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Rehabilitation Of Athletic Injuries > Upper Extremity Techniques > Flashcards

Upper Extremity Techniques Flashcards

1
Q

What muscles make up the rotator cuff?

A
  • Supraspinatus
  • Insfraspinatus
  • Teres Minor
  • Subscapularis
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2
Q

Rotator Cuff Muscle Actions

A
  • Supraspinatus
    ~ Shoulder Abduction
  • Insfraspinatus
    ~ Shoulder ER
  • Teres Minor
    ~ Shoulder ER
  • Subscapularis
    ~ Shoulder IR
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3
Q

Rotator Cuff Function

A
  • Muscles work together to stabilize the shoulder by maintaining articulation between the humeral head and glenoid
    ~ Humeral head compression and
    depression during shoulder
    movements
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4
Q

If the Rotator Cuff is not the primary mover of the shoulder, who is?

A
  • Pec major
  • Teres major
  • Latissimus dorsi
  • Deltoids
  • Biceps
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5
Q

How is the Rotator Cuff traditionally rehabbed?

A
  • In Isolation!
    ~ Asking the group to internally rotate,
    externally rotate and abduct the
    shoulder.
    > Does this make sense when
    considering functional or end
    stage rehabilitation? NO
    > Does this make sense when
    considering the size of the
    muscles involved? NO
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6
Q

How should the rotator cuff be rehabbed to enhance function?

A
  • Ask it to do what it does
    ~ Cooperate
    > IR, ER, Abduct along with other
    movement patterns
    ~ Move the shoulder in functional
    movement patterns
    > Anytime you move the shoulder,
    the cuff works (especially away
    from body to train it to stabilize)
    ~ Work in a diverse way
    > Concentrically, eccentrically, and
    isometrically
    ~ Remember Integrated Isolation
    > Move shoulder in conjunction
    with the core and LE
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7
Q

What makes the rotator cuff unhappy?

A
  • Overuse
  • Impingement: cuff tendon against AC ligament or acromion
  • Mechanical problem down the chain asks the muscles of the shoulder to work harder including the cuff.
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8
Q

Link between the hip and shoulder

A
  • The most efficient upper extremity movements utilize loading and unloading by the lower extremity (especially the hip) to more efficiently load and unload the upper extremity.
    ~ Efficient because
    > Loading involves eccentric
    contraction, lengthening of
    muscle, and activation of MS
    > Loading of the LE creates high
    momentum (momentum
    transferred to UE through the core)
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9
Q

Sagittal Plane Loading Patterns for Shoulder

A
  • Shoulder Flexion
    ~ Same side hip flexion
    ~ Loads same side hip extensors and
    shoulder flexors
  • Shoulder Extension
    ~ Opposite side hip flexion
    ~ Loads opposite side hip extensors
    and shoulder extensors
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10
Q

Frontal Plane Loading Patterns for Shoulder

A
  • Shoulder Abduction
    ~ Opposite side hip adduction
    ~ Loads opposite side hip abductors
    and shoulder abductors
  • Shoulder Adduction
    ~ Same side hip adduction
    ~ Loads same side hip abductors and
    shoulder adductors
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11
Q

Transverse Frontal Plane for Shoulder

A
  • Shoulder ER
    ~ Opposite side hip IR
    ~ Loads opposite side hip external
    rotators and shoulder external
    rotators
  • Shoulder IR
    ~ Same side hip IR
    ~ Loads same side hip external rotators
    and shoulder internal rotators
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12
Q

Link Between Hip and Shoulder in Sports

A
  • Since we are most successful at movements in the transverse plane understanding and applying the transverse plane loading patterns is
    important.
    ~ Abnormalities in the mechanics
    down the chain can cause transverse
    plane compensations and injury.
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13
Q

What would make the anterior shoulder unhappy?

A

Bad same side LE (especially hip)

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14
Q

What would make the posterior shoulder unhappy?

A

Bad opposite side LE (especially hip)

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15
Q

Characteristics of Functional Movement: Scapula and Humerus

A
  • Scapula acts as a base for movement of the humerus.
  • As the humerus moves the scapula must follow.
  • Scapulothoracic Rhythm: for every 2 degrees of humeral elevation there’s 1 degree of scapular upward rotation
    ~ Scapula needs to move symmetrically
    with the humerus
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16
Q

What limits scapular motion?

A
  • Muscle Tightness/Imbalance/ Diminished NMC.
  • Pain associated with injury.
  • Immobilization
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17
Q

What else needs to move properly to allow for normal shoulder function?

A
  • Thoracic cage, especially with motions occurring in the transverse plane
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18
Q

What happens when the scapula is not moving properly? And how do you fix it?

A
  • Impingement
    ~ Humerus is banging against the
    acromion because scapula is not
    getting out of the way of the
    humerus.
  • Fix it by enhancing scapula and thoracic cage mobility and/or NMC.
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19
Q

What else causes impingement?

A
  • Anatomic Variation
    ~ Bony alignment that’s abnormal
  • Chronic Inflammation
  • Capsular Limitation
    ~ Beware of the throwing athlete with
    a tight posterior/inferior capsule.
    > Forces humeral head anterior/
    superior when the opposite
    should be happening
  • Tight muscles/joint capsule can pull on the humerus causing it to move in the wrong direction leading to impingement which can result in rupture
20
Q

How to determine impingement: GIRD (Glenohumeral Internal Rotation Deficit) vs. Total Motion

A
  • Sometimes patients appear to have a deficit in IR rotation when they do not.
  • When assessed, internal rotation is limited, but ER is excessive.
    ~ True GIRD would show diminished
    IR, but ER would be normal
  • As long as total motion is 150-190 degrees GIRD is not likely.
  • Possible that the shape of the humerus has been changed by forceful, overhead activities.
21
Q

Shoulder Instability

A
  • Laxity is a clinical sign and instability is a symptom
  • Instability is a joint’s inability to function under the stresses on functional activity
  • Glenohumeral Joint
    ~ Relatively Unstable Joint
    > Small, Flat Glenoid v. Large,
    Round Head
    > Loose Capsule
    > Allows for High Mobility
    > Majority of Stability from Rotator
    Cuff
22
Q

How do you make the shoulder more stable?

