Upper Limb Rehabilitation Revision

Question 1

What is the scapular based rehabilitation algorithm?

Answer 1

Lack of soft tissue flexibility
▶️ scapular muscles ➡️ pec minor, levator scapulae, rhomboids ➡️ stretching and mobilisation
▶️ GH muscles/capsule ➡️ posterior capsule, infraspinatus, latissimus dorsi ➡️ stretching and mobilisation

Lack of muscle performance
▶️ muscle control ➡️ co-contraction and force couples ➡️ neuromuscular control ➡️ conscious muscle control
▶️ muscle strength ➡️ lower/middle traps, serratus anterior ➡️ strength training ➡️ conscious muscle control

Question 2

In scapular rehabilitation how is ROM improved?

Answer 2

Soft tissue flexibility:
- pectoral release techniques:
▶️stretching, eccentric loading, soft tissue release
- upper trap & levator scapulae
▶️needling, soft tissue release, stretching

Question 3

In scapular biased scapular rehabilitation what exercises are good for motor control?

Answer 3

Scapular clock - retraction
Scapular setting
Wall press (serratus anterior activation)

Question 4

In scapular biased rehabilitation what exercises are good for strength?

Answer 4

Cables,
Reverse flys
Single arm press

Question 5

In thoracic biased rehabilitation, what exercises are needed to improve ROM, stability, motor control and strength?

Answer 5

Thoracic mobility:

• manual therapy
• foam roller stretches

Cervical stability:
- deep neck flexors

Motor control/postural awareness

• high rep low load
• taping to facilitate

Strengthening

• paraspinal muscles
• back extension and upright rows

Question 6

What are the three types of scapula dyskinesis?

Answer 6

Type 1 = infero-medial prominence
- more evident in cocking motion of overhead sports

Type 2 = medial border prominence

• winging of entire medial border
• more prominent in cocking and repetitive elevation

Type 3 = superomedial border prominence
- associated with impingement and rotator cuff injury

Question 7

Why are closed kinetic chain exercises preferred?

Answer 7

• they make compressive forces as opposed to shearing ones in open chain
• they are nearer to activities of daily living
• they use multiple joints in activity whereas open chain ones use one
• they work multiple muscle groups simultaneously