Shoulder Treatment Lab: Pt 1 Flashcards
(31 cards)
Manual therapy options for the shoulder
Passive accessory movements (PAM) Passive physiological movements (PPM) Mobilization of the scapulothoracic joint Soft tissue mobilization Muscle length interventions Regional interdependence
What joints are treated by passive accessory movements discussed in class?
Glenohumeral, AC, and SC joints
When selecting accessory techniques for GHJ intervention, what should help guide your initial decision making?
The concave-convex rule
Why should one be careful when applying the concave-convex rule when treating GHJ intervention
The selection of techniques may not follow the concave-convex rule.
(i.e. posterior glides have been shown to improve shoulder external rotation)
Where does the treatment plane lie?
Over the concave articular surface
Where does the treatment plane move?
In the same direction as the convex partner
How does the treatment plane behave when the joint partner moves?
It remains stationary
What are grades 1 and 2 used to treat?
Pain prior to reaching resistance
What are grades 3 and 4 used to treat?
Resistance/joint restrictions when pain is not a limitation
Objective of GH caudal glides in full flexion mobs
Mobilize inferior and posterior capsule to increase shoulder flexion
Objective of GH caudal glides in abduction
Mobilize inferior capsule to increase shoulder abduction
Objective of PA mobilization in abduction
Mobilizing anterior capsule. May be useful for patients with significant ER, extension, and horizontal abduction restrictions
What are the precautions for PA mobilization in abduction?
Caution should be applied to patients with a history of GH instability, such as subluxation/dislocation
Objective of AP mobilization in abduction?
Mobilize the posterior capsule to address flexion, internal rotation, and external rotation deficits
Objective of mobilization progression in prone (FABER progression)
To progress through mob techniques in a stiffness dominant shoulder (e.g. stiffness > pain)
Objective of AC joint PAMs
Improve overall movement of the clavicle
Objective of SC joint PAMs
Improve overall movement of the clavicle, though less commonly used as the SC joint is generally hypomobile
In regards to glenohumeral PPM’s, the test…
becomes the treatment
Glenohumeral PPM’s areas of focus
Consider quality of movement and R1 and R2 and relationship to symptoms
Use grades of mobilization (e.g. grades 1-4)
Intention of Low load prolonged stretch (LLPS)
Intended to apply gradual strain on fibrotic capsular and soft tissue structures
When should LLPS be used?
Non-irritable, non-sever patients (i.e. stage 4 frozen shoulder)
Parameters for LLPS
5-10 minute holds, multiple times per day (protocols vary in nature)
Scapulothoracic mobilization options
Clocks
Distraction
Thrust technique
2 examples of scapulothoracic self mobs
Sweeps
Bow and arrow
