This document provides information on managing glenohumeral joint hypomobility through various treatment phases including protection, controlled motion, and return to function. It describes exercises and techniques for each phase such as pendulum exercises, muscle setting, joint mobilization, stretching, and strengthening. Precautions for glenohumeral arthroplasty rehabilitation are also outlined including limitations during the protection phase and gradual progression of range of motion and strengthening exercises.
Dr. Robin McKenzie developed the McKenzie Method for treating back pain mechanically without surgery or medication. The method involves assessing a patient's pain response to various spinal movements to determine the underlying problem. Treatment focuses on specific exercises that centralize the pain by improving spinal mechanics. Exercises may involve extension, flexion, or lateral movements. The goal is to reduce pain and improve range of motion over several weeks with a home exercise program. Precautions are taken for certain conditions like spinal stenosis or recent trauma. The McKenzie Method provides an alternative to medication for many back pain issues.
This document discusses transfemoral prostheses. It begins with an introduction to transfemoral amputation, which is the amputation of the leg between the knee and hip. It then covers the rehabilitation process for individuals with a transfemoral amputation, including exercises and management of the residual limb. Finally, it describes the components of transfemoral prostheses, including different socket designs, suspension methods, knee and foot options. The goal of rehabilitation and prosthetic training is to help individuals regain mobility and independence.
Biomechanics of cane, crutch and walkerRashmitadash3
Walking aids such as crutches, walkers, and canes are used to assist with locomotion by reducing pressure on injured tissues and compensating for loss of mobility. They work by transmitting body weight through the hands and arms to provide stability, support, and assist with propulsion during walking. The proper selection and fitting of an assistive device, along with training in safe usage techniques, can help ensure users experience the physiological and psychological benefits of increased mobility while minimizing forces placed on the body.
Re-education means educating something, which is already known by an individual.
Here the patient knows the activities or movements or functions that has, to be performed but due to his ailment or diseased pathology he could not perform it properly.
An Immediate Post operative Prosthesis (IPOP) or Immediate Post-surgical fitting is a device that is applied before or after wound closure that protects the suture site and allows limited weight bearing and gait training. It serves as a bridge between surgery and a definitive prosthesis. IPOPs can be custom fabricated or prefabricated and are commonly used at the transtibial and transradial levels. Advantages include reducing phantom limb pain and sensations, earlier weight bearing and rehabilitation, and shorter recovery times. Air splints are a type of non-custom IPOP that provide uniform pressure distribution, easy inspection of incision sites, and partial weight bearing ability.
Osteotomy is a surgical procedure that cuts or divides bone to improve the function of a limb or provide stability to a joint. It involves three stages - dividing the bone, immobilizing it to allow correction and realignment, and physiotherapy to restore full function. Different types of osteotomies like closing wedge, opening wedge, and oblique cuts are used to correct various bone deformities and dysfunctions. Post-surgery physiotherapy focuses on reducing pain and swelling, maintaining stability, and gradually improving range of motion and strength. Complications can include under or overcorrection of deformity, nerve damage, compartment syndrome, and non-union of bone.
A complete description of the lower limb orthosis is available in the following presentation with an in depth understanding of the same.It covers the ankle foot orthosis,Knee orthosis the knee ankle foot orthosis and hip orthosis.
Measurements for prescription of wheelchairalma_snyman
This document provides guidelines for measuring a client for wheelchair prescription, including measuring the width of the hips/shoulders, length of the seat from back of pelvis to back of knee, height of the footrest from back of knee to bottom of heel, various heights for the backrest, and height of armrests from seat base to bent elbow. The measurements are used to determine the appropriate dimensions for a wheelchair to provide optimal support, function, and prevention of secondary disabilities for an individual client. A form is included to record all body measurements needed for wheelchair specification.
Dr. Robin McKenzie developed the McKenzie Method for treating back pain mechanically without surgery or medication. The method involves assessing a patient's pain response to various spinal movements to determine the underlying problem. Treatment focuses on specific exercises that centralize the pain by improving spinal mechanics. Exercises may involve extension, flexion, or lateral movements. The goal is to reduce pain and improve range of motion over several weeks with a home exercise program. Precautions are taken for certain conditions like spinal stenosis or recent trauma. The McKenzie Method provides an alternative to medication for many back pain issues.
This document discusses transfemoral prostheses. It begins with an introduction to transfemoral amputation, which is the amputation of the leg between the knee and hip. It then covers the rehabilitation process for individuals with a transfemoral amputation, including exercises and management of the residual limb. Finally, it describes the components of transfemoral prostheses, including different socket designs, suspension methods, knee and foot options. The goal of rehabilitation and prosthetic training is to help individuals regain mobility and independence.
Biomechanics of cane, crutch and walkerRashmitadash3
Walking aids such as crutches, walkers, and canes are used to assist with locomotion by reducing pressure on injured tissues and compensating for loss of mobility. They work by transmitting body weight through the hands and arms to provide stability, support, and assist with propulsion during walking. The proper selection and fitting of an assistive device, along with training in safe usage techniques, can help ensure users experience the physiological and psychological benefits of increased mobility while minimizing forces placed on the body.
Re-education means educating something, which is already known by an individual.
Here the patient knows the activities or movements or functions that has, to be performed but due to his ailment or diseased pathology he could not perform it properly.
An Immediate Post operative Prosthesis (IPOP) or Immediate Post-surgical fitting is a device that is applied before or after wound closure that protects the suture site and allows limited weight bearing and gait training. It serves as a bridge between surgery and a definitive prosthesis. IPOPs can be custom fabricated or prefabricated and are commonly used at the transtibial and transradial levels. Advantages include reducing phantom limb pain and sensations, earlier weight bearing and rehabilitation, and shorter recovery times. Air splints are a type of non-custom IPOP that provide uniform pressure distribution, easy inspection of incision sites, and partial weight bearing ability.
Osteotomy is a surgical procedure that cuts or divides bone to improve the function of a limb or provide stability to a joint. It involves three stages - dividing the bone, immobilizing it to allow correction and realignment, and physiotherapy to restore full function. Different types of osteotomies like closing wedge, opening wedge, and oblique cuts are used to correct various bone deformities and dysfunctions. Post-surgery physiotherapy focuses on reducing pain and swelling, maintaining stability, and gradually improving range of motion and strength. Complications can include under or overcorrection of deformity, nerve damage, compartment syndrome, and non-union of bone.
A complete description of the lower limb orthosis is available in the following presentation with an in depth understanding of the same.It covers the ankle foot orthosis,Knee orthosis the knee ankle foot orthosis and hip orthosis.
Measurements for prescription of wheelchairalma_snyman
This document provides guidelines for measuring a client for wheelchair prescription, including measuring the width of the hips/shoulders, length of the seat from back of pelvis to back of knee, height of the footrest from back of knee to bottom of heel, various heights for the backrest, and height of armrests from seat base to bent elbow. The measurements are used to determine the appropriate dimensions for a wheelchair to provide optimal support, function, and prevention of secondary disabilities for an individual client. A form is included to record all body measurements needed for wheelchair specification.
This document provides definitions and descriptions of various hip, knee, ankle, and foot orthoses. It describes a hip-knee-ankle-foot orthosis (HKAFO) as an orthosis that stabilizes or locks the hip, knee, and ankle. The typical HKAFO consists of two knee-ankle-foot orthoses linked above the hip with a pelvic band or lumbosacral orthosis. It also discusses indications, principles, components, and fabrication of HKAFOs as well as other orthoses like reciprocal gait orthoses and hip orthoses.
This document provides an overview of wheelchairs. It discusses the history and types of manual and powered wheelchairs. Key details include the various components of wheelchairs like frames, seats, armrests and how to properly measure and set them up. Indications for wheelchair usage and factors to consider when prescribing one are also outlined. Complications from long-term usage are mentioned.
Classified according to design characteristics
Minimal motion control ……. Collars that encircle the neck with fabric, resilient foam, or rigid plastic.
