaining elbow extension.
3. Abduction should not exceed 90°; in scaption, keep thumbs neutral with slight horizontal adduction (~30°).
How is isotonic strengthening for the supraspinatus (scaption with theraband) performed?
• Position: Standing or Seated.
• Technique:
1. Secure a theraband to an immovable object or anchor it under the foot.
2. Abduct the arm against the resistance of the band (maintain elbow extension).
3. Abduction should not go beyond 90°; in scaption, keep thumbs neutral with slight horizontal adduction (~30°).
Which muscles are responsible for upward rotation of the scapula?
Upper and Lower Trapezius (Serratus Anterior is listed under protractors)
How can you isometrically strengthen the upper trapezius?
Position: Standing with arms at the side
• Isometric: Stand on a strap and attempt to elevate the shoulder without movement
• Isotonic: Use a resistance band or handheld weight to perform shoulder shrugs
How can you strengthen the lower trapezius in a prone position?
Position: Prone (Y-T-I’s)
• Arms abducted to 120°
• Isometric: Place towel/bolster under arms to change joint angle
• Contraction: Squeeze shoulder blades down and in
• Needs to be done with a handheld weight
Which muscles act as scapular protractors?
Serratus Anterior and Pectoralis Minor
How do you passively stretch the pectoralis minor?
Position: Hooklying with the shoulder off the table
• Therapist cradles the scapula while forward-flexing the arm to ~45° (elbow flexed)
• Therapist applies posterior pressure at an oblique angle
• Client can exhale fully to increase the sense of stretch
How do you perform a self-stretch for the serratus anterior?
Position: Standing or quadruped
• Perform a push-up stand with elbows extended
• Exhale and allow the torso to sag forward without moving elbows or GH joint
• Scapula should be in retraction
How do you isometrically strengthen the serratus anterior?
Position: Supine or seated
• Secure a belt to a stable object behind you
• Shoulder flexed to 90°, elbows extended
• Perform protraction against the belt’s resistance
• Bolsters can be used under scapula to modify protraction angle
How do you isotonic strengthen the serratus anterior?
Position: Supine, seated, or quadruped
• Theraband resistance: Shoulder flexed to 90°, elbows extended
• Push-up with a plus: Start in cat pose with elbows extended and push up
• Increase difficulty: Shift to plank/push-up position and protract scapula
Which muscles make up the rotator cuff, and what are their actions?
Supraspinatus: Abduction
Infraspinatus & Teres Minor: External rotation
Subscapularis: Internal rotation & GH stabilization
What is the main function of the rotator cuff?
To stabilize the glenohumeral joint by compressing the humeral head into the glenoid during movement
How do you stretch the supraspinatus?
Position: Standing or seated
• Place a towel roll in the axilla for slight joint distraction
• Internally rotate the shoulder (hand behind back or in front)
• Use the opposite hand to adduct the arm across the body
• Increase stretch: Add chin tuck & contralateral neck flexion
How can you isometrically strengthen the supraspinatus?
Position: Standing/seated beside a wall
• Place a towel pad between hand and wall
• Abduct the arm into resistance (keep elbow extended)
• Joint angle can be changed by adjusting abduction height
