Pathomechanics of Common Shoulder Injuries
|
|
- Alvin Roberts
- 5 years ago
- Views:
Transcription
1 Pathomechanics of Common Shoulder Injuries Kevin E. Wilk,, DPT Birmingham, Alabama, USA kevinwilk.. com
2 Shoulder Injuries in Sports Introduction Shoulder injuries are common in sports» Collision sports football, wrestling, skiing College football 4 th most common injured joint Kaplan et al: AJSM 05 Professional Football NFL Combine 5 th AC joint sprains 9 th GH joint instability Brophy et al:med Sci Sports 07» Contact sports soccer, basketball, Shoulder injuries occur in various sports Shoulder Injuries in Sports Contact Sports Collision Sports Contact Sports Shoulder Injuries in Sports Contact Sports Bankart Lesion Detachment of capsulolabral complex increases translation by nearly 200% Lazarus: JBJS 96 The Overhead Thrower Introduction Shoulder & elbow injuries are common in baseball In professional baseball 28 % of all injuries occur to the shoulder joint 22 % of all injuries occur to elbow joint Length of injury time is increasing days on the disabled list days Conte et al: Am J Spts Med 01 In youth baseball 50 % of players (9-14) complained of elbow or shldr pain Lyman et al: Am J Spts Med 02 Number of injuries increasing & age decreasing UCL injuries Petty, Andrews, Fleisig: : AJSM 04
3 The Overhead Thrower Introduction Biomechanics of the Shoulder Joint Complex During Throwing The Thrower s s Shoulder Excessive Motion especially External Rotation Requires stability Inherent hyper-laxity Allows tremendous mobility Fine line: Too loose & just right!!! Paradox of the Thrower s s Shoulder Biomechanics Laboratory Set-Up 85 x 30 x 15 ft. Indoor Laboratory Loose enough to throw, but stable enough to prevent symptoms Wilk: AJSM 02
4 Biomechanics Laboratory Equipment Motion Analysis System (Motion Analysis Corp.) 8 high-speed cameras (240 Hz) Automatic 3D digitizing Reflective markers Pitching Biomechanics : Process Marker Placement 21 total (4 on hat) Acromion Lateral Epicondyle Greater Trochanter Distal Radius (only on pitching hand) Distal Ulna Distal 3 rd Metacarpal (only on pitching hand) 2 in. Superior to Proximal Fibula Lateral Malleolus Distal 3 rd Metatarsal Biomechanics Laboratory Equipment High-Speed Video (Vision Research Inc.)» 450 frames/second Pitching Biomechanics : Process Scientific Feedback Written Report High-Speed Video Unlimited Support Pitching Biomechanics : Introduction Kinetic Chain» Coordinated activation of body segments Pitching Biomechanics : Phases of Pitching 1. Wind-Up 2. Stride 3. Arm Cocking Six Phases 4. Arm Acceleration 5. Arm Deceleration 6. Follow-Through
5 Pitching Biomechanics : Phases of Pitching Windup Low force/torque on shoulder & elbow Stride Pitching Biomechanics : Stride Foot Contact Lead Leg Stride Foot Contact Stride Direction Stride Length & Knee Angle Foot Contact 0 in Shoulder: Abduction = 90 Ext. Rotation = 60 % Height 12 in 5 in Pitching Biomechanics : Stride Foot Contact Upper Arm Stride Foot Contact Shoulder External Rotation Shoulder Abduction Pitching Biomechanics : Stride Foot Contact Upper Arm Stride Foot Contact Shoulder Horizontal Abduction Elbow Flexion
6 Pitching Biomechanics : Phases of Pitching Arm Cocking Pitching Biomechanics : Arm Cocking Trunk Rotation: Stride Foot Contact to MER Pelvis Max. Velocity = /sec 19-39% after FC Upper Trunk Max. Velocity = 1,077 1,229 /sec 40-56% after FC From Stride Foot Contact to Maximum Shoulder External Rotation Pitching Biomechanics : MER Upper Arm MER Maximum Elbow Flexion 9 1 Maximum External Rotation Body rotates forward as the arm rotates backwards Arm Cocking Maximum External Rotation = 145> Arm Acceleration Arm Acceleration How fast is 7500 /s? Internal Rotation Velocity = 7500 /s Fastest measured human joint motion If the arm maintained that peak speed for 1 second, it would make about 20 full revolutions!
