Scapular Muscle Rehabilitation

This paper is going to be over rotator cuff injuries and what to do if this occurs to an athlete. The rotator cuff consists of four muscles which are the Subscapularis, infraspinatus, teres minor, and the supraspinatus and their associated tendons that insert into the Humerus. These groups of muscles are responsible for rotating the arm internally and externally as well as abducting the shoulder. The acronym for the four muscles of the rotator cuff is known as SITS. The best treatment for symptomatic, nontraumatic rotator cuff tears is unknown. The purpose of this trial was to compare the effectiveness of physiotherapy, acromioplasty, and rotator cuff repair for this injury. The way this trial worked was that 180 shoulders with the symptomatic,

To provide measurements for safe reintroductions of the athletes to their respected sports, Standard Functional Tests (SFT) have been developed. (8,9,10) Most of these tests combined complex movements together to test and measure strength and neuromuscular control of athletes with activities that resemble athletic movements such as jumping, landing, and cutting. No universal accepted protocol exists to date (11), however, hop tests are the most common used in determining return to play follow ACL reconstruction (12) and have shown good reliability (13,14) and validity (14). Hop tests include single leg hop (SLH), triple hop (TH), cross over hop (COH), and timed hops (15). The single leg hop has been studied extensively and can help detect function limitations for up to 54 weeks postoperatively with good test-retest reliability. (16,17,18,19,20) It has also been shown to be

Studies show that the magnitude of GIRD and TROM deficits can change acutely following repetitive throwing exposure, such as after a baseball game(19, 30). Not only does this implicate soft tissue involvement in allowing for shifts of arcs of motion, it also indicates that dynamic stabilizers of the shoulder play an important role in prevention of injury as they safeguard the GIRD-affected shoulder from extremes of motion. Fatigue can thus predispose significantly to soft tissue injuries such as thrower’s SLAP tears and impingement(31). A reasonable assertion would be that shoulder overuse likely confounds any study in GIRD as a primary source of tissue injury. As such, training programs should not neglect rest and strengthening as part of the therapy regimen(20).

608) puts forth in their report that the glenohumeral joint is the most movable joint in the body that is at the risk of decreased stability, therefore, complex interaction between static (osseous, soft tissue stabilizers) and dynamic stabilizers (tendon-muscle complex) commands elaborate balance and synchronicity. Any disruption in this intricate mechanism can lead to shoulder instability. In the research study of Rerko, Pan, Donaldson, Jones, & Bishop (2013), the examiners systematically interrupted the glenoid bone to show if it has any effect on the stability of the shoulder and if there is any impact, what imaging modality would be the best to demonstrate it to guide the surgeon in repairing the shoulder instability. The researchers used fresh cadavers shoulders and strategically created defects to the glenoid bone. Imaging modalities such as X-rays, CT scan, and MRI were taken. Measurement of the specificity and sensitivity of the various diagnostic imaging were made, and 3D CT scan has demonstrated a very high specificity and sensitivity compared to the other imaging tools. Furthermore, Bishop, Jones, Rerko, & Donaldson (2013, p. 1255) asserted the significance of preoperative 3-D CT scan to determine the anterior shoulder instability with a concern for a osseous loss of the glenoid bone. The authors believe that 3D CT scan is the most consistent imaging modality in providing an estimation of the bone deterioration compared

The participants included 87 individuals (28 men, 49 women) with various shoulder dysfunctions who were assessed during a routine clinical evaluation and consented for shoulder arthroscopy. Also, all individuals were required to have a magnetic resonance image (MRI), to have completed the dedicated special tests of interest in the study, and to have a detailed diagnosis after arthroscopic surgery.

During the rehab process, exercises that emphasize kinetic chain activation of the leg, trunk, and scapula should be established. Different types of exercises talked about were trunk extension, scapular retraction, trunk rotation and scapular retraction, and 1-legged stance. The rotator cuff exercises were not implemented until after the proximal base had been established. The closed-chain rotator cuff exercise performed included humeral head depressions and rotations on a ball, “wall washes”, and punches.

The differing results are likely because of differences in skill level among test subjects, methods of evaluation, and erratic sprint distances. The main strength qualities being explored in this data analysis are: absolute strength, relative strength, high-load speed strength, and low-load speed strength. Every sport requires several combinations of these strength qualities to be successful (13). Absolute strength is the measurement of how much force a subject can exert with no regard to body size (3). Relative strength is the measurement of strength to body size. High-load speed strength is the ability for the muscle to exert a high amount of force while contracting at a high speed. The tests to gauge high-load speed strength are typically short in nature, executed at maximal speeds, and produce high power outputs, and include exercises such as the power clean, snatch, and push jerk (1). Triple extension of the hips, knees, and ankles during these movements allows the athletes to express force against the ground rapidly. Low-load speed strength involves low velocity movements, and is a quality that “reflects the dynamic abilities necessary for sport. They are the maximal strength tests of choice for strength and conditioning professionals”

For shoulder flexion 61% of the variance could be accounted for by the sit-and-reach. A correlation was also found between the modified sit-and-reach test and both the shoulder extension and hip flexion tests. For shoulder extension 33% of the variance was accounted for by the modified sit-and-reach and for hip flexion 22% of the variance was accounted for by the modified sit-and-reach.

