Shoulder Trauma and Hypomobility

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Shoulder Trauma and Hypomobility

INTRODUCTION

Optimal functioning of the shoulder and arm can take place only if the delicate balance of healthy anatomy, proper biomechanics, and normal physiology is maintained. Disruption of any one of these three factors may lead to overload and injury, resulting in pain and dysfunction. A vast amount of information regarding the pathoanatomy and biomechanics of the shoulder has contributed to the clinician's ability to understand and manage patients with shoulder complaints more accurately and effectively. Surgical techniques grounded in basic scientific principles related to the restoration of normal anatomy, biomechanics, and the physiology of injured or compromised structures have changed to allow for earlier introduction of rehabilitation. Keeping pace with changes in surgical intervention, rehabilitation programs are now based upon principles derived from pathophysiology, functional anatomy, and restoration of the entire kinetic chain from the lower extremity through the trunk, shoulder girdle, and arm.

Proper rehabilitation of the injured shoulder should be based on knowledge of the normal anatomy and function of the entire shoulder girdle complex and the inherent demands and potential mechanisms that may contribute to or cause injury to this region. Goals of simply increasing range of motion and/or improving strength at the glenohumeral joint are no longer acceptable; rather, clinicians must be mindful of how the glenohumeral and scapulothoracic complex functions as part of the entire kinetic chain and understand the subtle relationships among all these interrelated components. Rehabilitation programs prescribed for the treatment of shoulder conditions should be centered on principles of treatment as well as specific condition exercise protocols, and these principles should be coupled with the clinician's knowledge of the shoulder, particularly how it functions under both normal and abnormal circumstances. Hopefully, advances in management of the injured shoulder are reflected in improved and earlier return to functional status for patients.

An advantage of managing the injured shoulder according to general treatment principles, rather than specific protocols, is the adaptability of these principles to many different situations. In other words, patients with different shoulder pathologies can benefit from the application of some or all of these treatment principles as they share the same goals of "normalizing" shoulder anatomy, biomechanics, and physiology.