The Philadelphia collar has mandibular and occipital extensions; sometimes used for upper cervical injuries
Maximum orthotic control of neck
Spinal orthoses are external devices that are applied to the spinal segments to manage various spinal conditions. They work by limiting spinal motion and decreasing load on the treated region. Common uses include treating unstable fractures, providing support after surgery or for osteoporosis, and relieving back pain. Spinal orthoses include cervical collars, halo devices, and braces that extend from the neck to the lower back. They work through principles like balanced forces, fluid compression, and serving as a reminder to restrict movement.
Shoulder dislocation with physiotherapy managementKrishna Gosai
The document summarizes the types, diagnosis, treatment, and physiotherapy management of shoulder dislocations. There are three main types of shoulder dislocations - anterior, posterior, and luxatio erecta. Anterior dislocations are the most common, often caused by a fall on an outstretched hand. Treatment involves reduction, immobilization for 3 weeks, followed by a mobilization phase and physiotherapy to regain full range of motion. Physiotherapy focuses on strengthening muscles around the shoulder and regaining passive range of motion to prevent recurrent dislocations and return to full function.
physiotherapy Management in obesity,osteoporosis,diabetes,ricketsAakash jainth
1. The document discusses physiotherapy management for several conditions including rickets, osteoporosis, diabetes, and obesity. It provides information on prevalence, causes, signs and symptoms, and the effects of exercise for each condition.
2. Exercise recommendations include aerobic exercise, resistance training, and balancing exercises. Physiotherapy aims to educate patients, prevent further bone loss, increase strength, improve mobility and balance, and help patients return to regular activities.
3. Flexion exercises are contraindicated for osteoporosis, while regular low-impact exercise can help increase bone mineral density and prevent fractures when managing these chronic conditions.
Spinal orthotics are external devices that limit spinal motion, correct deformities, reduce loading, or improve spinal function. They include flexible braces made of fabric or elastic and rigid braces made of thermoplastics or metals. Cervical collars come in soft and hard varieties and are used for neck injuries or post-operatively. Thoracic-lumbar-sacral orthoses (TLSO) and lumbosacral corsets (LSO) are used for lumbar injuries or fractures. The halo cervical orthosis provides the greatest cervical immobilization using pins in the skull. Drawbacks of orthotics include discomfort, skin issues, and decreased function with prolonged use.
Physiotherapy plays an important role in the management of burn injuries. It focuses on positioning, splinting, and scar management to prevent contractures and promote wound healing. Positioning aims to maintain joints in functional positions opposite to the direction of potential contracture. Splinting is used during the acute inflammatory phase and following skin grafting to maintain positioning. Physiotherapy also addresses scar management through pressure therapy, stretching, and exercises to improve range of motion and function.
Gait training Physiotherapy perspective.pptxSusan Jose
do you know what is gait?
lets know more this presentation.
can physiotherapist help you with your walking abilities. click on the above slide to know more.
Advances in shoulder surgery and rehabilitation - Len Funk 2012Lennard Funk
This document discusses how arthroscopic shoulder surgery rehabilitation has progressed along with the surgery itself. While surgery has advanced significantly with smaller incisions and faster recovery times, the literature finds the rehabilitation protocols lack evidence. Early mobilization is beneficial for tendon healing, strength recovery, and restoration of the kinetic chain. However, immobilization does not necessarily lead to more stiffness long-term. Further research is still needed on the effects of immobilization versus early motion on re-tear rates. Overall, rehabilitation should aim to restore the shoulder kinetic chain through closed-chain exercises in a progressive manner based on the specific procedure.
The document discusses wheelchairs and their components. It describes the basic parts of a wheelchair including the frame, tires, wheels, brakes, casters, push rims, footrests, backrests, armrests, seats, cushions, and anti-tip bars. It explains that wheelchairs come in different sizes for adults, children, and infants. The appropriate wheelchair must be prescribed based on the individual's needs and circumstances to provide maximum comfort.
The patient is a 29-year-old male policeman who fractured his left tibial condyle in a MVA 3 months ago and underwent surgery to repair it. He has since been immobilized for 6 weeks to allow healing but now demonstrates moderate loss of flexion and extension in the left knee with residual swelling, weakness, and intermittent pain. The immediate goal of physical therapy is to regain motion in the left knee through joint mobilization, soft tissue stretching, and strengthening exercises.
A presentation created for Pulmonary Rehab about energy conservation. Teaches ways for COPD patients to conserve their energy both in the home and away from home. Tips to rearrange their home to better suit their needs.
Total knee replacement is a salvage procedure in orthopaedic surgery to provide a painless, mobile and stable knee joint to improve quality of life of patients suffering from afvanced painful arthritis commonly osteoarthritis, rheumatoid arthritis and rarely post-traumatic arthritis. Damaged cartilages and bones are carefully removed by measured resection and the collateral ligaments are preserved and balanced for creating a equal gap both in knee flexion as well as in knee extension for restoring anatomy. the main indication for doing total knee replacement is pain relief. The overall functional outcomes in terms of functional results are good after total knee replacement. Wound infection must be prevented by strict aseptic precautions during surgery.
This presentation will give an basic insights about the spinal mobilisation and various manual therapy techniques used on Lumbar spine especially Maitland & Mulligan techniques.
The Brunnstrom approach is a motor recovery model developed for stroke patients. It is based on the theory that development occurs in reverse order after stroke. The approach uses reflexes and primitive movement patterns to facilitate recovery of voluntary movement. Treatment progresses from reflex movements to voluntary movements to functional movements. Facilitation techniques are reduced as the patient gains voluntary control. The main goals are to move the patient through Brunnstrom's stages of recovery from flaccid to near normal movement. Bed positioning, mobility, and facilitation techniques target specific synergies and are used early in recovery.
This document describes three upper limb tension tests (ULTT1, ULTT2, ULTT3) used to assess the cervical spine and brachial plexus. ULTT1 involves abducting, supinating, and laterally rotating the shoulder while extending the elbow and wrist. ULTT2 adds shoulder depression while extending the elbow and laterally rotating the arm. ULTT3 (ulnar nerve bias) assesses the cubital tunnel by having the patient flex their elbow while the examiner controls their hand and arm. Precautions are described and variations discussed, including assessing different angles of abduction. The tests aim to isolate tensions and identify symptoms to determine involved structures.
This document discusses coronary artery bypass graft (CABG) surgery and cardiac rehabilitation. It defines CABG as a surgery that creates new routes around blocked coronary arteries using healthy vessels from other parts of the body. It then describes the various types of CABG procedures and the heart-lung machine used. Post-operation, patients undergo cardiac rehabilitation in phases to promote recovery through exercise and education while reducing risk factors. The goals are to restore blood flow, relieve chest pain, improve quality of life and lower heart attack risk.
The document discusses various mobility devices used to increase patient mobility. It describes devices from ancient times like canes made from tree branches to modern devices with aluminum, steel, plastic and rubber. Key devices discussed include canes, crutches, walkers, wheelchairs and scooting boards. The document provides details on appropriate usage, measurements, adjustments and positioning for different mobility devices.
PNF is an approach to therapeutic exercise that combines diagonal movement patterns with techniques to improve neuromuscular control and function. It uses manual contacts by the therapist during movement to provide resistance and cues. Patterns involve multi-joint movements of the extremities and trunk. Techniques include stretches, contractions against resistance, and variations in speed and direction to strengthen muscles. Mechanical resistance can also be used to improve strength through varied exercises targeting major muscle groups. Guidelines recommend moderate intensity resistance training 2-3 times per week that gradually increases in difficulty.
This document defines and describes different types of passive range of motion (PROM) exercises. It begins by defining PROM as movements produced by an external force during muscular inactivity or reduced range of motion. There are three main types of PROM discussed: relaxed PROM, forced PROM, and continuous passive motion (CPM). Relaxed PROM is performed slowly through pain-free range by a therapist, while forced PROM exerts external force to end range. CPM uses a machine to passively move the joint continuously after surgery. The goals of PROM are to maintain range of motion, mobility, and prevent contractures while allowing for healing. Precautions are discussed as well as limitations compared to active exercises.
