Thoughts on shoulder injuries
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Transcript of Thoughts on shoulder injuries
THOUGHTS ON SHOULDER
INJURIES
John M. Cissik
Human Performance Services, LLC
Injuries and Modifications AC Joint Injuries Impingement
AC Joint Injuries
Dislocation Distal clavicle fractures Osteoarthritis
AC Separation
From Johnson,R.J. (2001). Usually caused by falling on the adducted shoulder Type 1 & 2 can be treated by exercise Type 3 treated by immobilization Type 4, 5, 6 treated by surgery
Treating AC Separation with Exercise
From Johnson, R.J. (2001b).
Distal Clavicle Fractures
10-20% of all clavicle fractures (Johnson, R.J. 2001)
Usually caused by lateral force directed against shoulder
Types of Distal Clavicular Fractures
Type 1: fracture is lateral to the coraclavicular ligaments. Treatment is use of a sling then rotator cuff and scapular exercises.
Type 2a: Occur medially to the coraclavicular ligaments. Displacement.
Type 2b: Occurs between the conoid and trapezoid ligaments, displacement.
Surgery for type 2 fractures.
Osteoarthritis
Caused by age, repetitive upper body exercises, previous injuries, etc.
Lateral shoulder pain, pain aggravated by horizontal adduction, worse at night
Treated with physical therapy, NSAIDs, corticosteroids, and surgery (removal of distal clavicle)
Rotator Cuff Injuries
Causes Types
Primary ImpingementSecondary ImpingementInternal or posterior superior glenoid
impingement
Predisposition to Rotator Cuff Injuries?
From Wolin & Tarbet (1997). Shape of acromion may predispose to injury. Type II & III correlated with full tears Type II tears correlated with partial tears
Primary Impingement
Repetitive overhead activity leads to impingement of supraspinatus against the inferior acromion and/or coracromial ligament
Shoulder Secondary Impingement, Scapulothoracic Causes
Excessive anterior tilt of the scapula
Fatigue of muscles stabilizing scapula (trapezius, serratus anterior)
From DePalma & Johnson (2003).
Diagnosing Scapulothoracic Rhythm Deficiencies
Medial “winging” Indicates
weaknesses or difficulties with the serratus anterior
From DePalma & Johnson (2003).
Diagnosing Scapulothoracic Rhythm Deficiencies
Lateral “winging” Indicates trapezius
weakness
From DePalma & Johnson (2003).
Rehabbing Scapulothoracic Rhythm
Isometric Stabilization Exercises
“Simple” Closed Chain
“Complex” Closed Chain
Rotator Cuff Exercises
Scapulothoracic Isometric Exercises Protraction Retraction Elevation Depression
“Simple” Closed Chain Exercises On all fours, elbows extended:
ElevationDepressionProtractionRetraction
“Complex” Closed Chain Exercises From retraction:
RowingPush-UpsPress-Ups
Internal/Posterior Superior Glenoid Impingement
Overhead activities where arm abducted to 90 degrees and maximally externally rotated.
Supraspinatus caught between humerus and glenoid labrum.
From Wolin & Tarbet (1997).
Rotator Cuff Injury Therapy
ROM Exercises
Very light weight, isotonic exercises
Weight-bearing, closed chain exercises
Rotator Cuff Rehab Guidelines
Initially performed with light weights or elastic bands
Performed with arm below shoulder level or at the side
Exercises that isolate specific cuff muscles should not be done at greater than 90 degrees of abduction
Modifying Exercises for RC Injuries Bench Press Dumbbell Press Seated Row Lat Pulldown
Bench Press
Towel Bench Press Floor Press Close Grip Bench Press
Dumbbell Press
Using a neutral grip Elbows at side
Seated Row 1
Higher Seat (arm less than 90 degrees of flexion)
From Lantz & McNamara (2003a).
Seated Row 2
Initiate movement with retraction
From Lantz & McNamara (2003a).
Seated Row 3
Arms travel to side of body only
From Lantz & McNamara (2003a).
Lat Pulldown 1
Depress and retract the scapula at beginning.
Maintain this position
From Lantz & McNamara (2003b).
Lat Pulldown 2
Don’t let elbows travel past the body.
From Lantz & McNamara (2003b).