7 Pitching Biomechanics : Arm Acceleration Pitching Biomechanics : Ball Release Upper & Lower Body Ball Release Shoulder Abduction & Lateral Trunk Tilt Hip Flexion & Knee Angle Elbow Max. Extension Velocity 2,224 2,684 /sec Shoulder Max. Internal Rotation Velocity 6,688 8,352 /sec Large deceleration forces on shoulder Maximum Internal Rotation = 0 Arm Deceleration Shoulder resists and controls horizontal adduction Large body parts dissipate energy from arm Follow-Through Balance is necessary for fielding position Pathomechanics Max. ER Two critical instants Ball Release 40 Max. ER Pathomechanics Shoulder» Abduction = 90 º» Ext Rotation = 180 º» Anterior Force = 400 N» Int Rot Torque = 67 Nm (equivalent to 40 lbs. pulling down on the hand)
8 Biomechanical Evaluations: Examples Faults Internal Impingement What is it?! Occurs during abduction & excessive external rotation! Late cocking during pitching Foot Contact Foot Contact Pelvis Rotation Ball Release! Supraspinatus / Infraspinatus rubs on the posterosuperior glenoid rim & labrum! Results in fraying of cuff and glenoid labrum inflammation Andrews: Tech Orthop 88 Walch: : JSES 91 Andrews, Wilk,, Reed et al: Sprg Trn asymptomatic professional baseball pitchers in spring training MRI of glenohumeral joint 28/31 (90 %) abnormal glenoid labrum 27/31 (87 %) abnormal rotator cuff appearance 12/31 (39%) humeral head changes All pitchers were pain-free at time of study Jost, Zumstein,, Gerber: CORR competitive Swiss handball players MRI performed both shoulders 93% throwing abnormal MRI - but only 37% were symptomatic Partial rotator cuff tears most common Superolateral osteochondral of humeral head defects present Evaluation critical to diagnosis not just MRI External Rotation " Performance The Shoulder Joint in Tennis External Rotation Forward Trunk Time Elbow Vel Time Shoulder Vel Low Velocity 166 ± 9 29 ± ± 2 % 104 ± 2 % High Velocity 179 ± 8 37 ± 7 91 ± 2 % 102 ± 2 %
9 Shoulder Injuries in Tennis Goals of Presentations Physical characteristics of tennis players Discuss some research in tennis Discuss specific injuries & Rx» Impingement» Scapular dysfunction» Biceps pain The Serve KINEMATIC VARIABLES GH ABD: MAX GH ER: GH IR 7550 /s 4950 /s 1514 /s ELB FLXN ELBOW EXT: 2340 /s 1760 /s 1700 /s FLEISIG ET AL, 96, SHAPIRO & STINE, 92
10 Comparison Baseball Throwing to Tennis Serve Kinematics Joint Kinematics Tennis Serve:! 83 deg abduction! 1,074-2,300 deg/sec! ER to 154 degrees Shapiro: Unpub 92 Dillman: USTA 91 Baseball Throwing:! deg abduction! 7250 deg/sec accel.! 0.5 x BW late cocking! ER to 175 deg.! % BW decel phase! Late cocking ball 0.03sec Fleisig:AJSM 95 Wilk: Spts Med Arthro 00 The Forehand The Backhand
11 Injuries in Tennis Introduction Repetitive overuse UE injuries:» Tendinitis» Muscle strains» SLAP lesions» Tendonosis» Epicondylitis» Stress fractures Overuse Trauma Shoulder injuries:» Impingements Injuries in Tennis Upper Extremity Injuries Impingements Internal impingement Subacromial impingement» Glenoid labrum SLAP lesions» Tendinitis» Tendonosis» Partial thickness tears PASTA lesions PAINT lesions The Biomechanics of the Golf Swing
12 Maximum Velocity During Swing (Degrees Per Second) PGA LPGA Hip turn Shoulder turn Arm velocity Club velocity THE GOLF SWING Set-up position Backswing phase Downswing phase» Forward swing» Acceleration Follow-through phase SET-UP POSITION Important phase of golf swing Align golfer with target Establish postural balance» Knee flexion » Wt distribution 50-60% back foot» Primary spinal angle (trunk flexion)» Secondary spinal angle (lateral R bend) IMPROPER SET-UP POSITION Very common among amateurs Most common not using hip- hinge positions» primary spinal angle formed by spine Improper grip pressure» excessive grip pressure Poor postural balance