Principles of Shoulder Treatment

· Proper and thorough assessment

· Early protected motion after a period of immobilization

· Proper evaluation and treatment of local and distant deficits

· Scapular control

· Pain management

· Sensorimotor control

· Progressions

· Closed chain axial loading exercise

· Functional exercises

Common Principles of Treatment

Shoulder Anatomy

SHOULDER FUNCTION

STERNOCLAVICULAR AND ACROMIOCLAVICULAR JOINT INJURIES

Function of the Sternoclavicular Joint

Chapter Five Shoulder Trauma and Hypomobility

Sternoclavicular Joint Dislocations

Chapter Five Shoulder Trauma and Hypomobility

Clinical Presentation of Sternoclavicular Joint Dislocations

Treatment of Sternoclavicular Joint Dislocations

Chapter Five Shoulder Trauma and Hypomobility

Complications of Sternoclavicular Posterior Dislocation

Acromioclavicular Joint

Function of the Acromioclavicular Joint

Acromioclavicular Joint Injuries

Chapter Five Shoulder Trauma and Hypomobility

Clinical Presentation of Acromioclavicular Joint Injuries

Chapter Five Shoulder Trauma and Hypomobility

Treatment of Acromioclavicular Joint Injuries

Chapter Five Shoulder Trauma and Hypomobility

FROZEN SHOULDER

Chapter Five Shoulder Trauma and Hypomobility

Clinical Presentation of Frozen Shoulder

Chapter Five Shoulder Trauma and Hypomobility

Treatment of Frozen Shoulder

Chapter Five Shoulder Trauma and Hypomobility

SHOULDER FRACTURES

Scapular Fractures

Clinical Evaluation of Scapular Fractures

Treatment of Scapular Fractures

Chapter Five Shoulder Trauma and Hypomobility

Clavicular Fractures

Clinical Evaluation of Clavicular Fractures

Chapter Five Shoulder Trauma and Hypomobility

Treatment of Clavicular Fractures

Chapter Five Shoulder Trauma and Hypomobility

Proximal Humeral Fractures

Radiographic Signs of Little Leaguer's Shoulder

Clinical Presentation of Proximal Humeral Fractures

Chapter Five Shoulder Trauma and Hypomobility

ROTATOR CUFF INJURIES

BICEPS TENDON AND SUPERIOR LABRAL LESIONS

Chapter five Shoulder Trauma and Hypomobility

Etiology of Biceps Lesions

Relevant Anatomy

Function of the Biceps

Classification of Biceps Lesions

Chapter Five Shoulder Trauma and Hypomobility

Clinical Presentation of Biceps Lesions

Chapter Five Shoulder Trauma and Hypomobility

Treatment of Biceps Injuries

NERVE INJURIES OF THE SHOULDER

Chapter five Shoulder Trauma and Hypomobility

CHAPTER SIX

INTRODUCTION

FUNCTIONAL ANATOMY

Chapter Six Shoulder Instability

PRINCIPLES OF SHOULDER ASSESSMENT

Key Elements for a Clinical Diagnosis

Chapter Six Shoulder Instability

Chapter Six. Shoulder Instability

ROTATOR CUFF DEGENERATION AND DYSFUNCTION (SHOULDER "IMPINGEMENT")

Chapter Six Shoulder Instability

Functional Assessment of the Unstable or Dysfunctional Rotator Cuff and "Impinging" Shoulder

Chapter Six Shoulder Instability

Surgical Treatment of Rotator Cuff Dysfunction

Shoulder Instability, Subluxation, and Dislocations

Chapter Six Shoulder Instability

Anterior Dislocations

Chapter Six Shoulder Instability

Posterior Dislocations

TREATMENT PRINCIPLES FOR A DISLOCATED SHOULDER

Chapter Six Shoulder Instability

SURGICAL TREATMENT OF SHOULDER INSTABILITY

Chapter Six Shoulder Instability

POSTSURGICAL TREATMENT OF THE SHOULDER

Principles of Specificity Related to Sports and Rehabilitation

Chapter Six Shoulder Instability

PITFALLS OF TREATMENT FOR SHOULDER INSTABILITY AND IMPINGEMENT MANAGEMENT

Chapter Six Shoulder Instability

. Incorrect movement patterns

· Inability to "hit" target

. Instability jog or catching movement

· Facial signs of fatigue

Chapter Six Shoulder Instability

Step one point one: Reduce Pain (Aim: Pain Control)

Step one point two: Allow Freedom of Movement (Aim: To Restore Normal Arthrokinematic and Osteokinematic Movement)

Chapter six Shoulder Instability

Tight Structures Seen in Shoulder Instability and Impingement

Chapter six Shoulder Instability

Step two point one: Ensure Proper Muscle Function (Aim: To Ensure All Muscles Contract Individually)

Chapter six Shoulder Instability

Step two point two: Ensure Proper Muscle Recruitment and Motor Patterns (Aim: To Ensure All Muscles Contract When They Should)

Chapter six Shoulder Instability

Step Two point three: Correct Muscle Imbalances (Aim: To Ensure Correct Force-Couple Action)

Chapter Six Shoulder Instability

Correcting Strength Discrepancies

Chapter six Shoulder Instability

Step four point one: Retrain Proprioception and Kinesthesia (Aim: To Ensure Voluntary Control and Awareness of Movement)

Chapter six Shoulder Instability

Step five point one: Reeducate the Stability Muscles Statically (Aim: To Ensure Isometric Positioning for Form and Skill Execution)

Reeducating the Muscle Stabilizers Statically

Chapter six Shoulder Instability

Step five point two: Advanced Static Stabilization Exercises (Aim: Isometric Positioning for Activity-Specific Skills)

Chapter six Shoulder Instability

Step five point three: Dynamic Stabilization Exercises (Aim: Dynamic Form and Execution with Voluntary Control)

Step five point four: Advanced Dynamic Stabilization (Aim: Dynamic Form and Execution of Activity-Specific Skills)

Teaching Advanced Dynamic Stabilization Exercises

Step five point five: Functional Stabilization (Aim: Functional Form and Skill Execution)

Chapter six Shoulder Instability

Criteria for Return to Activity

Chapter six Shoulder Instability

Step six point one: Fitness Aim: To Restore or Maintain Fitness throughout Program

SUMMARY

Chapter six Shoulder Instability

Rotator Cuff Pathology

ROTATOR CUFF ANATOMY

Rotator Cuff Muscles

Chapter Seven Rotator Cuff Pathology

Chapter seven Rotator Cuff Pathology

Muscles Controlling the Movement of the Scapula

ROTATOR CUFF FUNCTION

Clinical Note

Chapter Seven Rotator Cuff Pathology

Functions of the Rotator Cuff

Chapter Seven Rotator Cuff Pathology

deceleration phase, to keep the humeral head centered in the glenoid. Thus, repetitive throwing motion can lead to repetitive microtrauma or impingement on the posterior glenoid margin, usually involv

