Lab 8 Shoulder (Long Answer)

Introduction to Shoulder Rehabilitation

Supplementary material for lecture notes; not to be used in isolation. The rehabilitation process is tailored to the individual's specific conditions, emphasizing the importance of personal note-taking for coaching others effectively. It is crucial to note that numerous exercises exist beyond what is outlined here, and practitioners should adapt programs as necessary based on patient response and progress.

Anatomy of the Shoulder

Joint Types

The shoulder consists of a highly flexible ball and socket joint, which facilitates a wide range of motion at the expense of stability. Key joints involved in shoulder mechanics include:

• Glenohumeral Joint: This is the primary joint of the shoulder, where the humeral head interacts with the glenoid fossa of the scapula.

• Scapulothoracic Joint: This joint is not a true anatomical joint, but it is crucial for the overall function of the shoulder as it allows the scapula to glide over the ribcage.

• Sternoclavicular Joint: This joint connects the sternum and clavicle, playing an essential role in shoulder mobility.

• Acromioclavicular Joint: This joint supports the connection between the clavicle and the acromion of the scapula, important for shoulder stability.

Stability

The Glenohumeral joint is known to be the least stable of these, with only approximately 25% of the humeral head contacting the glenoid fossa at any position, highlighting its reliance on surrounding muscles and ligaments for support.

Phases of Rehabilitation

Phase 1: Inflammation Management and ROM Improvement

Aims:

• Reduce inflammation and pain through rest, ice, compression, and elevation (RICE).

• Increase range of motion (ROM) while maintaining muscle strength to prevent atrophy.

Focus:

• Engage in rest or reduced activity to avoid exacerbating the injury.

• Address postural issues through education and guidance in physiotherapy treatments.

Exercises include:

• Passive ROM: Caregiver-assisted movements to help maintain mobility without overloading the joint.

• Active-assisted: Exercises where the patient uses assistance to perform movements.

• Isometric exercises: Contractions without joint movement to help maintain strength in key shoulder stabilizers.

Pendular Exercises:These mobility-enhancing exercises involve lean forward while allowing the arm to dangle and gently swing, utilizing a good arm to assist the injured arm.

Phase 1 Exercises

• Active Assisted Exercises (Using a Pole or Stick):

  • Shoulder flexion and extension.

  • Abduction and adduction movements.

  • External and internal rotation.

Practice Recommendations:Encourage self-practice and integration of partner instruction to enhance learning outcomes.

Phase 1 Additional Focus Areas

• Emphasis on mobility to stretching transitions; incorporate isometric exercises to maintain strength in:

  • Posterior capsule

  • Superior capsule

  • Shoulder retractors (important for stability in performing everyday tasks).

Rehabilitation Goals:Progress from mobility exercises to a variety of stretches, focusing on isometric exercises that help ensure strength maintenance as joint function improves.

Phase 2: Strength and Control Improvement

Aims:

• Sustain proper posture, maintain ROM, improve control through targeted exercises, and strengthen dynamic stabilizers.

Focus:

• Emphasize strengthening exercises for the rotator cuff and deltoid muscles, which are essential for shoulder stability during more challenging activities.

• Progress to functional exercises that mimic daily and sports-related movements.

Phase 2 Exercises

• Prone Arm Raises: Focus on scapular stabilization.

• Scapular Depression: Target the muscles of the upper back to improve posture.

• Dynamic movements: Bent arm internal and external rotation with provided counter-resistance.

Practice Recommendations:Reinforce the importance of both self and partner instruction practice to increase exercise effectiveness.

Phase 3: Advanced Rehabilitation

Aims:Achieve a gradual return to sport-specific activities while ensuring pain-free ROM and functional stability.

Focus:

• Correct postural alignment and refine movement patterns while improving dynamic stability under functional load conditions.

• Incorporate advanced and progressive sport-specific exercises to prepare athletes for return to competition.

Phase 3 Exercises

• Upper-body Ergometer: Enhances endurance and strength with low joint stress.

• Seated Row: Engages upper back and shoulder stabilizers.

• Shoulder Press and Upright Row: Build strength in overhead activities.

• Shoulder Shrugs and Variations of Push-Ups: Focus on enhancing shoulder girdle stability through different supportive positions.

• Controlled Throws: Involves shoulder flexion and extension, incorporating catching exercises to improve hand-eye coordination and shoulder endurance.

Additional Exercises:Incorporate resistance training aimed at shoulder muscle development while maintaining balance from an upper body perspective.

Guidelines for Return:Ensure a slow, progressive return to typical sports activity; this may include participation in contact practices with proper precautions.

Concluding Remarks

The shoulder complex is a complex, unstable joint that requires significant dynamic stability for proper function. Failure to address imbalances can lead to impingement pathology, which may progress without proper rectification of strength, balance, and control. Collaboration with medical professionals is recommended for any persistent issues during rehabilitation.