This document provides definitions and descriptions of various hip, knee, ankle, and foot orthoses. It describes a hip-knee-ankle-foot orthosis (HKAFO) as an orthosis that stabilizes or locks the hip, knee, and ankle. The typical HKAFO consists of two knee-ankle-foot orthoses linked above the hip with a pelvic band or lumbosacral orthosis. It also discusses indications, principles, components, and fabrication of HKAFOs as well as other orthoses like reciprocal gait orthoses and hip orthoses.
This document provides an overview of wheelchairs. It discusses the history and types of manual and powered wheelchairs. Key details include the various components of wheelchairs like frames, seats, armrests and how to properly measure and set them up. Indications for wheelchair usage and factors to consider when prescribing one are also outlined. Complications from long-term usage are mentioned.
Classified according to design characteristics
Minimal motion control ……. Collars that encircle the neck with fabric, resilient foam, or rigid plastic.
The Philadelphia collar has mandibular and occipital extensions; sometimes used for upper cervical injuries
Maximum orthotic control of neck
Spinal orthoses are external devices that are applied to the spinal segments to manage various spinal conditions. They work by limiting spinal motion and decreasing load on the treated region. Common uses include treating unstable fractures, providing support after surgery or for osteoporosis, and relieving back pain. Spinal orthoses include cervical collars, halo devices, and braces that extend from the neck to the lower back. They work through principles like balanced forces, fluid compression, and serving as a reminder to restrict movement.
Shoulder dislocation with physiotherapy managementKrishna Gosai
The document summarizes the types, diagnosis, treatment, and physiotherapy management of shoulder dislocations. There are three main types of shoulder dislocations - anterior, posterior, and luxatio erecta. Anterior dislocations are the most common, often caused by a fall on an outstretched hand. Treatment involves reduction, immobilization for 3 weeks, followed by a mobilization phase and physiotherapy to regain full range of motion. Physiotherapy focuses on strengthening muscles around the shoulder and regaining passive range of motion to prevent recurrent dislocations and return to full function.
physiotherapy Management in obesity,osteoporosis,diabetes,ricketsAakash jainth
1. The document discusses physiotherapy management for several conditions including rickets, osteoporosis, diabetes, and obesity. It provides information on prevalence, causes, signs and symptoms, and the effects of exercise for each condition.
2. Exercise recommendations include aerobic exercise, resistance training, and balancing exercises. Physiotherapy aims to educate patients, prevent further bone loss, increase strength, improve mobility and balance, and help patients return to regular activities.
3. Flexion exercises are contraindicated for osteoporosis, while regular low-impact exercise can help increase bone mineral density and prevent fractures when managing these chronic conditions.
Spinal orthotics are external devices that limit spinal motion, correct deformities, reduce loading, or improve spinal function. They include flexible braces made of fabric or elastic and rigid braces made of thermoplastics or metals. Cervical collars come in soft and hard varieties and are used for neck injuries or post-operatively. Thoracic-lumbar-sacral orthoses (TLSO) and lumbosacral corsets (LSO) are used for lumbar injuries or fractures. The halo cervical orthosis provides the greatest cervical immobilization using pins in the skull. Drawbacks of orthotics include discomfort, skin issues, and decreased function with prolonged use.
Physiotherapy plays an important role in the management of burn injuries. It focuses on positioning, splinting, and scar management to prevent contractures and promote wound healing. Positioning aims to maintain joints in functional positions opposite to the direction of potential contracture. Splinting is used during the acute inflammatory phase and following skin grafting to maintain positioning. Physiotherapy also addresses scar management through pressure therapy, stretching, and exercises to improve range of motion and function.
Gait training Physiotherapy perspective.pptxSusan Jose
do you know what is gait?
lets know more this presentation.
can physiotherapist help you with your walking abilities. click on the above slide to know more.
Advances in shoulder surgery and rehabilitation - Len Funk 2012Lennard Funk
This document discusses how arthroscopic shoulder surgery rehabilitation has progressed along with the surgery itself. While surgery has advanced significantly with smaller incisions and faster recovery times, the literature finds the rehabilitation protocols lack evidence. Early mobilization is beneficial for tendon healing, strength recovery, and restoration of the kinetic chain. However, immobilization does not necessarily lead to more stiffness long-term. Further research is still needed on the effects of immobilization versus early motion on re-tear rates. Overall, rehabilitation should aim to restore the shoulder kinetic chain through closed-chain exercises in a progressive manner based on the specific procedure.
The document discusses wheelchairs and their components. It describes the basic parts of a wheelchair including the frame, tires, wheels, brakes, casters, push rims, footrests, backrests, armrests, seats, cushions, and anti-tip bars. It explains that wheelchairs come in different sizes for adults, children, and infants. The appropriate wheelchair must be prescribed based on the individual's needs and circumstances to provide maximum comfort.
The patient is a 29-year-old male policeman who fractured his left tibial condyle in a MVA 3 months ago and underwent surgery to repair it. He has since been immobilized for 6 weeks to allow healing but now demonstrates moderate loss of flexion and extension in the left knee with residual swelling, weakness, and intermittent pain. The immediate goal of physical therapy is to regain motion in the left knee through joint mobilization, soft tissue stretching, and strengthening exercises.
A presentation created for Pulmonary Rehab about energy conservation. Teaches ways for COPD patients to conserve their energy both in the home and away from home. Tips to rearrange their home to better suit their needs.
Total knee replacement is a salvage procedure in orthopaedic surgery to provide a painless, mobile and stable knee joint to improve quality of life of patients suffering from afvanced painful arthritis commonly osteoarthritis, rheumatoid arthritis and rarely post-traumatic arthritis. Damaged cartilages and bones are carefully removed by measured resection and the collateral ligaments are preserved and balanced for creating a equal gap both in knee flexion as well as in knee extension for restoring anatomy. the main indication for doing total knee replacement is pain relief. The overall functional outcomes in terms of functional results are good after total knee replacement. Wound infection must be prevented by strict aseptic precautions during surgery.
This presentation will give an basic insights about the spinal mobilisation and various manual therapy techniques used on Lumbar spine especially Maitland & Mulligan techniques.
The Brunnstrom approach is a motor recovery model developed for stroke patients. It is based on the theory that development occurs in reverse order after stroke. The approach uses reflexes and primitive movement patterns to facilitate recovery of voluntary movement. Treatment progresses from reflex movements to voluntary movements to functional movements. Facilitation techniques are reduced as the patient gains voluntary control. The main goals are to move the patient through Brunnstrom's stages of recovery from flaccid to near normal movement. Bed positioning, mobility, and facilitation techniques target specific synergies and are used early in recovery.
This document describes three upper limb tension tests (ULTT1, ULTT2, ULTT3) used to assess the cervical spine and brachial plexus. ULTT1 involves abducting, supinating, and laterally rotating the shoulder while extending the elbow and wrist. ULTT2 adds shoulder depression while extending the elbow and laterally rotating the arm. ULTT3 (ulnar nerve bias) assesses the cubital tunnel by having the patient flex their elbow while the examiner controls their hand and arm. Precautions are described and variations discussed, including assessing different angles of abduction. The tests aim to isolate tensions and identify symptoms to determine involved structures.
This document discusses coronary artery bypass graft (CABG) surgery and cardiac rehabilitation. It defines CABG as a surgery that creates new routes around blocked coronary arteries using healthy vessels from other parts of the body. It then describes the various types of CABG procedures and the heart-lung machine used. Post-operation, patients undergo cardiac rehabilitation in phases to promote recovery through exercise and education while reducing risk factors. The goals are to restore blood flow, relieve chest pain, improve quality of life and lower heart attack risk.