ROTATOR CUFF INJURIES

Chapter Seven Rotator Cuff Pathology

Tendinopathy

Determinants for Treatment of Rotator Cuff Tendinopathy

Impingement Syndromes

Chapter Seven Rotator Cuff Pathology

Rotator Cuff Tears

Chapter Seven Rotator Cuff Pathology

Natural History of Rotator Cuff Tears

Chapter Seven Rotator Cuff Pathology

General Treatment of Rotator Cuff Tears

CLINICAL PRESENTATION OF ROTATOR CUFF PATHOLOGY

Patient History

Patient Profile

Mechanism of Injury

Aggravating and Easing Factors

Pain

Function and Health-Related Quality of Life

Physical Examination

Chapter Seven Rotator Cuff Pathology

Mobility

Chapter Seven Rotator Cuff Pathology

Strength

Chapter Seven Rotator Cuff Pathology

Special Tests

Diagnostic Imaging

Chapter Seven Rotator Cuff Pathology

TREATMENT OF ROTATOR CUFF PATHOLOGY

Operative versus Nonoperative Management

Chapter Seven Rotator Cuff Pathology

Nonoperative Management

Chapter Seven Rotator Cuff Pathology

Operative Management

Postoperative Management

Chapter seven Rotator Cuff Pathology

Chapter eight

INTRODUCTION

PREVALENCE OF SHOULDER ARTHROPLASTY

ANATOMY AND JOINT DESIGN

INDICATIONS FOR SHOULDER ARTHROPLASTY

Chapter eight Shoulder Arthroplasty

EVALUATION OF THE ARTHRITIC SHOULDER

Chapter Eight Shoulder Arthroplasty

Physical Examination

Inspection (Observation)

Palpation

Range of Motion

Strength Testing

Chapter Eight Shoulder Arthroplasty

DIAGNOSTIC MODALITIES

Plain Radiographs

Key Factors That Determine the Need for Arthroplasty

Arthrography

Chapter Eight Shoulder Arthroplasty

Computed Tomography

Chapter Eight Shoulder Arthroplasty

Other Modalities

YOUNG SHOULDER ARTHROPLASTY PATIENTS

Preoperative Laboratory Tests with Normal Ranges

Chapter Eight Shoulder Arthroplasty

PREOPERATIVE REHABILITATION

Rehabilitation Guidelines after Shoulder Arthroplasty-cont'd

Chapter Eight Shoulder Arthroplasty

Clinical Note

Risks and Complications of Arthroplasty

HEMIARTHROPLASTY VERSUS TOTAL SHOULDER ARTHROPLASTY

Patients Unsuitable for Shoulder Arthroplasty

Chapter Eight Shoulder Arthroplasty

OPERATIVE TECHNIQUE FOR TOTAL SHOULDER REPLACEMENT

Chapter Eight Shoulder Arthroplasty

Preparation of the Glenoid

Implantation of the Prosthesis

Chapter Eight Shoulder Arthroplasty

READMISSION

POSTOPERATIVE REHABILITATION

Immediate Postoperative Phase (Days zero to seven)

Immediate Postoperative Phase Milestones

Early Postoperative Phase (Weeks one to six)

Chapter eight Shoulder Arthroplasty

Chapter Eight Shoulder Arthroplasty

Early Postoperative Phase Milestones

Intermediate Postoperative Phase (Weeks Six to Twelve)

Chapter Eight Shoulder Arthroplasty

Intermediate Postoperative Phase Milestones

Return to Activity Phase (Weeks Twelve to Twenty-Four)

Return to Activity Phase Milestones

Key Points in Rehabilitation

Activity after Total Shoulder Arthroplasty: One Thousand Nine Hundred Ninety-Nine American Shoulder and Elbow Surgeons Survey

OUTCOMES OF SHOULDER ARTHROPLASTY

Chapter Eight Shoulder Arthroplasty

SUMMARY

Overview

The document offers an in-depth analysis of shoulder trauma and hypomobility, detailing relevant anatomical aspects, biomechanics, and rehabilitation strategies. It aims to equip clinicians with principles and practical approaches for effective assessment and treatment of shoulder injuries.

Key Points

1Optimal shoulder function requires a delicate balance of anatomy, biomechanics, and physiology
2Rehabilitation must incorporate principles tailored to the individual's functional needs
3Early protected motion is crucial after immobility to prevent stiffness
4Effective assessment includes evaluating local and distal deficits affecting the kinetic chain
5Pain management and sensorimotor control are essential components of rehabilitation.

Details

Authors: Judy C. Chepeha
Category: Health and Medicine

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