The Shoulder and Shoulder Girdle Chapter 17 Part

  • Slides: 44
Download presentation
The Shoulder and Shoulder Girdle Chapter 17 Part IV: Exercise Interventions by Body Region

The Shoulder and Shoulder Girdle Chapter 17 Part IV: Exercise Interventions by Body Region Copyright © 2013. F. A. Davis Company

STRUCTURE AND FUNCTION OF THE SHOULDER GIRDLE Copyright © 2013. F. A. Davis Company

STRUCTURE AND FUNCTION OF THE SHOULDER GIRDLE Copyright © 2013. F. A. Davis Company

Joints of the Shoulder Girdle Complex § Synovial Joints – Glenohumeral joint • Arthrokinematics

Joints of the Shoulder Girdle Complex § Synovial Joints – Glenohumeral joint • Arthrokinematics • Stability – Acromioclavicular joint • Arthrokinematics • Stability – Sternoclavicular joint • Arthrokinematics • Stability Copyright © 2013. F. A. Davis Company

Joints of the Shoulder Girdle Complex (cont'd) § Functional Articulations – Scapulothoracic articulation •

Joints of the Shoulder Girdle Complex (cont'd) § Functional Articulations – Scapulothoracic articulation • Motions of the Scapula § Scapular Stability – Postural relationship – Active arm motions – Faulty posture – Suprahumeral (subacromial) space Copyright © 2013. F. A. Davis Company

Shoulder Girdle Function § Scapulohumeral Rhythm § Clavicular Elevation and Rotation With Humeral Motion

Shoulder Girdle Function § Scapulohumeral Rhythm § Clavicular Elevation and Rotation With Humeral Motion § External Rotation of the Humerus With Full Elevation § Deltoid: Short Rotator Cuff and Supraspinatus Mechanisms Copyright © 2013. F. A. Davis Company

Referred Pain and Nerve Injury § Common Sources of Referred Pain in the Shoulder

Referred Pain and Nerve Injury § Common Sources of Referred Pain in the Shoulder Region – Cervical spine – Referred pain from related tissues § Nerve Disorders in the Shoulder Girdle Region – Brachial plexus in the thoracic outlet – Suprascapular nerve in the suprascapular notch – Radial nerve in the axilla Copyright © 2013. F. A. Davis Company

MANAGEMENT OF SHOULDER DISORDERS AND SURGERIES Copyright © 2013. F. A. Davis Company

MANAGEMENT OF SHOULDER DISORDERS AND SURGERIES Copyright © 2013. F. A. Davis Company

Joint Hypomobility: Nonoperative Management § Glenohumeral Joint – Related pathologies and etiology of symptoms

Joint Hypomobility: Nonoperative Management § Glenohumeral Joint – Related pathologies and etiology of symptoms • • Copyright © 2013. F. A. Davis Company Rheumatoid arthritis and osteoarthritis Traumatic arthritis Post immobilization arthritis or stiff shoulder Idiopathic frozen shoulder

Joint Hypomobility: Nonoperative Management (cont'd) § Glenohumeral Joint (cont’d) – Clinical signs and symptoms

Joint Hypomobility: Nonoperative Management (cont'd) § Glenohumeral Joint (cont’d) – Clinical signs and symptoms – Common structural and functional impairments – Common activity limitations and participation restrictions Copyright © 2013. F. A. Davis Company

Joint Hypomobility: Nonoperative Management (cont'd) § Glenohumeral Joint Hypomobility: Management—Protection Phase – Maintain soft

Joint Hypomobility: Nonoperative Management (cont'd) § Glenohumeral Joint Hypomobility: Management—Protection Phase – Maintain soft tissue and joint integrity and mobility – Maintain integrity and function of associated regions Copyright © 2013. F. A. Davis Company

Joint Hypomobility: Nonoperative Management (cont'd) § Glenohumeral Joint Hypomobility: Management—Controlled Motion Phase – Control

Joint Hypomobility: Nonoperative Management (cont'd) § Glenohumeral Joint Hypomobility: Management—Controlled Motion Phase – Control pain, edema, and joint effusion – Progressively increase joint and soft tissue mobility – Inhibit muscle spasm and correct faulty mechanics – Improve joint tracking – Improve muscle performance Copyright © 2013. F. A. Davis Company

Joint Hypomobility: Nonoperative Management (cont'd) § Glenohumeral Joint Management: Return to Function Phase –