The document discusses various mobility devices used to increase patient mobility. It describes devices from ancient times like canes made from tree branches to modern devices with aluminum, steel, plastic and rubber. Key devices discussed include canes, crutches, walkers, wheelchairs and scooting boards. The document provides details on appropriate usage, measurements, adjustments and positioning for different mobility devices.
PNF is an approach to therapeutic exercise that combines diagonal movement patterns with techniques to improve neuromuscular control and function. It uses manual contacts by the therapist during movement to provide resistance and cues. Patterns involve multi-joint movements of the extremities and trunk. Techniques include stretches, contractions against resistance, and variations in speed and direction to strengthen muscles. Mechanical resistance can also be used to improve strength through varied exercises targeting major muscle groups. Guidelines recommend moderate intensity resistance training 2-3 times per week that gradually increases in difficulty.
This document defines and describes different types of passive range of motion (PROM) exercises. It begins by defining PROM as movements produced by an external force during muscular inactivity or reduced range of motion. There are three main types of PROM discussed: relaxed PROM, forced PROM, and continuous passive motion (CPM). Relaxed PROM is performed slowly through pain-free range by a therapist, while forced PROM exerts external force to end range. CPM uses a machine to passively move the joint continuously after surgery. The goals of PROM are to maintain range of motion, mobility, and prevent contractures while allowing for healing. Precautions are discussed as well as limitations compared to active exercises.
This document defines and describes different types of passive range of motion (PROM) exercises. It begins by defining PROM as movements produced by an external force during muscular inactivity or reduced range of motion. There are three main types of PROM discussed: relaxed PROM, forced PROM, and continuous passive motion (CPM). Relaxed PROM is performed slowly through pain-free range by a therapist, while forced PROM exerts external force to end range. CPM uses a machine to passively move the joint continuously after surgery. The goals of PROM are to maintain range of motion, mobility, and prevent contractures while allowing for healing. Precautions are discussed as well as limitations compared to active exercises.
Osteoarthritis of the Knee Joint is a quite common condition found in Indian Population. This presentation is made to understand how this condition affects patients and what are the different Physiotherapy measures to make the patient functionally independent.
0004 AC, SC and ST joints dislocation-Copy.pdfeyobkaseye
This document discusses disorders of the acromioclavicular (AC), sternoclavicular (SC), and glenohumeral (GH) joints. It describes common conditions like AC joint dislocation and arthritis. It also discusses signs, risk factors, classifications systems, treatments, and physiotherapy management for AC joint disorders. For SC joint injuries, it outlines signs, causes, and treatments. Finally, it provides details on shoulder dislocation types, diagnostic procedures, conservative and surgical management, and physiotherapy rehabilitation protocols.
This document discusses range of motion (ROM) exercises including self-assisted ROM, wand exercises, continuous passive motion (CPM), and ROM through functional patterns. Self-assisted ROM uses the uninvolved extremity to move the involved extremity and can be done manually, with equipment, or using reciprocal motion devices. Wand exercises provide guidance for shoulder and elbow ROM. CPM machines passively move a joint through a controlled ROM post-surgery to prevent stiffness and adhesions. Early ROM training focuses on functional patterns like eating, reaching, and dressing.
Stretching is a therapeutic maneuver to increase flexibility by elongating shortened soft tissues. Several factors can contribute to hypomobility including immobilization, poor posture, and injury. Stretching protocols should involve proper alignment, stabilization, low intensity stretches held for 20-30 seconds repeated 3-5 times per week. Common stretching types include static, PNF, and ballistic stretching. Stretching is contraindicated for acute injuries, infections, or joint instability.
The document discusses mobility, range of motion (ROM) exercises, and their purposes and types. It describes active, passive and active-assisted exercises and how they are used. ROM exercises are important to maintain joint function and flexibility. The document outlines different joint movements and provides examples of ROM exercises for each body part from head to toe. It also discusses postural drainage techniques used to clear secretions from the lungs.
The document discusses mobility, range of motion exercises, and postural drainage techniques. It defines mobility and immobility as endpoints on a continuum, with many degrees of partial immobility in between. It describes active, passive and active assisted range of motion exercises and their purposes in maintaining joint function and flexibility. It provides details on different postural drainage positions and manual techniques like percussion, vibration and shaking used to drain secretions from the lungs into larger airways.
The document discusses the rotator cuff, which is made up of four muscles and tendons that hold the humerus in the shoulder joint. Rotator cuff tears are a common cause of shoulder pain and disability. Tears can be classified based on timing (acute or chronic) and depth (partial or complete). Treatment for acute tears is usually surgical repair, while chronic tears may be treated with rest, physical therapy, and surgery if conservative treatment fails. Rehabilitation after repair focuses on protecting the repair while regaining range of motion and strength over 3 phases lasting 3-6 months.
This document provides an introduction to therapeutic exercise and range of motion techniques. It discusses different types of movements including active, passive, assisted and resisted motions. The goals and indications for range of motion exercises like passive and active are explained. Principles, procedures and applications of range of motion techniques are outlined. Different types of assisted and resisted exercises are also described along with their uses.
Therapeutic exercise aims to treat diseases and injuries. There are two main types - passive and active movements. Passive movements are externally assisted and aim to maintain range of motion. Active movements involve patient effort and can be assisted, free, or resisted. The document outlines guidelines for applying range of motion exercises safely and effectively based on a patient's condition and goals. Progressive resistance training is also discussed as a method to gradually increase muscle strength over time.
This document provides information on therapeutic exercises used in physiotherapy. It defines different types of range of motion exercises including passive, active, and active-assisted exercises. It describes goals and indications for each type. Principles of range of motion techniques and how to apply different techniques like for the upper extremities are covered. Factors that affect joint mobility like flexibility, contractures, and immobilization are summarized. Contraindications to stretching and how collagen is affected by immobilization are also mentioned.
Physiotherapy Rehab After Total Hip ReplacementMozammal Rabby
This document outlines the phases of rehabilitation following a total hip replacement surgery. It discusses examination of the patient, education provided, and four phases of rehabilitation: immobilization, maximum protection, moderate protection, and minimum protection. Each phase focuses on specific goals like regaining range of motion, strengthening muscles, improving gait, and resuming normal activities. Precautions are provided to prevent dislocation and protect the new hip joint at each stage of recovery.
This document discusses range of motion (ROM) exercises, including passive, active, and active-assistive ROM. It describes the goals and techniques for each type of exercise, as well as precautions. The principles of ROM techniques involve examination, patient preparation, and application of movements within a patient's pain-free range.
Traction is a physical force which brings about separation of the joint through the bone along its long axis. This can be done manually or mechanically and provides several beneficial effects.
This document provides guidance on rehabilitation for various ankle injuries including gastrocnemius strains, soleus muscle strains, Achilles tendon ruptures, and lateral collateral ligament (LCL) ankle sprains. For gastrocnemius strains, the rehabilitation plan focuses on reducing pain and swelling followed by gentle stretching and progressive strengthening exercises. For Achilles tendon ruptures, the plan involves initial immobilization followed by range of motion and strengthening exercises over several weeks before returning to full weight bearing and functional activities. For LCL ankle sprains, the rehabilitation follows the RICE method initially and focuses on restoring range of motion, strengthening, proprioception training, and functional exercises before returning to sport. Protective taping or bra
The document summarizes the Mulligan technique, an evidence-based manual therapy developed by Brian Mulligan. It was founded on the concept of mobilizing joints with movement to reduce pain and improve range of motion. The technique uses sustained natural glides applied by a therapist concurrently with an active movement by the patient. It aims to correct minor positional faults in joints that cause pain and stiffness. The document outlines the technique's mechanisms of action, principles, indications, contraindications and specific mobilization techniques such as SNAGs, MWMs, and SMWLMs.
Rehabilitation following a reversed total shoulder arthroplasty nwulg 28.2.12Lennard Funk
This document discusses the rehabilitation of reverse total shoulder replacements (rTSR). It notes that rTSR rehabilitation differs from traditional shoulder replacements by focusing initially on stability and deltoid rehabilitation, addressing scapular control, and emphasizing restoration of external rotation. Key points include immobilizing the shoulder initially, progressing to active-assisted then active range of motion, addressing movement deficits, and advancing to functional exercises while monitoring for complications like scapular notching. The goal is improved pain relief and movement, though some patients may have poor outcomes requiring additional support strategies.
