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Shoulder Key Points
Shoulder Lecture
| Question | Answer |
|---|---|
| Post-Op Rehab Emphasis | Immediate Motion Muscle Activation Restricted fxnal activities |
| Primary Goals of Surgery | Restore fxnal abilities Maintain integrity of repair Reduce pain/muscle inhibition Re-establish PROM Re-establish muscular balance/motor control |
| What are 2 major factors in the ability of tendons to heal? | Patient's age Tear size |
| What increases risk of poor tendon healing without associated injury? | Biceps & AC joint pathology |
| 4 Types of RTC Tears | Bursal side partial-thickness Mid-substance Articular side- vascularty/ssn may be less than that of bursal side tears Full-thickness |
| Tear Sizes | Small- <1 cm Medium- 1-3 cm Large- 3-5 cm Massive- >5 cm |
| When can someone with a medium tear lift arm against gravity? Massive tear? | 6 weeks 12 weeks |
| What factors determine tears? | Age >60 Weak shoulder abduction (+) impingement (Neer's/H-K) 98% chance of full-thickness tear |
| Dx of RTC Tears | (+) painful arc sign Drop arm sign Weak ER >90% chance having full-thickness tear |
| When is stiffness significant? | Full-thickness tears Posterior superior tears Patients with trauma |
| Obligate GH Translation | Abnormal arthrokinematics Result when capsule asymmetrically tight May be selective posterior or inferior |
| RROM Guidelines | Protect surgical repair Shortened musculo-tendon unit length-tension Neuromotor control Sub-max Pain-free |
| AROM Based on Tear Size | Small- 4 wks Medium- 6 wks Large- 8 wks Massive- 10-12 wks |
| Criteria to progress from phase 1 to 2 | Passive fwd elevation 125 Passive ER/IR in scapular plane 75 Passive abd in scapular plane 90 |
| Can strengthening be performed in phase 1? | Gentle GH submax isometrics in balance position |
| Goals of Phase 2 | Allow soft tissue healing Don't overstress healing tissue Normalize arthrokinematics Gradually restore full PROM ~wk 5-6 Improve neuromm control of shoulder complex |
| Phase 2 Precautions | NO: Lifting, support of full body wt on hands, sudden jerking motion, excessive behind back motions, bike/ergometer till wk 6 |
| Criteria to progress from phase 2 to 3 | Full ROM Minimal pn/tenderness Good MMT of IR, ER, flexion |
| Keys to Phase 2 | Don't initiate scapula/shoulder mm activation ex's till overall shoulder pain is low Ex's can't create pain or increase s/sx DON'T allow shrug sign; if it occurs, work on ex's below 90 degrees with no AROM >90 |
| ROM in Phase 2 | Begin more aggressive IR stretching Mobilization of post capsule/cuff critical Begin shoulder ext, cross body, sleeper stretches |
| Phase 2 Strengthening | Gentle RTC sub-max isometrics AROM in other planes Low load, high rep Light side-lying isotonics NM control, trunk ex's, UE endurance ex's |
| Goals of Phase 3 | Gradual restoration of GH/ST strength, power, endurance Gradual return to fxnal activities Optimize NM control |
| Criteria to progress phase 3 to phase 4 | Able to tolerate progression to low-level fxnal activities Demo return of strength/dynamic shoulder stability Re-establish dynamic shoulder stability |
| Phase 4 goals | Maintain full non-painful AROM Advanced conditioning ex's for enhanced fxnal & sport-specific use Improve mm endurance, power, strength Gradual return to all fxnal activities |
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