Shoulder Lecture


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Shoulder Lecture

  1. 1. Shoulder Mobilization Case Study Proximal Humeral Fracture
  2. 2. History <ul><li>61 year old male </li></ul><ul><li>Fractured the greater tuberosity of the right shoulder eight weeks ago </li></ul><ul><li>Partially tore the rotator cuff muscle of the same shoulder. </li></ul><ul><li>Patient was immobilized in a sling for eight weeks. </li></ul>
  3. 3. Clinical Presentation <ul><li>Sever limitation of right shoulder motions </li></ul><ul><li>Demonstrates a capsular pattern </li></ul><ul><ul><li>External rotation, abduction , medial rotation </li></ul></ul><ul><li>Complains on a dull constant ache within the shoulder at rest. Rating the resting pain as a 6/10 on the pain scale. </li></ul><ul><li>Experiences sharp pains with any motion of the shoulder . Pain is rated as a 8/10. </li></ul><ul><li>X-rays and MRI indicates that the fracture is healed and the rotator cuff is partially healed. </li></ul>
  4. 4. Physical Therapy Referral <ul><li>Restore motion and normal strength to the right shoulder </li></ul>
  5. 5. Clinical Considerations <ul><li>Patient has moderate to sever pain with any movement. </li></ul><ul><li>Shoulder restriction is due primarily to capsular and muscle shortening around the fracture site. </li></ul><ul><li>Muscular strength of the right shoulder complex is weak due to the prolong immobilization. </li></ul>
  6. 6. Treatment Plan <ul><li>Modalities </li></ul><ul><li>Mobilization techniques </li></ul><ul><li>Strengthening exercises </li></ul>
  7. 7. Mobilization <ul><li>Joints to be mobilized </li></ul><ul><ul><li>Glenohumeral </li></ul></ul><ul><ul><li>Sternoclaviclar </li></ul></ul><ul><ul><li>Acromclavical </li></ul></ul><ul><ul><li>Scapula </li></ul></ul><ul><li>Potential muscled that are shorten. </li></ul><ul><ul><li>Subscapularis </li></ul></ul><ul><ul><li>Pectoral major & minor </li></ul></ul><ul><ul><li>Infaspinatus & teres minor </li></ul></ul><ul><ul><li>Lat </li></ul></ul><ul><ul><li>Rhomboids </li></ul></ul><ul><ul><li>Serrtaus </li></ul></ul><ul><ul><li>Upper mid and lower trap </li></ul></ul>
  8. 8. Goal Increase shoulder glenohumeral motion without exacerbation of pain.
  9. 9. Concepts To Remember In The Glenohumeral Joint <ul><li>Osteokinematic : There is 3 degrees of freedom </li></ul><ul><ul><li>Flexion/Extension, ABd /ADd, Internal/External Rot. </li></ul></ul><ul><li>Articulator surface anatomy </li></ul><ul><ul><li>Concave glenoid & convex humerus </li></ul></ul><ul><ul><li>Loose pack position 20 degrees scapulohumeral abduction with 30 degrees elevation in the scapular plane. </li></ul></ul>
  10. 10. Concepts To Remember In The Shoulder Complex Joint <ul><li>Accessory (C omponent ) Motions </li></ul><ul><ul><li>Arthokinematic movements that must occur in order for normal osteokinematic movement to take place </li></ul></ul><ul><ul><ul><li>Eg. Inferior Glide </li></ul></ul></ul><ul><li>Joint Play Motion </li></ul><ul><ul><li>Those accessory that can be produced passively at a joint but not actively. </li></ul></ul><ul><ul><ul><li>Eg. Lateral Distraction </li></ul></ul></ul>
  11. 11. Physiological Movements Refer to Matiland CD
  12. 12. Shoulder Flexion <ul><li>Glenohumeral </li></ul><ul><ul><li>Lateral distaction </li></ul></ul><ul><ul><li>Inferior glide </li></ul></ul><ul><ul><li>Posteior glide </li></ul></ul><ul><li>Sternoclavicular </li></ul><ul><ul><li>Inferior gilde </li></ul></ul><ul><ul><li>Anterior glide </li></ul></ul><ul><li>Scapula </li></ul><ul><ul><li>Distraction </li></ul></ul><ul><ul><ul><li>Upward rotation </li></ul></ul></ul><ul><ul><ul><li>Elevation </li></ul></ul></ul>
  13. 13. Scapluar Plane Oscillations <ul><li>General technique </li></ul><ul><ul><li>Introductory </li></ul></ul><ul><ul><li>Pain </li></ul></ul><ul><ul><li>Lubication of tissues </li></ul></ul>
  14. 14. Glenohumeral Lateral Distraction <ul><li>Often one of the first technique to use </li></ul><ul><li>Good for general capsular tightness </li></ul><ul><li>Pain control </li></ul>
  15. 15. Inferior Glide In Loose Pack <ul><li>For restriction in flexion and abduction </li></ul><ul><li>Used to decreased pain </li></ul><ul><ul><li>with grade I & II oscillation </li></ul></ul>
  16. 16. Inferior Glide At 90º of Abduction <ul><li>Increase mid-range </li></ul><ul><ul><li>flexion and abduction </li></ul></ul>
  17. 17. Anterior Glide In Loose Pack <ul><li>The primary tissue affect by this technique is the anterior capsular region </li></ul>
  18. 18. Posterior Glide In Loose Pack Matiland Technique <ul><li>Indication for posterior capsular tightness </li></ul><ul><li>Used in the early phases of the rehab to began </li></ul><ul><li>To increase internal rotation </li></ul>
  19. 19. Posterior Glide At 90º Abduction <ul><li>Posterior Glide at 90 degrees abduction </li></ul><ul><li>Increase flexion and internal rotation </li></ul>
  20. 20. Posterior Glide in Flexion <ul><li>Advance technique that gives a strong localized stretch to posterior capsule </li></ul>
  21. 21. Sternoclavicluar Inferior Glide <ul><li>Used to improve component motion for shoulder flexion. </li></ul>
  22. 22. Anterior & Posterior Glide of AC Joint <ul><li>Assist in improving shoulder flexion </li></ul><ul><li>Used to decreased joint pain in the AC joint </li></ul>
  23. 23. Scapula Mobilizations <ul><li>The purpose of these techniques is to increase range of motion in scapular: </li></ul><ul><ul><li>Superior glide </li></ul></ul><ul><ul><li>Inferior glide </li></ul></ul><ul><ul><li>Medial rotation </li></ul></ul><ul><ul><li>Lateral rotation </li></ul></ul>
  24. 24. Advance Soft Tissue Stretching Latissmus Dorsi <ul><li>Patient supine </li></ul><ul><li>Therapist at the head of patient </li></ul><ul><li>One hand grips medial side of patient hand just above elbow and move it into flexion while laterally rotating the shoulder </li></ul><ul><li>The other hand and forearm stabilizes the lower thorax </li></ul><ul><li>Using the grip begin to stretch into flex and lateral rotation </li></ul>
  25. 25. Advance Soft Tissue Stretching Pectoralis Major <ul><li>Patient supine </li></ul><ul><li>Therapist using both hands grips the medial side of the patient’s elbow and flexs and laterally rotate the arms </li></ul><ul><li>Placing a stretch on the pectoral muscles </li></ul>
  26. 26. Subscapularis Stretch End Range
  27. 27. End Range Internal Rotation <ul><li>Use graded oscillations </li></ul><ul><li>This technique may also be performed in prone </li></ul>