Upper Extremity Techniques Flashcards
(47 cards)
1
Q
What muscles make up the rotator cuff?
A
- Supraspinatus
- Insfraspinatus
- Teres Minor
- Subscapularis
2
Q
Rotator Cuff Muscle Actions
A
- Supraspinatus
~ Shoulder Abduction - Insfraspinatus
~ Shoulder ER - Teres Minor
~ Shoulder ER - Subscapularis
~ Shoulder IR
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
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
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
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
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.
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)
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
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
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
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.
13
Q
What would make the anterior shoulder unhappy?
A
Bad same side LE (especially hip)
14
Q
What would make the posterior shoulder unhappy?
A
Bad opposite side LE (especially hip)
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
16
Q
What limits scapular motion?
A
- Muscle Tightness/Imbalance/ Diminished NMC.
- Pain associated with injury.
- Immobilization
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
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.
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
Labral Tears
- 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
Which way does the humerus translate during flexion, extension, abduction, IR, ER?
- Flexion: Posterior
- Extension: Anterior
- IR: Posterior
- ER: Anterior
- Abduction: Inferior
27
Muscles important at the elbow: Flexor/Pronator Group
- All originate at the medial epicondyle
~ Pronator Teres
~ Palmaris Longus
~ Flexor Carpi Radialis
~ Flexor Carpi Ulnaris
~ Flexor Digitorum Superficialis
~ Flexor Digitorum Profundus
28
What does the flexor/pronator group do?
- Flexes wrist and fingers.
- Pronates the forearm.
- Stabilizes the medial elbow.
29
If flexor/pronator group does not do its job what can result?
Sprain/rupture of UCL
30
How should the flexor/pronator group be rehabbed to enhance function?
- 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
Muscles Important at the elbow: Extensor/Supinator Group
- All originate at the lateral epicondyle
~ Extensor Carpi Radialis Longus
~ Extensor Carpi Radialis Brevis
~ Extensor Digitorum
~ Extensor Carpi Ulnaris
~ Supinator
32
What does the extensor/supinator group do?
- 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
What makes the muscle groups of the elbow unhappy?
- Overuse
- Mechanical problems down the chain
- Same as the shoulder, efficient UE
movements utilize loading and
unloading of the LE
34
Transverse Plane Loading Patterns for Elbow
- 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
What would make the flexor/pronator group unhappy?
Bad same side LE (especially hip)
36
What would make the extensor/supinator group unhappy?
Bad opposite side LE (especially hip)
37
A bad same side LE may be a factor in which elbow conditions? (Medial epicondyle)
- Little leaguer’s elbow (apophysitis or fracture)
- Golfer’s elbow (medial epicondylitis)
- UCL sprain
38
A bad opposite side LE may be a factor in which elbow conditions? (Later epicondyle)
- Tennis Elbow (lateral epicondylitis)
~ extensor carpi radialis is most
commonly affected
- Maybe: RCL sprain
39
Elbow ROM Concerns
- 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
Fingers/Hand Rehab
- 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
Types of Prehension (grips): Cylindrical
Used for a cylindrical object, such as for a hollow cylinder and coffee mug.
42
Types of Prehension (grips): Tip
Used to hold a small a sharp object, such as a nail or a piece of paper.
43
Types of Prehension (grips): Hook
Used for heavy objects
44
Types of Prehension (grips): Palmar
Used for a flat and relatively thick object
45
Types of Prehension (grips): Spherical
Used for a spherical object, such as a ball or an apple
46
Types of Prehension (grips): Lateral (key grip)
Used for a thin and flat object
47
Specific contributions to Grip Strength
- Thumb: 17%
- Index: 22%
- Middle: 31%
- Ringle and Little: 29%
