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Shoulder Lecture



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