Introduction of community medicine & Rehabilitation.pptxDrkAnwerAli
Community medicine aims to understand all factors influencing health and disease. It investigates how disorders affect society and the economy. Epidemiology studies disease patterns in populations. The father of epidemiology was John Snow, and the father of public health was Charles Winslow. Health is defined by the WHO as complete physical, mental, and social well-being without disease. Morbidity refers to disease incidence while mortality refers to death rates. Impairment involves any loss of normal structure or function. Disability restricts activities, and handicap causes disadvantages due to disability. Rehabilitation helps achieve independence through therapy. Medicine involves prevention, diagnosis, and treatment, with preventive measures including vaccination and nutrition programs.
Primary health care (PHC) refers to essential health care services provided at the local community level, including health promotion, disease prevention, and treatment of common illnesses. PHC aims to make health care accessible, affordable, and equitable for all through a community-based approach. Key principles of PHC include community participation, intersectoral coordination between health and other sectors, and making available basic services such as maternal/child care, immunization, treatment of common diseases, and ensuring access to safe water and nutrition. PHC forms the first level of contact with the larger health system and aims to deliver fundamental health care that is close to where people live and work.
This document discusses health education and mental health. It defines health education as a process aimed at encouraging people to maintain and improve their health. The document outlines the aims and key principles of health education, including generating interest, ensuring credibility, promoting participation, and motivating behavior change. It also discusses the communication process, types of communication, barriers to communication, and the scope of information, education, and communication related to health and mental health. Specifically, it defines mental health and mental illness, and outlines the large burden that mental disorders place worldwide.
Cerebral palsy is a group of disorders that affect movement and posture due to non-progressive damage to the developing brain. It is the most common motor disability in childhood. The document discusses the various types of cerebral palsy including spastic, dyskinetic, ataxic and mixed. Treatment focuses on managing symptoms through physical, occupational and speech therapy as well as bracing, medication and surgery. The goal is to improve functional ability and quality of life.
This document provides information on evaluating the thoracic and lumbar spine through clinical examination. It discusses taking a patient history including pain location and characteristics, bowel/bladder issues, and prior injuries. The physical exam involves inspecting posture, curvature, skin, breathing and palpating bony landmarks. Specific conditions like scoliosis, kyphosis and spondylolisthesis are described in terms of causes, signs, grading severity and associated symptoms.
The document discusses the benefits of exercise for mental health. Regular physical activity can help reduce anxiety and depression and improve mood and cognitive function. Exercise causes chemical changes in the brain that may help alleviate symptoms of mental illness and boost overall mental well-being.
A joint dislocation occurs when two bones that meet at a joint are separated from their normal positions. Dislocations are usually caused by trauma like blows, falls, or impacts to the joint. Symptoms of a dislocation include pain, swelling, difficulty moving the joint, numbness, and an unnatural appearance or position of the joint. Treatment involves reducing the dislocation as soon as possible by applying traction or manipulating the joint back into position, immobilizing it, and checking for nerve or blood vessel damage.
The document summarizes the cardiac cycle, which consists of systole and diastole. During diastole, the heart relaxes and fills with blood, while during systole the heart contracts and pumps blood through the arteries. The cardiac cycle contains atrial and ventricular events that occur simultaneously. Atrial events include rapid ventricular filling, diastasis, and atrial contraction that push the remaining 25% of blood into the ventricles. Ventricular events include diastole where the ventricles fill similarly to the atria, and systole where the ventricles contract and eject blood, beginning with the closure of the atrioventricular valves and ending with the closure of the semilunar valves and
This document discusses different types of abnormal postures, including lordosis, kyphosis, scoliosis, and forward head posture. Lordosis and kyphosis involve abnormal curvatures of the spine, with lordosis being an exaggerated forward curvature of the lumbar and cervical spine and kyphosis giving a hunched appearance from increased curvature in the mid back and neck. Scoliosis is a sideways curvature of the spine that is often diagnosed in adolescents. Forward head posture positions the head so the ears are in front of the body's midline rather than aligned with the shoulders, which can cause neck pain and stiffness. The document also notes that correct posture minimizes stress on joints and defines ideal static posture alignment.
Case 1: A 35-year-old male presented with severe lower back pain after heavy lifting. Exam found tender lumbar spine, reduced flexion, and no neurological symptoms. Diagnosis is acute mechanical lower back pain. Management is pain medication, muscle relaxants, and advice on recovery expectations.
Case 2: A 37-year-old male also had lower back pain after heavy lifting, but now the pain radiates down his left leg. Exam found reduced back movement, weak left ankle plantar flexion and big toe flexion, and altered sensation in the left foot. Diagnosis is acute neurogenic lower back pain likely due to herniated disc. Management includes medications and advice, with consideration of imaging and specialist
This document provides an overview of stroke, including its definition, pathophysiology, types, causes, signs and symptoms, diagnosis, and treatment. It notes that stroke is the 5th leading cause of death in the US, occurring when blood flow to the brain is interrupted. There are three main types of stroke: ischemic, hemorrhagic, and transient ischemic attack. Risk factors include hypertension, smoking, heart disease, and diabetes. Diagnosis involves assessing symptoms like numbness or weakness based on the FAST criteria and may include imaging tests and bloodwork. Treatment aims to restore blood flow, reduce complications, and involve physical therapy to improve function.
This document outlines key information about hypertension including its definition, classification, prevalence, complications, contributing factors, and treatment. Hypertension is classified based on systolic and diastolic blood pressure readings into normal, prehypertension, stage 1 hypertension, and stage 2 hypertension. Essential or primary hypertension has no identifiable cause in 90-95% of cases. Complications of hypertension can impact the cardiovascular, central nervous, and renal systems. Lifestyle modifications and medications are used to treat hypertension with the goal of lowering blood pressure.
This document discusses the sacroiliac joint, including common impairments, symptoms, examination techniques, and treatment approaches. Key examination techniques include positional tests like the standing flexion test and stork's test to assess sacral mobility and leg movements. Pain provocation tests apply stress to the joint to identify sensitive areas. Treatment involves joint mobilization, manipulation, muscle stretching, and trunk stabilization exercises. Specific correction techniques are described to address bilateral or unilateral sacral nutation.
The document discusses the Kaltenborn Treatment Plane and translatoric joint movements. Some key points:
- The Kaltenborn Treatment Plane passes through the joint at a right angle to the axis of rotation and lies on the concave articular surface.
- Translatoric joint movements include traction (separation from the treatment plane), compression (approximation toward the treatment plane), and gliding parallel to the treatment plane.
- Joint movements can be assessed using grades I-III, with grade I providing slight loosening and grades II-III increasing tightening and potential stretching of tissues.
The document describes the anatomy and clinical presentations of spinal syndromes affecting the cervical, thoracic, and lumbar regions. Key points include:
1. Cervical syndromes can cause headaches, migraines, and disturbances in senses due to proximity of nerves. Lower cervical issues can influence upper cervical symptoms.
2. Thoracic syndromes are often misdiagnosed as internal organ issues due to referred pain patterns. Mobilization can help differentiate musculoskeletal from visceral causes.
3. Lumbar issues commonly involve discs, facet joints, and nerve roots, causing low back pain and radicular leg symptoms. Visceral causes can mimic nerve root involvement.
This document describes tendon release therapy. It explains that tendons are innervated by the autonomic nervous system and respond similarly to smooth muscles. When a tendon is hypertonic, it becomes rigid. The treatment involves applying pressure to the tendon for 1 minute to release the hypertonicity. Steps for performing tendon release on the Achilles tendon are provided as an example. Indications for tendon release therapy include tendonitis, hypertonicity, and tears/ruptures. Common tendons and disorders that respond well to the therapy are also listed.
