Joanne Bloggs - (OUTCOME MEASURES (Oxford scale, AROM, PROM, Active…
Joanne Bloggs -
VAS / NPRS
Shoulder stability exercises
shoulder stability resistance tubes
Quadruped scapular push ups
Shoulder strengthening and progression
Shoulder plank variations
dynamic shoulder stability
Internal and external rotation - plyometrics
Special Tests for assessment
Hawkins-Kennedy impingement test video
sensitivity of 63-74% and specificity of 40-89%
Neers' Impingement test video
sensitivity of 54-81% and specificity of 10-95%
Painful Arc video
Scapular Dyskinesia - Scapular Assistance Test (SAT)
Scapular Dyskinesia - Scapular Retraction Test (SRT)
Serratus Anterior strength assessment
Rotator Cuff Tendinopathy exercises
Tight upper trapezius
Eccentric exercise - video
patient needs high motivation
Subacromial Impingement Syndrome - information from NHS website
Rotator Cuff Tendinopathy Fact Sheet NHS Staffordshire and Stoke on Trent Partnership
Shoulder impingement fact sheet - Oxford University Hospital
Subacromial Bursitis - information from NHS website
Shoulder impingement explained - video
SCAPULAR STABILITY EXERCISES
Early stage - journal
Scapular Clock, Low Row, Lawn Mower, Inferior Glide
Muscles controlling the scapular. Trapezius (upper, middle, lower), Serratus Anterior, Rhomboids, Levator Scapular, Pectoralis Minor
Muscle control - activation of muscles in a specific pattern to facilitate skilled and coordinated movements.
Rehab focus on repetition and practice of correct movement patterns
held for 5 sec with 10 sec rest
can be performed frequently during the day in sets of 10 reps
number of sets varies at different stages of the rehab programme
Corticosteroid injections, Wolverhampton Social prescribing network - GP
CBT - psychology
Reasonable adjustments for occupation and home support - OT
OPEN CHAIN EXERCISES
PROS - Decrease joint compression, exercise in non-weight bearing positions, exercise through increased ROM, isolate individual muscles.
CONS - Decreased functionality
CLOSED CHAIN EXERCISES
PROS - Increased functionality
CONS - Not able to exercise through an increased ROM. Not able to isolate individual muscles
Resistance exercise programme to promote muscle balance
1st - Side lying - external rotation and prone shoulder extension
progression - prone horizontal abduction and prone external rotation - with scapular retraction
Prone horizontal abduction at 90 degrees abduction to reduce subacromial contact. High levels of supraspinatus activation. Empty can exercise not recommended as it can cause impingement during movement.
Standing external rotation exercise with TheraBand or elastic tubing. Small towel placed under axilla = increase in subacromial space.
Rehabilitation of SIS and Rotator Cuff Injuries
SETS AND REPS
3 sets; 15-20 reps; 1 min rest = creates a fatigue response to develop local muscular endurance.
STRENGTH / HYPERTROPHY
8-12 reps; 3 sets; 2-3 mins rest.
RANGE OF MOTION
Grade 1-2 - Pain. Grade 3-4 - ROM. 1-4 sets; 20-30 seconds.
Clinical effectiveness of Kinesiology taping in shoulder impingement
K Tape application video
Acupuncture treatment of shoulder impingement
Wolverhampton Social Prescribing Network
GP referral needed
Shoulder joint positioning in space assessment
Exercise programme aim to address
· muscle activation and motor control
· muscle strength, power and endurance
· cardiovascuar fitness
· funtional ex
· sports specific skills
· correction of biomechanical abnormalities
Painful arc exercises - video
. Upper trapezius combines with lower trapezius and serratus anterior to control upward rotation; upper trapezius and pectoralis minor combine with serratus anterior and lower trapezius to control the anterior/posterior tilt, and rotation.
Specific muscles that are usually tight - Pectoralis Minor, Levator scapular, Latissimus Dorsi. Rhomboids.
Group exercise - low cost, improve social interaction, improve mood, improve self-efficacy
Reddy et al., 2000 found significant decrease in muscle activity of the supraspinatus and infraspinatus of symptomatic rotator cuff impingement individuals in comparison to the non-symptomatic individual.
Erol, Ozcakar and Celiker, 2008 found consistent weakness and muscle imbalance of the internal and external rotator muscles of those presenting with rotator cuff impingement.
Ludewig et al., 2004 found incorporating kinetic chain exercises in to specific shoulder rehab programmes to be beneficial, they identified altering lower limb position during push ups variations increased the activity of the serratus anterior. Therefore incorporating their ideas in to a rehab programme may be beneficial, adapting the exercises to more functional based tasks appropriate for the individual
Subacromial rehab DRMESS Document