This followed fastballs throws at 18.4 m from a mound at 3 different effort levels: 60%, 80%, and full effort. Kinetic values for humeral internal rotational torque and elbow valgus load were recorded for each throw. Repeated-measures analyses of variance were used to compare all 7 throwing conditions within pitchers. Kinetic data was also compared against ball velocity to determine throwing efficiency. A separate analysis was also conducted using a 3-level repeated-measures analysis of variances comparing just the variable-effort throws from the mound. There were significant differences in humeral IR and elbow valgus load off the mound at 60-100%. The study showed that partial effort pitching placed lower loads on the shoulder and elbow. Flat ground throwing had similar loads with pitching from the mound but at a significantly lower ball velocity. The mechanical advantage of throwing from a mound or using the crow hop is likely protective during rehabilitation and training throws. Repetitive use of the shoulder and elbow in overhead athletes places stress and physiological limits leading to breakdown, furthermore

Increasing the stability and decreasing spasticity while strengthening muscles surrounding the joint over a six-week period will improve scapular stabilization thus improving scapulohumeral rhythm, which is an essential part of healthy shoulder function. The results of this study used a combination of stretching and joint stabilization exercises for spastic joint dysfunction in the selected patients reversed the pathological changes in tendons and improved shoulder function. This is seen by the results discussed with the affected tendons being measured before and after the study showing a decrease in the thickness of the tendons over time. The third group had the greatest decrease in thickness. This group was the one that received 15 minutes of joint stabilization exercise and 15 minutes of stretching. The other two groups showed a decrease as well, however, less difference than the third. One of the groups had 30 minutes of joint stabilization exercise while the other had 30 minutes of stretching (Young Youl You, Jin Gang Her, Ji-Hea Woo, Taesung Ko, & Sin Ho Chung,

Therefore, numerous spectrums of instability types and associated lesions affecting capsuloabral, ligamentous, and osseous structures can be identified (Stayner et al., 2000). The pathophysiology of an anterior shoulder dislocation involves violent external rotation in abduction levers causing the humerus to be dislodged from the glenoid socket, tearing the shoulder capsule and detaching the labrum from the glenoid (the Bankart lesion) (Farber et al., 2006). Additionally, the posterior part of the humeral head exits the joint, colliding with the anterior rim of the glenoid, producing a bony depression at the back of the humeral head (the Hill Sachs lesion) (Farber et al., 2006). Furthermore, anterior dislocation can occur when people fall with a combination of abduction, extension, and a force directed posteriorly on the arm; this is a common mechanism in the elderly (Stayner et al. 2000). A fracture of the humeral head, neck or greater tuberosity can occur with a dislocation (Stayner et al., 2000). In contrast, a posteriorly dislocated shoulder is less common. It is commonly caused by external forces acting on the shoulder when the shoulder is held in internal rotation and adduction caused by direct trauma experienced during sporting activities (Hegedus et al., 2008). Additionally, it may be result from an epileptic fit,

Proprioceptive rehabilitation methods look to return the ankle to its previous risk factor level, and return it to its previous function level. Scott et. al (1997) says that afferent feedback to the brain and spinal pathways is mediated by skin, articular, and muscle mechanoreceptors. Rehabilitation aims to re-establish those spinal pathways so that movements can be performed fully again. Scott et. al (1997) believes that rehabilitation programs should be designed to include a proprioceptive component that addresses the following three levels of motor control: spinal reflexes, cognitive programming, and brainstem activity. A program which is set out in this way is highly recommended to promote and return dynamic joint and functional stability. Another study, conducted by Lephart (1995), examined the role of proprioceptive training in the treatment of injuries, and also looked at recent developments in the area of proprioceptive rehabilitation methods. Lephart (1995) notes that ligaments play a major role in normal joint kinematics, providing mechanical restraint to abnormal joint movement when a stress is placed on the joint. Following injury to these tissues there is a loss of mechanical stability to the joint, resulting in changes to normal kinematics. Management of these sport-related injuries focuses on restoring joint kinematics by enhancing muscular stabilisation through rehabilitation. By restoring joint stability through rehabilitation, the athlete should be able to return to playing sport, while the chance of re-injury will be reduced. Some believe that rehabilitation of ankle injuries should be set and individualised for each athlete as no athlete or injury is the same, and react differently to different exercises. Carl (2002) said that in the acute phase, the focus should be on controlling the inflammation and once pain is gone and

Conditioning is always specific to the injury and the athlete involved. Rehabilitation procedures following a dislocated shoulder will differ, as it will include strengthening the rotator cuff muscles as soon as it is possible. These are the muscles that are used to stabilise the shoulder joint and are often damaged and weakened after a dislocation. Often, these exercises don’t involve any light weights but more isometric exercises to strengthen the muscles. These strengthening exercises should begin with isometric contractions such as extension, adduction and rotations. Rotations are particularly effective as they target the rotator cuff muscles that are used to strengthen the stability of the shoulder joint. Like the hamstring, these movements

As mentioned by Wilk and Leonard4 it has been found most shoulder lesions can be rehabilitated conservative without requiring operation.4 Furthermore, it can be speculated that rehabilitation after a required surgery is critical to return the patients to their functional goals. Additionally, a concrete designed rehabilitation program to increase the range of motion, strength, endurance while increasing the stability of the shoulder is a determinant factor as seen in athletes.4

The consequences of weak muscles around the scapula affect your arm movements and strength as well as your posture. The scapula is important for a variety of movements of the arm by moving the glenoid fossa into the best position for the head of the humerus. Elevating the scapula uses your levator scapulae, rhomboids, and trapezius 1 and 2 muscles. Elevation of the scapula allows you to shrug and lift your shoulders up. If the muscles needed for elevating your scapula are weak, then your shoulders wouldn’t be able to lift if someone pushes down on them. Trapezius 1 and 2 are used when are carrying something heavy with your hand by your side and with them being weak you wouldn’t be able to carry heavy things for long distances or maybe not at