Download - Shoulder Lecture
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Shoulder Mobilization Case Study
Proximal Humeral Fracture
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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.
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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.
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Physical Therapy Referral
•Restore motion and normal strength to the right shoulder
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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.
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Treatment Plan
• Modalities• Mobilization techniques
• Strengthening exercises
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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
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Goal
Increase shoulder glenohumeral motion without exacerbation of
pain.
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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.
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Concepts To Remember In The Shoulder Complex Joint
• Accessory (Component) 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
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Physiological Movements
Refer to Matiland CD
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Shoulder Flexion
• Glenohumeral – Lateral distaction
– Inferior glide– Posteior glide
• Sternoclavicular– Inferior gilde– Anterior glide
• Scapula– Distraction
• Upward rotation• Elevation
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Scapluar Plane Oscillations
• General technique– Introductory– Pain– Lubication of tissues
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Glenohumeral Lateral Distraction
• Often one of the first technique to use
• Good for general capsular tightness
• Pain control
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Inferior Glide In Loose Pack
• For restriction in flexion and abduction
• Used to decreased pain – with grade I & II oscillation
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Inferior Glide At 90º of Abduction
• Increase mid-range– flexion and abduction
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Anterior Glide In Loose Pack
• The primary tissue affect by this technique is the anterior capsular region
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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
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Posterior Glide At 90º Abduction
• Posterior Glide at 90 degrees abduction
• Increase flexion and internal rotation
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Posterior Glide in Flexion
• Advance technique that gives a strong localized stretch to posterior capsule
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Sternoclavicluar Inferior Glide
• Used to improve component motion for shoulder flexion.
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Anterior & Posterior Glide of AC Joint
• Assist in improving shoulder flexion
• Used to decreased joint pain in the AC joint
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Scapula Mobilizations
• The purpose of these techniques is to increase range of motion in scapular:– Superior glide– Inferior glide – Medial rotation– Lateral rotation
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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
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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
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Subscapularis Stretch End Range
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End Range Internal Rotation
• Use graded oscillations
• This technique may also be performed in prone