Joint Hypomobility: Nonoperative Management (cont'd) § Glenohumeral Joint Management: Return to Function Phase – Progressively increase flexibility and strength – Prepare for functional demands § Glenohumeral Joint Management: Postmanipulation Under Anesthesia Copyright © 2013. F. A. Davis Company

Joint Hypomobility: Nonoperative Management (cont'd) § Acromioclavicular and Sternoclavicular Joints – Related pathologies and

Joint Hypomobility: Nonoperative Management (cont'd) § Acromioclavicular and Sternoclavicular Joints – Related pathologies and etiology of symptoms • Overuse syndromes • Subluxations or dislocations • Hypomobility – Common structural and functional impairments Copyright © 2013. F. A. Davis Company

Joint Hypomobility: Nonoperative Management (cont'd) § Acromioclavicular and Sternoclavicular Joints – Common activity limitations

Joint Hypomobility: Nonoperative Management (cont'd) § Acromioclavicular and Sternoclavicular Joints – Common activity limitations and participation restrictions – Nonoperative management of AC or SC joint strain or hypermobility – Nonoperative management of AC or SC joint hypomobility Copyright © 2013. F. A. Davis Company

Glenohumeral Joint Surgery and Postoperative Management § Glenohumeral Arthroplasty – Indications for surgery –

Glenohumeral Joint Surgery and Postoperative Management § Glenohumeral Arthroplasty – Indications for surgery – Procedures • Background – Implant design, materials, and fixation – Selection of procedure • Operative procedures • Complications Copyright © 2013. F. A. Davis Company

Glenohumeral Joint Surgery and Postoperative Management (cont'd) § Glenohumeral Arthroplasty – Postoperative management •

Glenohumeral Joint Surgery and Postoperative Management (cont'd) § Glenohumeral Arthroplasty – Postoperative management • Special considerations – Integrity of the rotator cuff – Intraoperative ROM – Posture • Immobilization and postoperative positioning • Exercise – Maximum protection phase – Moderate protection/controlled motion phase – Minimum protection/return to function phase Copyright © 2013. F. A. Davis Company

Glenohumeral Joint Surgery and Postoperative Management (cont'd) § Glenohumeral Arthroplasty (cont’d) – Outcomes •

Glenohumeral Joint Surgery and Postoperative Management (cont'd) § Glenohumeral Arthroplasty (cont’d) – Outcomes • Pain relief • ROM • Functional use of the UE Copyright © 2013. F. A. Davis Company

Painful Shoulder Syndromes (Rotator Cuff Disease, Impingement Syndromes): Nonoperative Management § Related Pathologies and

Painful Shoulder Syndromes (Rotator Cuff Disease, Impingement Syndromes): Nonoperative Management § Related Pathologies and Etiology of Symptoms – Intrinsic impingement: rotator cuff disease – Extrinsic impingement: mechanical compression of tissues • Primary extrinsic impingement • Secondary extrinsic impingement • Internal extrinsic impingement Copyright © 2013. F. A. Davis Company

Painful Shoulder Syndromes: Nonoperative Management (cont'd) § Related Pathologies and Etiology of Symptoms (cont’d)

Painful Shoulder Syndromes: Nonoperative Management (cont'd) § Related Pathologies and Etiology of Symptoms (cont’d) – Tendinitis/bursitis • • Supraspinatus tendinitis Infraspinatus tendinitis Bicipital tendinitis Bursitis (subdeltoid or subacromial) – Other impaired musculoskeletal tissues – Insidious (atraumatic) onset Copyright © 2013. F. A. Davis Company

Painful Shoulder Syndromes: Nonoperative Management (cont'd) § Common Structural and Functional Impairments – –

Painful Shoulder Syndromes: Nonoperative Management (cont'd) § Common Structural and Functional Impairments – – – Impaired posture and muscle imbalances Decreased thoracic ROM Rotator cuff overuse and fatigue Muscle weakness secondary to neuropathy Hypomobile posterior GH joint capsule § Common Activity Limitations and Participation Restrictions Copyright © 2013. F. A. Davis Company

Painful Shoulder Syndromes: Nonoperative Management (cont'd) § Management: Protection Phase – Control inflammation and

Painful Shoulder Syndromes: Nonoperative Management (cont'd) § Management: Protection Phase – Control inflammation and promote healing – Patient education – Maintain integrity and mobility of the soft tissues – Control pain and maintain joint integrity – Develop support in related regions Copyright © 2013. F. A. Davis Company