This document discusses goals and techniques for spinal joint mobilization. It describes 4 types of mobilization: 1) pain-relief mobilization using low-grade movements to reduce pain, 2) relaxation mobilization to decrease muscle spasm, 3) stretch mobilization to increase range of motion, and 4) manipulation for high-velocity adjustments. Key points include using low-grade traction initially, sustaining stretches for 7+ seconds, fixing one joint to effectively stretch tissues, and monitoring a patient's response to determine if mobilization is helping or worsening their condition.
The document outlines the elements of an osteopathic manual therapy (OMT) evaluation. It describes the screening exam, detailed exam components including history, inspection, tests of function, palpation, and neurologic/vascular exams. It then discusses medical diagnostic studies, diagnosis/trial treatment, and various OMT treatment approaches to relieve symptoms, increase mobility, limit movement, and educate patients. Key elements are screening exams to identify problem regions, detailed exams to diagnose musculoskeletal issues treatable with OMT, and customized OMT plans to address patients' signs, symptoms, and stage of pathology.
The document discusses the Kaltenborn Treatment Plane and translatoric joint movements. Some key points:
- The Kaltenborn Treatment Plane passes through the joint at a right angle to the axis of rotation and lies on the concave articular surface.
- Translatoric joint movements include traction (separation from the treatment plane), compression (approximation toward the treatment plane), and gliding parallel to the treatment plane.
- Joint movements can be assessed using grades I-III, with grade I providing slight loosening and grades II-III increasing tightening and potential stretching of tissues.
This document describes spinal syndromes and the anatomy of the cervical, thoracic, and lumbar regions of the spine. It discusses:
1) Common cervical syndromes including headaches and dizziness caused by dysfunction in the upper cervical spine. Lower cervical issues can radiate to the shoulders.
2) Thoracic syndromes are often mistaken for internal organ issues due to referred pain patterns. Segmental restrictions here can mimic heart or lung problems.
3) Lumbar syndromes frequently involve discs and facet joints. Acute low back pain is commonly misdiagnosed but presents with a flattened lumbar curve rather than muscle spasm.
One health condition that is becoming more common day by day is diabetes.
According to research conducted by the National Family Health Survey of India, diabetic cases show a projection which might increase to 10.4% by 2030.
Travel vaccination in Manchester offers comprehensive immunization services for individuals planning international trips. Expert healthcare providers administer vaccines tailored to your destination, ensuring you stay protected against various diseases. Conveniently located clinics and flexible appointment options make it easy to get the necessary shots before your journey. Stay healthy and travel with confidence by getting vaccinated in Manchester. Visit us: www.nxhealthcare.co.uk
Hiranandani Hospital in Powai, Mumbai, is a premier healthcare institution that has been serving the community with exceptional medical care since its establishment. As a part of the renowned Hiranandani Group, the hospital is committed to delivering world-class healthcare services across a wide range of specialties, including kidney transplantation. With its state-of-the-art facilities, advanced medical technology, and a team of highly skilled healthcare professionals, Hiranandani Hospital has earned a reputation as a trusted name in the healthcare industry. The hospital's patient-centric approach, coupled with its focus on innovation and excellence, ensures that patients receive the highest standard of care in a compassionate and supportive environment.
Integrating Ayurveda into Parkinson’s Management: A Holistic ApproachAyurveda ForAll
Explore the benefits of combining Ayurveda with conventional Parkinson's treatments. Learn how a holistic approach can manage symptoms, enhance well-being, and balance body energies. Discover the steps to safely integrate Ayurvedic practices into your Parkinson’s care plan, including expert guidance on diet, herbal remedies, and lifestyle modifications.
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Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
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Osteoporosis is an increasing cause of morbidity among the elderly.
In this document , a brief outline of osteoporosis is given , including the risk factors of osteoporosis fractures , the indications for testing bone mineral density and the management of osteoporosis
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
2. Glenohumeral Joint Hypomobility
Management
•
PROTECTION PHASE (ACUTE)
• *Control pain, edema, muscle guarding
• may use immobilization, such as a sling (temporary)
• -intermittent PROM / AAROM within pain-free ranges
• *Maintain soft tissue, joint integrity, and mobility
• PROM all planes, progress to AAROM
• Pendulum Exercises (Codman’s)- uses gravity to distract the
humeral head from the fossa (no use of weight at this phase)
• gentle muscle setting
• *Maintain Integrity and Function of Associated Areas
• -keep unaffected joints mobile (neck, elbow, wrist/hand, etc)
3. • Pendulum (Codman’s) Exercises
It is important that the patient uses the momentum from
rocking back and forth.
• No active shoulder motion! For gentle distraction (acute
weight Using a light weight causes grade III (stretching)
Motion can be side to side, clockwise, or
4. • Multiple-Angle Muscle Setting
Multi-angle muscle setting without resistance then
resisted isometrics In later phases the patient can
resistance once further healing has occurred.
5. Glenohumeral Joint Hypomobility
Management
• CONTROLLED MOTION PHASE (SUBACUTE)
• *Control pain, edema
• -PROM, progressing to AAROM (i.e. ‘wand’, ‘table top’ exercises)
• -may continue Codman’s
• *Progressively increase joint and soft tissue mobility
• -patient can be taught self-mobilization (caudal glide, anterior glide, and/or
posterior glide)
• -manual stretching by PT/PTA
• -self-stretching exercises
• *Inhibit muscle spasm and correct faulty mechanics
• -avoid “hiking the shoulder”
• -strengthen RTC to prevent impingement
• *Improve muscle performance (correct faulty spine posture if needed)
6. • Gentle joint oscillation techniques to help decrease
the muscle spasm (grade I or II).
• Sustained caudal glide joint techniques to
reposition the humeral head in the glenoid fossa.
• Protected weight bearing, such as leaning hands
against a wall or on a table, to stimulate co-
contraction of the rotator cuff and scapular
stabilizing muscles. If tolerated, gentle rocking
forward/backward and side to side requires the
muscles to begin controlling motion. Because
weight bearing causes joint compression, the
benefits of intermittent compression stimulates
synovial fluid motion. Techniques are progressed
within the tolerance of the joint
• External rotation exercises to help to depress the
humeral head.
7. Wand Exercises
• The involved extremity in this picture is the
left UE (upper extremity)Placing a towel roll
under the distal humerus decreases stress
on the anterior joint capsule by decreasing
extension at the GH (glenohumeral) joint
The motion involved in both pictures is
external (lateral) rotation.
8. Glenohumeral Joint Hypomobility
Management
• RETURN TO FUNCTION PHASE (CHRONIC STAGE)
• *Progressively Increase Flexibility and Strength
• -progressive stretching and strengthening as the tissue
tolerates
• -emphasis is on correct mechanics, safe progression, and
home exercise strategies
• -if capsular tissue is still restricting motion at this point
consult with the PT (POC may need modification, i.e. PT may
need to do joint mobilizations if they haven’t been already)
• -prepare for work or recreational activities (i.e. work
hardening)-occasionally a patient may need to undergo
manipulation under anesthesia to regain motion
10. upper Extremity Plyometrics
• Pictures depict a progression
through a plyometric scenario
Begin with patient supported
in a stable position, then
progress to standing in one
plane, followed by diagonal
patterns through short and
then full ranges of motion
Weight of the ball should
start off light and can later
become heavier as strength
progresses
11. Acromioclavicular and Sternoclavicular Joints
Related Pathologies and Etiology of Symptoms
• Overuse Syndromes
The causes may be from repeated stressful movement of the joint with
the arm at waist level, such as with grinding, packing assembly, and
construction work.
Subluxations or Dislocations.
Subluxations or dislocations of either joint are usually caused by falling
against the shoulder or against an outstretched arm
12. Common Impairments
• Pain localized to the involved joint or ligament
• Painful arc with shoulder elevation
• Pain with shoulder horizontal adduction or abduction
• Hypermobility in the joints if trauma or overuse is involved
• Hypomobility in the joints if sustained posture or immobility is
involved.
