Exercise Interventions for the Shoulder Girdle Flashcards
Classification systems to guide treatment for non-operative shoulder conditions
- stage approach for rehab of shoulder disorders (STAR-Shoulder): includes screening tool, pathoanatomic diagnosis, & rehab classification based on irritability rating & primary impairments
- allows for matching of intervention strategies & tactics with the categories of classification
- results in directed rehab treatment program
What makes a patient not appropriate for physical therapy
- tumor
- infection
- fracture or unreduced dislocation
- neurologic lesion
- visceral pathology
Pathoanatomic diagnosis for subacromial pain syndrome
- Rule in: impingement signs (Near, Hawkins, Jobe tests), painful arc, pain with isometric resistance, weakness, atrophy
- Rule out: significant loss of motion & signs of instability
Pathoanatomic diagnosis for adhesive capsulitis
- Rule in: spontaneous progressive pain. loss of ROM, external rotation most limited, pain at end range
- Rule out: normal motion & age <40
Pathoanatomic diagnosis for glenohumral instability
- Rule in: age <40, history of dislocation or subluxation, apprehension test, relocation test, generalized laxity
- Rule out: no history of dislocation or subluxation, no apprehension with testing
What movement systems contribute to insufficient scapular upward rotation
- insufficient lower serratus anterior force or activation
- insufficient lower trapezius force or activation
What movement system contributes to excessive scapular internal rotation
- insufficient lower or middle trapezius force or activation
What is the importance of scapular muscles
- weakness may result in abnormal positioning of the scapula, impaired rhythm, & generalized shoulder disfunction
- the serratus anterior & lower trapezius are most commonly involved
- impacts on the force couple relationship may cause a decrease in the subacromial space
Parameters for different shoulder deficits
- Strength/power deficit: low reps, high load
- Coordination/control deficit: motor control retraining
- Endurance deficit: high reps, low load
- Soft tissue flexibility deficit: stretching. mobilization
Exercise techniques for acute/early subacute
- Early motion of the GH joint: wand/cane exercises, ball rolling or table top dusting, wall/window washing, & pendulum (Codman’s exercise)
- Early motion of the scapula: PROM and AAROM of the scapula
- Early neuromuscular control: protected weight bearing, multiple angle muscle setting
Exercise techniques for flexibility & ROM
- self stretching directional techniques used to improve ROM
- flexion & horizontal adduction (Cross chest stretch)
- flexion & elevation of the arm in sitting with use of pulley system
- external & internal rotation stretches
- abduction & elevation of the arm in sitting using different body positions, a table top or theraball
Shoulder exercises for performance initiation, motor control, and stability
- isometrics with scapular focus: scapular squeezes/pinches, “robbery” pinches
- multiple angle isometrics with GH focus: ER, IR, ABD, ADD, scapular elevation, extension, elbow flexion with supination
- progress to self applied multiple angle isometrics
- stabilization exercises: scapular stability is trained in closed chain, GH stability is trained in open chain
What exercises will activate each part of trapezius the most/least
- standing exercises will increase upper trap activation the most (60-120 degrees elevation)
- prone exercises will produce the least upper trap activation but increase middle & lower trap activation
What does scapular retraction strengthen
- rhomboids
- middle trapezius
What does scapular retraction with shoulder horizontal abduction/extension strengthen
- rhomboids
- middle trapezius
- poster deltoid