Painful Shoulder Syndromes: Nonoperative Management (cont'd) § Management: Controlled Motion Phase – Patient education

Painful Shoulder Syndromes: Nonoperative Management (cont'd) § Management: Controlled Motion Phase – Patient education – Develop strong, mobile tissues – Modify joint tracking and mobility – Develop balance in length and strength of shoulder girdle muscles – Develop muscular stabilization and endurance – Progress shoulder function Copyright © 2013. F. A. Davis Company

Painful Shoulder Syndromes: Nonoperative Management (cont'd) § Management: Return to Function Phase – Increase

Painful Shoulder Syndromes: Nonoperative Management (cont'd) § Management: Return to Function Phase – Increase muscular endurance – Develop quick motor responses to imposed stresses – Progress functional training Copyright © 2013. F. A. Davis Company

Painful Shoulder Syndromes: Surgery and Postoperative Management § Subacromial Decompression – Indications for surgery

Painful Shoulder Syndromes: Surgery and Postoperative Management § Subacromial Decompression – Indications for surgery – Procedures • Surgical approach • Component procedures Copyright © 2013. F. A. Davis Company

Painful Shoulder Syndromes: Surgery and Postoperative Management (cont'd) § Subacromial Decompression (cont’d) – Postoperative

Painful Shoulder Syndromes: Surgery and Postoperative Management (cont'd) § Subacromial Decompression (cont’d) – Postoperative management • Immobilization • Exercise progression – Maximum protection phase – Moderate protection phase – Minimum protection/return to function phase – Outcomes Copyright © 2013. F. A. Davis Company

Painful Shoulder Syndromes: Surgery and Postoperative Management (cont'd) § Rotator Cuff Repair – Indications

Painful Shoulder Syndromes: Surgery and Postoperative Management (cont'd) § Rotator Cuff Repair – Indications for surgery – Procedures • Type of repair • Components of a rotator cuff repair • Selection of surgical procedures Copyright © 2013. F. A. Davis Company

Painful Shoulder Syndromes: Surgery and Postoperative Management (cont'd) § Rotator Cuff Repair (cont’d) –

Painful Shoulder Syndromes: Surgery and Postoperative Management (cont'd) § Rotator Cuff Repair (cont’d) – Postoperative management • Immobilization • Exercise – Maximum protection phase – Moderate protection phase – Minimum protection/return to function phase – Outcomes – Pain relief, ROM, strength, functional abilities Copyright © 2013. F. A. Davis Company

Shoulder Instabilities: Nonoperative Management § Related Pathologies and Mechanisms of Injury – Atraumatic hypermobility

Shoulder Instabilities: Nonoperative Management § Related Pathologies and Mechanisms of Injury – Atraumatic hypermobility – Unidirectional instability – Multidirectional instability • Common structural and functional impairments • Common activity limitations and participation restrictions Copyright © 2013. F. A. Davis Company

Shoulder Instabilities: Nonoperative Management (cont'd) § Related Pathologies and Mechanisms of Injury (cont’d) –

Shoulder Instabilities: Nonoperative Management (cont'd) § Related Pathologies and Mechanisms of Injury (cont’d) – Traumatic hypermobility • Traumatic anterior shoulder dislocation • Traumatic posterior shoulder dislocation – Recurrent dislocation • Common structural and functional impairments • Common activity limitations and participation restrictions Copyright © 2013. F. A. Davis Company

Shoulder Instabilities: Nonoperative Management (cont'd) § Closed Reduction of Anterior Dislocation – Management: protection

Shoulder Instabilities: Nonoperative Management (cont'd) § Closed Reduction of Anterior Dislocation – Management: protection phase • Protect the healing tissue • Promote tissue health – Management: controlled motion phase • Provide protection • Increase shoulder mobility • Increase stability and strength of rotator cuff and scapular muscles Copyright © 2013. F. A. Davis Company

Shoulder Instabilities: Nonoperative Management § Closed Reduction of Anterior Dislocation (cont’d) – Management: return

Shoulder Instabilities: Nonoperative Management § Closed Reduction of Anterior Dislocation (cont’d) – Management: return to function phase • Restore functional control • Return to full activity § Closed Reduction of Posterior Dislocation Copyright © 2013. F. A. Davis Company