13. • Common Functional Limitations/Disabilities
• Limited ability to sustain repeated loaded movements related to
forward/backward motions of the arm, such as with grinding,
packing, assembly, and construction work.
• Inability to reach overhead without pain. Inability to serve effectively
at tennis or spike a volleyball.
14. • Nonoperative Management of AC or SC Joint Strain or Hypermobility
• Rest the joint by putting the arm in a sling to support the weight of
the arm.
• Cross-fiber massage to the capsule or ligaments.
• Maintain ROM to the shoulder and grade II traction and glides to the
glenohumeral joint to prevent glenohumeral restriction.
• Instructions in self-application of cross-fiber massage if joint
symptoms occur after excessive activity
• Nonoperative Management of AC or SC Joint Hypomobility
• Joint mobilization techniques are used to increase joint mobility
15. GH Joint Management—Postmanipulation
Under Anesthesia
• The arm is kept elevated overhead in abduction and external rotation
during the inflammatory reaction stage; treatment principles progress as
with any joint lesion.
• Therapeutic exercises are initiated the same day while the patient is still
in the recovery room, with emphasis on internal and external rotation in
the 90 (or higher) abducted position.
• Joint mobilization procedures are used, particularly a caudal glide, to
prevent readherence of the inferior capsular fold.
• When sleeping, the patient may be required to position the arm
abducted for up to 3 weeks after manipulation
16. Glenohumeral Arthroplasty
• Total Shoulder Replacement Arthroplasty (TSR)= both glenoid
and humeral surfaces are replaced
• Hemireplacement Arthroplasty (hemiarthroplasty)= one surface is
replaced
• Reverse total shoulder arthroplasty is another type, typically used
when rotator cuff integrity is compromised.
• Different ‘designs’ are used for these surgeries, may include:
unconstrained, semi-constrained, and reverse ball and socket
*each design has it’s own limitations and precautions
(***close communication with PT is crucial to be compliant with the
surgeon’s recommendations and to get the best outcomes)
- Surgeon may give therapy a set of guidelines to follow, but the
PTA should never progress a patient without consulting PT first.
17. Glenohumeral Arthroplasty
• If the rotator cuff was torn and
also needed to be repaired,
rehab will be slower and more
caution must be used
Intraoperative ROM: surgeon
“tests” the ROM of the
shoulder before suturing back
up, therapy goals are based
on these findings
(communication is very
important!)
18. indications for Surgery
• The primary indication is persistent and incapacitating pain (at rest or
with activity) secondary to GH joint destruction.
• Secondary indications include loss of shoulder mobility or stability
and upper extremity strength leading to inability to perform
functional tasks with the involved upper extremity.
19. Procedures
• The designs of current-day total shoulder replacement (TSR),
composed of a high-density polyethylene glenoid component (usually
all plastic) and a modular humeral component made of an inert
metal, closely approximate the biomechanical characteristics of the
human shoulder.
• Fixation of the prosthetic components is achieved with a press fit, bio-
ingrowth, or cement. The type of fixation selected by the surgeon
depends on the component (glenoid or humeral), the underlying
pathology, and the quality of the bone stock
20. Glenohumeral Arthroplasty
Postoperative Management
• Correct faulty posture to prevent impingement (may see
forward head / shoulder posturing)
• MAXIMUM PROTECTIONS PHASE (MAY be 4-6 weeks)
• Patient education regarding precautions and Control Pain
• Maintain mobility of adjacent joints
• Gradually restore shoulder mobility (follow guidelines for
when PROM, AAROM, etc are allowed and to what
degrees)
• Minimize muscle guarding and atrophy
21. Glenohumeral Arthroplasty
Postoperative Management
• MODERATE PROTECTION / CONTROLLED MOTION PHASE
(MAY begin around 4-6 weeks post-op and last weeks +/-)
• *emphasis is on gaining active control, dynamic stability, and
strength while continuing to increase ROM
• - PT determines when patient is ready for this phase
• PT may order use of heat before tx to increase tissue stretch
with ROM and may end with cryotherapy to decrease any
inflammation and/or pain (no heat when patient is acute post-
op)
• Gradual progression through PROM, AAROM, AROM as well as
muscle setting and isometrics, progressing to light resistance
when allowed (keep resistance exercises below 90 deg
shoulder elevation)
22. Precautions
• When progressing a therapy program, avoid exacerbation of symptoms- if
symptoms do increase, decrease the intensity of the activity or withhold the
activity altogether for now (may be able to re-address at a later time). Consult
PT!
23. Glenohumeral Arthroplasty
Postoperative Management
• RETURN TO FUNCTIONAL ACTIVITY PHASE
(MAY begin around weeks and can last several months)
• *Pain-free strengthening for dynamic stability and
functional use of the UE- PT/ MD determines when
patient is ready for this phase, generally : full PROM
(based on intraoperative ranges), AROM in the scapular
plane to at least deg. without substitutions, RTC 4/5 MMT
• Patient may have to modify or eliminate certain
functional and recreational activities indefinitely
• gradual progression through end-range self stretching,
PRE’s, weight bearing through the UE, dynamic stability,
etc.
24. Shoulder Impingement
• Primary Impingement:
Wearing of the RTC against
the acromion during
shoulder elevation
• *Supraspinatus Tendonitis
• Secondary Impingement:
• Results when there are
faulty mechanics due to
hypermobility or instability
of the GH head
25. • Faulty Posture Forward head,
increased thoracic kyphosis,
forward tilt of the scapula, IR of the
humerus Causes Muscle
Imbalances
• -tight pectoralis minor, levator
scapulae, scalenes, IRs-weak
serratus anterior or trapezius
muscles, Ers
• *Impingement occurs during UE
elevation
26. • Painful Arc Commonly seen
with impingement syndromes
Can be due to compression
tendons and/or subacromial
within the subacromial space
elevation of the humerus
27. • Supraspinatus tendinitis. With supraspinatus tendinitis, the lesion is usually near
the musculotendinous junction, resulting in a painful arc with overhead reaching.
• Pain occurs with the impingement test (forced humeral elevation in the plane of
the scapula while the scapula is passively stabilized so the greater tuberosity
impacts against the acromion.
• Infraspinatus tendinitis. With infraspinatus tendinitis, the lesion is usually near
the musculotendinous junction, resulting in a painful arc with overhead or
forward motions. It may present as a deceleration (eccentric) injury due to
overload during repetitive or forceful throwing activities.
• Bicipital tendinitis. With bicipital tendinitis, the lesion involves the long tendon in
the bicipital groove beneath or just distal to the transverse humeral ligament.
Swelling in the bony groove is restrictive and compounds and perpetuates the
problem. Pain occurs with resistance to the forearm in a supinated position while
the shoulder is flexing (Speed’s sign) and on palpation of the bicipital groove.
• Bursitis (subdeltoid or subacromial). When acute, the symptoms of bursitis are
the same as those seen with supraspinatus tendinitis. Once the inflammation is
under control, there are no symptoms with resistance.
28. Common Impairments with Rotator Cuff
Disease and Impingement Syndromes
• Some, all, or none of the following may be present.
• Pain at the musculotendinous junction of the involved muscle with palpation, with
resisted muscle contraction, and when stretched
• Positive impingement sign (forced internal rotation at 90 of flexion) and painful arc
• Impaired posture: thoracic kyphosis, forward head, and forward (anterior) tipped scapula
with decreased thoracic mobility
• Muscle imbalances: hypomobile pectoralis major and minor, levator scapulae, and
internal rotators of the GH joint; weak serratus anterior and lateral rotators
• Hypomobile posterior GH joint capsule
• Faulty kinematics with humeral elevation: decreased posterior tipping of scapula related
to weak serratus anterior; scapular elevation and overuse of upper trapezius; and
uncoordinated scapulohumeral rhythm
• With a complete rotator cuff tear, inability to abduct the humerus against gravity When
acute, pain referred to the C5 and C6 reference zones
29. Rotator Cuff Overuse and Fatigue
•
If the rotator cuff musculature or long head of the biceps fatigue from
overuse, they no longer provide the dynamic stabilizing, compressive,
and translational forces that support the joint and control the normal
joint mechanics. This is thought to be a precipitating factor in
secondary impingement syndromes when there is capsular laxity and
increased need for muscular stability.
