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Shoulder Key Points

Shoulder Lecture

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
Created by: 1190550002



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