Shoulder Instabilities: Surgery and Postoperative Management § Glenohumeral Joint Stabilization Procedures – Indications for

Shoulder Instabilities: Surgery and Postoperative Management § Glenohumeral Joint Stabilization Procedures – Indications for surgery – Procedures • • • Copyright © 2013. F. A. Davis Company Bankart repair Capsulorrhaphy (capsular shift) Electrothermally assisted capsulorrhaphy (ETAC) Posterior capsulorrhaphy Repair of a SLAP lesion

Shoulder Instabilities: Surgery and Postoperative Management (cont'd) § Glenohumeral Joint Stabilization Procedures (cont’d) –

Shoulder Instabilities: Surgery and Postoperative Management (cont'd) § Glenohumeral Joint Stabilization Procedures (cont’d) – Postoperative management • General considerations • Immobilization • Exercise progression – Maximum protection phase – Moderate protection phase – Minimum protection/return to function phase – Outcomes • Recurrence of instability, ROM Copyright © 2013. F. A. Davis Company

Acromioclavicular and Sternoclavicular Joint Stabilization: Procedures and Postoperative Management § Acromioclavicular Joint Stabilization §

Acromioclavicular and Sternoclavicular Joint Stabilization: Procedures and Postoperative Management § Acromioclavicular Joint Stabilization § Sternoclavicular Joint Stabilization § Postoperative Management Copyright © 2013. F. A. Davis Company

EXERCISE INTERVENTIONS FOR THE SHOULDER GIRDLE Copyright © 2013. F. A. Davis Company

EXERCISE INTERVENTIONS FOR THE SHOULDER GIRDLE Copyright © 2013. F. A. Davis Company

Exercise Techniques During Acute and Early Subacute Stages of Tissue Healing § Early Motion

Exercise Techniques During Acute and Early Subacute Stages of Tissue Healing § Early Motion of the Glenohumeral Joint – Wand exercises – Ball rolling or table top dusting – Wall (window) washing – Pendulum (Codman’s) exercises – “Gear shift” exercises Copyright © 2013. F. A. Davis Company

Exercise Techniques During Acute and Early Subacute Stages of Tissue Healing (cont'd) § Early

Exercise Techniques During Acute and Early Subacute Stages of Tissue Healing (cont'd) § Early Motion of the Scapula § Early Neuromuscular Control – Multiple-angle muscle setting – Protected weight bearing Copyright © 2013. F. A. Davis Company

Exercise Techniques to Increase Flexibility and Range of Motion § Self-Stretching Techniques to Increase

Exercise Techniques to Increase Flexibility and Range of Motion § Self-Stretching Techniques to Increase Shoulder ROM – To increase flexion and horizontal adduction – To increase flexion and elevation of the arm – To increase external (lateral) rotation – To increase internal rotation – To increase abduction and elevation of the arm – To increase extension of the arm Copyright © 2013. F. A. Davis Company

Exercise Techniques to Increase Flexibility and Range of Motion (cont'd) § Manual and Self-Stretching

Exercise Techniques to Increase Flexibility and Range of Motion (cont'd) § Manual and Self-Stretching Exercises for Specific Muscles – To stretch the latissimus dorsi muscle – To stretch the pectoralis major muscles – To stretch the pectoralis minor muscle – To stretch the levator scapulae muscle – To stretch the upper trapezius muscle Copyright © 2013. F. A. Davis Company

Exercises to Develop and Improve Muscle Performance and Functional Control § Isometric Exercises –

Exercises to Develop and Improve Muscle Performance and Functional Control § Isometric Exercises – Scapular muscles – Multiple-angle isometrics to the GH muscles – Self-applied multiple-angle isometrics Copyright © 2013. F. A. Davis Company

Exercises to Develop and Improve Muscle Performance and Functional Control (cont'd) § Stabilization Exercises

Exercises to Develop and Improve Muscle Performance and Functional Control (cont'd) § Stabilization Exercises – Open-chain stabilization exercises for the scapular muscles – Open-chain stabilization exercises for the shoulder girdle – Static closed-chain (weight-bearing) stabilization exercises – Dynamic closed-chain stabilization exercises Copyright © 2013. F. A. Davis Company

Exercises to Develop and Improve Muscle Performance and Functional Control (cont'd) § Dynamic Strengthening