30. • Common Functional Limitations/Disabilities
• When acute, pain may interfere with sleep, particularly when rolling
onto the involved shoulder.
• Pain with overhead reaching, pushing, or pulling.
• Difficulty lifting loads.
• Inability to sustain repetitive shoulder activities (such as reaching,
lifting, throwing, pushing, pulling, or swinging the arm).
• Difficulty with dressing, particularly putting a shirt on over the head.
31. Management: Painful Shoulder Syndromes
• Management: Protection Phase
• Control Inflammation and Promote Healing Modalities and low-intensity cross-
fiber massage are applied to the site of the lesion. While applying the modalities,
position the extremity to maximally expose the involved region.
Support the arm in a sling for rest.
• Patient Education
• Maintain Integrity and Mobility of the Soft Tissues
Passive, active-assistive, or self-assisted ROM is initiated in pain-free ranges.
• Multiple-angle muscle setting and protected stabilization exercises are initiated
• Control Pain and Maintain Joint Integrity
• Management: Controlled Motion Phase
• Once the acute symptoms are under control, the main emphasis becomes use of
the involved region with progressive, nondestructive movement and proper
mechanics while the tissues heal.
32. Modify Joint Tracking and Mobility
• Mobilization with movement (MWM) may be useful for
modifying joint tracking and reinforcing full movement
• Posterolateral glide with active elevation
• Self-Treatment. A mobilization belt provides the posterolateral glide
while the patient actively elevates the affected limb against
progressive resistance to end range.
33. Develop Balance in Length and Strength of
Shoulder Girdle Muscles
• Stretch shortened muscles
• Strengthen and train the scapular stabilizers
Scapular stabilizers typically include the serratus anterior and lower trapezius for posterior tipping
and upward rotation and the middle trapezius and rhomboids for scapular retraction. It is
important that the patient learns to avoid scapular elevation when raising the arm.
• Strengthen and train the rotator cuff muscles, especially the shoulder lateral rotators
• Develop Muscular Stabilization and Endurance
34.
35.
36. Subacromial Decompression Surgery
• Subacromial decompression also is referred to as anterior
acromioplasty or decompression acromioplasty.
• Acromioplasty, which alters the shape of the acromion, is typically,
but not always, one component of subacromial decompression.
37. • Subacromial Decompression
Surgery
Most decompression surgeries are
arthroscopically May include:
*Bursectomy (subacromial)
*Release of the coricoacromial
*Acromioplasty (resection)
*Removal of any osteophytes
• Rehab may be quicker if the RTC is
procedure is arthroscopic
38. • Rotator Cuff Arthroscopic Repair
Keep in Mind:-PROM (and later
only through “safe” (MD ordered)
pain-free
• -Later in rehab, do not allow
elevation if the patient is hiking
• -It is crucial to follow PT / MD
guidelines for ROM and allowed
prevent damaging the surgical
39. • Rotator Cuff ‘open’ Repair
Keep in Mind:
• -Overall rehab and
through the stages / phases
longer vs arthroscopic repair
• -Greater caution during
indicated for these patients
• -Follow ROM / activities
do not progress unless PT /
approves
40. Shoulder Instabilities
• GLENOHUMERAL joint hypermobility can be atraumatic or traumatic.
• Atraumatic hypermobility occur as a result of connective tissue laxity
or from microtrauma related to repetitive activities.
• Traumatic instability caused by a single or sequence of high forces
event that compromised the integrity of stabilizing structure.
• Unidirectional instability
Anterior instability
Posterior instability
• Multidirectional instability
41.
42. • Traumatic Anterior Shoulder Dislocation
• Anterior dislocation most frequently occurs when there is a blow to the humerus while it is in a position
of external rotation and abduction.
• Traumatic anterior dislocation is usually associated with complete rupture of the rotator cuff
• Neurological or vascular injuries may occur during dislocations. The axillary nerve is most commonly
injured, but the brachial plexus or one of the peripheral nerves could be stretched or compressed.
• Traumatic Posterior Shoulder Dislocation
• Traumatic posterior shoulder dislocation is less common.
• The mechanism of injury is usually a force applied to the humerus that combines flexion, adduction, and
internal rotation, such as falling on an outstretched arm.
• Recurrent Dislocations
With significant ligamentous and capsular laxity, recurrent subluxations or dislocations may occur with any
movement that reproduces the humerus positions and forces that caused the original instability
43. Common Functional Limitations/Disabilities
• With rotator cuff rupture, inability to reach or lift objects to the level of
horizontal, thus interfering with all activities using humeral elevation
• Possibility of recurrence when replicating the dislocating action With anterior
dislocation, restricted ability in sports activities, such as pitching, swimming,
serving (tennis, volleyball), spiking (volleyball)
• Restricted ability, particularly when overhead or horizontal abduction movements
are required while dressing, such as putting on a shirt or jacket, and with self-
grooming, such as combing the back of the hair
• Discomfort or pain when sleeping on the involved side in some cases
• With posterior dislocation, restricted ability in sports activities, such as follow-
through in pitching and golf; restricted ability in pushing activities, such as
pushing open a heavy door or pushing one’s self up out of a chair or out of a
swimming pool
44. Management:
• Activity restriction is recommended for 6 to 8 weeks
• The position of dislocation must be avoided when exercising, dressing, or doing
other daily activities
• Promote Tissue Health
• Increase Shoulder Mobility:Mobilization techniques are initiated using all
appropriate glides except the anterior glide. The anterior glide is contraindicated
even though external rotation is necessary for functional elevation of the
humerus.
• The posterior joint structures are passively stretched with horizontal adduction
self-stretching techniques.
• Increase Stability and Strength of Rotator Cuff and Scapular Muscles
45. • Closed Reduction of Anterior Dislocation
• Closed Reduction of Posterior Dislocation
• Shoulder Instabilities: Surgery and Postoperative Management
Indications for Surgery
The following are common indications for surgical stabilization of the GH joint.
■ Recurrent episodes of GH joint dislocation or subluxation that impair functional
activities
■ Unidirectional or multidirectional instability during active shoulder movements
that causes apprehension about placing the arm in positions of potential
dislocation, leading to compromised use of the arm for functional activities
■ Instability-related impingement (secondary impingement syndrome) of the
shoulder
■ Significant inherent joint laxity resulting in recurrent involuntary dislocation
■ High probability of subsequent episodes of recurrence of dislocation after an
acute traumatic dislocation in young patients involved in high-risk (overhead),
work-related, or sport activities
■ Dislocations associated with significant cuff tears or displaced tuberosity or
glenoid rim fractures
46. Shoulder-Bankart Lesion Repair
• Anterior shoulder dislocation usually
results from a blow to the humerus when
in abduction and ER causing damage to
the anterior GH joint capsule and likely
tearing the RTC
• this repair involves an open or arthroscopic repair
of a Bankart lesion, which is the detachment of the
capsulolabral complex from the anterior rim of the
glenoid commonly associated with traumatic
anterior dislocation
• May also have a Hill-Sachs lesion
(compression of the posterolateral edge
of the humerus
• Avoid strain to the anterior shoulder
during early rehab (very limited ER &
Extension)
47. • Shoulder SLAP Lesion /
Repair
• Involves tearing of the
Labrum, Extending Anterior
• Can have a tear of the long
Biceps
• During repair the surgeon
need to perform anterior
there is instability
48. Special Tests for Shoulder Instability
•
* Anterior
apprehension Test
for anterior
instability
• *Inferior
apprehension Test
for inferior instability
• * Impingement Test*
• + Sulcus Sign for
inferior instability