A
  • Make it move more functionally
  • Only training IR and ER doesn’t result in a more stable shoulder
  • Only training the scapula to stay still doesn’t result in a more stable shoulder
23
Q

What type of muscle contraction is being used when the rotator cuff is stabilizing the shoulder?

A

Isometric

24
Q

How can rotator cuff activity be characterized?

A
  • Low resistance
  • High reps
25
Q

Labral Tears

A
  • As with any shoulder repair follow physician protocols closely during early stages.
  • Address obvious deficits.
  • Train the Cuff for stabilization
  • Avoid movements that will overly stress repair.
    ~ Remember shoulder kinematics.
  • Common with dislocations
26
Q

Which way does the humerus translate during flexion, extension, abduction, IR, ER?

A
  • Flexion: Posterior
  • Extension: Anterior
  • IR: Posterior
  • ER: Anterior
  • Abduction: Inferior
27
Q

Muscles important at the elbow: Flexor/Pronator Group

A
  • All originate at the medial epicondyle
    ~ Pronator Teres
    ~ Palmaris Longus
    ~ Flexor Carpi Radialis
    ~ Flexor Carpi Ulnaris
    ~ Flexor Digitorum Superficialis
    ~ Flexor Digitorum Profundus
28
Q

What does the flexor/pronator group do?

A
  • Flexes wrist and fingers.
  • Pronates the forearm.
  • Stabilizes the medial elbow.
29
Q

If flexor/pronator group does not do its job what can result?

A

Sprain/rupture of UCL

30
Q

How should the flexor/pronator group be rehabbed to enhance function?

A
  • Move the UE in functional patterns.
    ~ Anytime you elevate the limb the
    elbow groups work to stabilize
    especially in overhead movements.
  • Work in a diverse way.
    ~ Concentrically, Eccentrically and
    Isometrically/NM control activity.
  • Incorporate Integrated Isolation
31
Q

Muscles Important at the elbow: Extensor/Supinator Group

A
  • All originate at the lateral epicondyle
    ~ Extensor Carpi Radialis Longus
    ~ Extensor Carpi Radialis Brevis
    ~ Extensor Digitorum
    ~ Extensor Carpi Ulnaris
    ~ Supinator
32
Q

What does the extensor/supinator group do?

A
  • Extends wrist and fingers.
  • Supinates the forearm.
  • Stabilizes the lateral elbow
    ~ But less compared to the flexor/
    pronator group
    ~ Resting position is always in valgus,
    so it’s uncommon to injure the
    lateral elbow
33
Q

What makes the muscle groups of the elbow unhappy?

A
  • Overuse
  • Mechanical problems down the chain
    - Same as the shoulder, efficient UE
    movements utilize loading and
    unloading of the LE
34
Q

Transverse Plane Loading Patterns for Elbow

A
  • Medial: Flexor/Pronator Group
    ~ Same side hip IR
    ~ Loads same side hip external
    rotators and flexor/pronator group
  • Lateral: Extensor/Supinator
    ~ Opposite side hip IR
    ~ Loads opposite side hip external
    rotators and external/supinator group
35
Q

What would make the flexor/pronator group unhappy?

A

Bad same side LE (especially hip)

36
Q

What would make the extensor/supinator group unhappy?

A

Bad opposite side LE (especially hip)

37
Q

A bad same side LE may be a factor in which elbow conditions? (Medial epicondyle)

A
  • Little leaguer’s elbow (apophysitis or fracture)
  • Golfer’s elbow (medial epicondylitis)
  • UCL sprain
38
Q

A bad opposite side LE may be a factor in which elbow conditions? (Later epicondyle)

A
  • Tennis Elbow (lateral epicondylitis)
    ~ extensor carpi radialis is most
    commonly affected
  • Maybe: RCL sprain
39
Q

Elbow ROM Concerns

A
  • Elbow and finger ROM is especially difficult to obtain.
    ~ Especially Extension
    > Normal resting position
    > Ability to function in flexed
    position
    > Difficulty in passive range
    > Pain = protected position
40
Q

Fingers/Hand Rehab

A
  • Rehab fingers like any other joint.
    ~ NMC
    ~ Mobility
    > Swelling loves to stay in the
    hands due to gravity
    • Will commonly be at the
    dorsal aspect due to a lack of
    musculature
    ~ Function - Remember to ask the
    fingers to do what they are designed
    to do.
    > Manipulate the envirnment
    > Prehension
    • Ability to apply force with
    the hand to perform a task.
41
Q

Types of Prehension (grips): Cylindrical

A

Used for a cylindrical object, such as for a hollow cylinder and coffee mug.

42
Q

Types of Prehension (grips): Tip

A

Used to hold a small a sharp object, such as a nail or a piece of paper.

43
Q

Types of Prehension (grips): Hook

A

Used for heavy objects

44
Q

Types of Prehension (grips): Palmar

A

Used for a flat and relatively thick object

45
Q

Types of Prehension (grips): Spherical

A

Used for a spherical object, such as a ball or an apple

46
Q

Types of Prehension (grips): Lateral (key grip)

A

Used for a thin and flat object

47
Q

Specific contributions to Grip Strength

A
  • Thumb: 17%
  • Index: 22%
  • Middle: 31%
  • Ringle and Little: 29%

Rehabilitation Of Athletic Injuries (13 decks)

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