Exercises to Develop and Improve Muscle Performance and Functional Control (cont'd) § Dynamic Strengthening Exercises: Scapular Muscles § Dynamic Strengthening Exercises: Glenohumeral Muscles Copyright © 2013. F. A. Davis Company

Exercises to Develop and Improve Muscle Performance and Functional Control (cont'd) § Functional Progression

Exercises to Develop and Improve Muscle Performance and Functional Control (cont'd) § Functional Progression for the Shoulder Girdle – Exercises using combined movement patterns with functional activities – Equipment – Integration of functional activities Copyright © 2013. F. A. Davis Company

Independent Learning Activities § Critical Thinking and Discussion § Laboratory Practice § Case Studies

Independent Learning Activities § Critical Thinking and Discussion § Laboratory Practice § Case Studies Copyright © 2013. F. A. Davis Company

Pectoral Girdle Shoulder Girdle The pectoral girdle consistPectoral Girdle Shoulder Girdle The pectoral girdle consist
Shoulder Girdle 2 1 4 3 Shoulder GirdleShoulder Girdle 2 1 4 3 Shoulder Girdle
8 1 The Pectoral Girdle Shoulder girdle Connects8 1 The Pectoral Girdle Shoulder girdle Connects
Appendicular Skeleton Pectoral Shoulder Girdle Pectoral Girdle AttachAppendicular Skeleton Pectoral Shoulder Girdle Pectoral Girdle Attach
Upper Extremity Pectoral Girdle Aka shoulder girdle 2Upper Extremity Pectoral Girdle Aka shoulder girdle 2
Shoulder Glenohumeral Joint AP shoulder girdle Three projectionsShoulder Glenohumeral Joint AP shoulder girdle Three projections
THE SHOULDER ANATOMY BONES Shoulder Girdle 1 ScapulawithTHE SHOULDER ANATOMY BONES Shoulder Girdle 1 Scapulawith
Lecture 10 Radiography of the shoulder Girdle ShoulderLecture 10 Radiography of the shoulder Girdle Shoulder
THE SHOULDER ANATOMY BONES Shoulder Girdle 1 ScapulawithTHE SHOULDER ANATOMY BONES Shoulder Girdle 1 Scapulawith
Upper Extremities Parts Shoulder Girdle Shoulder Joint ElbowUpper Extremities Parts Shoulder Girdle Shoulder Joint Elbow
Pelvic Girdle and Lower Limb Pelvic Girdle ConsistPelvic Girdle and Lower Limb Pelvic Girdle Consist
Shoulder Analysis Chapter 5 Shoulder Muscle Exercises ShoulderShoulder Analysis Chapter 5 Shoulder Muscle Exercises Shoulder
The Pelvic Girdle The Pelvic Girdle A GeneralThe Pelvic Girdle The Pelvic Girdle A General
Appendicular Skeleton Pectoral Girdle Arms Pelvic Girdle LegsAppendicular Skeleton Pectoral Girdle Arms Pelvic Girdle Legs
Radiography of Proximal Humerus and Shoulder Girdle PartRadiography of Proximal Humerus and Shoulder Girdle Part
SHOULDER SHOULDER OSTEOLOGY SHOULDER OSTEOLOGY ANATOMY MUSCLES ANATOMYSHOULDER SHOULDER OSTEOLOGY SHOULDER OSTEOLOGY ANATOMY MUSCLES ANATOMY
Shoulder Shoulder Shoulder Dislocations Most common type flattenedShoulder Shoulder Shoulder Dislocations Most common type flattened
Shoulder Joint Shoulder Glenohumeral Joint The shoulder jointShoulder Joint Shoulder Glenohumeral Joint The shoulder joint
The Shoulder Label the Shoulder The shoulder isThe Shoulder Label the Shoulder The shoulder is
Chapter 4 The Shoulder Girdle Manual of StructuralChapter 4 The Shoulder Girdle Manual of Structural
Muscles of Shoulder Girdle Chapter 4 Movements ofMuscles of Shoulder Girdle Chapter 4 Movements of
EXSC 314 CHAPTER 4 THE SHOULDER GIRDLE PPTEXSC 314 CHAPTER 4 THE SHOULDER GIRDLE PPT
Chapter 4 The Shoulder Girdle Manual of StructuralChapter 4 The Shoulder Girdle Manual of Structural
HESS 510 CHAPTER 4 THE SHOULDER GIRDLE PPTHESS 510 CHAPTER 4 THE SHOULDER GIRDLE PPT