Week 10 Lecture Flashcards
Scapula position:
Normal/optimal position
Upward rotation 2 degrees (+/-6)
Internal rotation 33 degrees (+/-9)
Anterior tilt 8 degrees (+/- 4)
Why might you have sub optimal scapula kinematics
How does it result in impingement
Sub-optimal scapula kinematics (impingement):
Alteration may be due to
Pain
Soft tissue tightness
Altered musculoskeltetal function of scapula force couple (reduced strength, endurance, altered timing)
Sub-optimal thoracic postures
May result in:
Sub-optimal starting postures of scapula
Altered axes of rotation of scapula during overheadactivity
Compromised ideal scapula position during overhead activity leading to compromised SA space
GHJ deprived of stable base upon which to move/Fx leading to compromised RC Fx
Altered scapula m/s activation/timing doesn’t necessarily = altered scapula kinematics
LIttle evidence of existence of ideal scapula position
Uncertain if alterations in scapula kinematics are causiative (of pain) or compensatory (adaptive) in presence of pain
Mus link apparent sub-optimal scapula mechanics to pain disorder in order to justifable ‘treat’ it.
Summary:
General belief that reduced upward rotation and posterior tilt during arm elevation could reduce available SA space and contribute to development or progression of impingement as well as contribute to a poorer environment for healing
• Describe the timeframes and management approach for patients who have undergone rotator cuff repair surgery
Weeks 0‐6
• Sling – adjust for optimal position & comfort
• No active movts of shoulder
• Passive physiological movts by physio, No ER past neutral OR abduction or flexion past 90
– “Cradle” pendular movts progressing to straight elbow pendular movts
• Gentle scar massage for softening when well healed
• Encourage / facilitate good spinal & scapula postures
Week 6
• Discontinue sling
• Stress analgesic cover – pain common at this stage as movt / activity
Week 6-8
• Progress to active‐assisted shoulder movts
(Pulleys – Self‐assisted with unaffected side – Stick – Start short lever progressing to longer lever)
Week 8+
Progress to active shoulder movts– short lever then long lever;
Flexion 1st progressing to abduction
PAMs introduced as required
Gentle RESISTED MOVEMENTS may be introduced week depending on surgeon – Start with isometric
(Some surgeons prefer no resistance to repaired tendon until 12/52 post op)
Week 13 +
• Graduated strengthening incl loading of repaired tendon – Isometric in elevation, through range resistance, through range resistance in elevation
Pain can persist 6 – 8/12 post op
At 3/12 expect ~60 – 70% function
6 – 12/12 post op return to work / sport
Extra slide on
• Describe methods and approaches to management which would be most appropriate to common clinical presentations in the shoulder region
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