13 BACKSWING PHASE Purpose of backswing is to position & align the golfer s s hub of rotation to execute a powerful swing Linear smooth movement Trunk rotation Backswing complete when club is parallel (near) to ground BACKSWING PHASE Right shoulder abducts & ER Left shoulder adducts & IR Scapula (L) protracts, elevates & upward rotates» Right shoulder ER » Left shoulder IR Proper shoulder turn Pelvic rotation of at least 45 0 Critical, but unnatural movement IMPROPER BACKSWING PHASE Most common flaw lateral movements of hips & legs Move laterally instead of rotating within base of support Lack of trunk rotation, (poor flexibility) shoulder mobility» Lead shoulder: limited adduction & IR» Back shoulder: limited ER (flying elbow!!!!) THE DOWNSWING PHASE Forward swing and acceleration Initiated by hip turn & wt. transfer Centrifugal force & angular momentum to generate clubhead speed Clubhead speed: /sec (100 mph) Pelvic rotation speed: /sec Arm speed: /sec Move laterally instead of rotating within base of support Lack of trunk rotation, (inflexibility): greater shoulder mobility
14 THE DOWNSWING PHASE Impact occurs for sec.» Highest incidence of injuries(50%) Highest muscle activity:» Right side: pectoralis major, subscapularis, latissimus dorsi» Left side: latissimus dorsi & subscapularis,, posterior muscles IMPROPER DOWNSWING PHASE Loss of swing path due to weight shifting» Lost swing in backswing Amateurs generate 50-80% greater spine forces & 50% greater EMG Yet professionals generate 34% greater clubhead speed THE FOLLOW-THROUGH PHASE Body gradually decelerates rotary movement through eccentric contractions Shoulder function as backswing (reverse)» Left shldr: abd, horiz abd, ER» Right shldr: horiz add, IR Arms reach shoulder level elbows flex Subscapularis, pect major, & lats Second highest incidence of injuries (30%) PHYSICAL FACTORS THAT CAN LIMIT SWING Shoulders - tightness which limits shoulder turn, inability to maintain swing plane» Lead shoulder: limited Horz add, IR then 55 deg abd» Back shoulder: limited ER at 45 deg abduction then horiz add with IR Low back - tightness which limits proper set-up, limits rotation Hip/pelvis - weakness & tightness limits rotation, posture swing plane PHYSICAL FACTORS THAT CAN LIMIT SWING Evaluation ROM & flexibility Strength test Golf functional test Will your body allow you to swing properly & effectively
15 Treat Kinetic Chain The Females Throwing Shoulder Windmill Softball Pitch 4 Phases of Pitch #Windup #Stride #Delivery #Follow through Barrentine, et al JOSPT
16 Windmill Softball Pitch Biomechanical Analysis Wind-up phase» Arm in hyperextension» Foot push-offs» Initiate forward translation of body Windmill Softball Pitch Stride phase» Emphasis on forward translation of body» Excessive shoulder flexion (180 0 )» Linear velocity of hips Biomechanical Analysis Windmill Softball Pitch Biomechanical Analysis Delivery phase» Trunk rotation 430 deg/sec» Torso rotation 650 deg/sec» Arm flexion & IR 5,000 deg/sec #*Shoulder flex 3x BW #*Superior forces 98% BW Windmill Softball Pitch Follow through phase» Gradually dissipate forces» Max shoulder post force 59% BW» Elbow compression force 56% BW Biomechanical Analysis Windmill Softball Pitch EMG Analysis Maffet: : AJSM 97 From 6 to 3 o clocko» Infraspinatus 93% MVIC» Supraspinatus 78% MVIC» Ant. Deltoid 38% MVIC Windmill Softball Pitch EMG Analysis Maffet: : AJSM 97 From 3 to 12 o clocko» Posterior deltoid 102%» Teres minor 87%» Infraspinatus 87%
17 Windmill Softball Pitch EMG Analysis Maffet: : AJSM 97 From 12 to 9 o clocko» Subscapularis 81%» Pectoralis major 575» Posterior deltoid 52% Windmill Softball Pitch EMG Analysis Maffet: : AJSM 97 From 9 o clock o to ball release» Pect major 76%» Subscapularis 75%» Serratus anterior 61% Shoulder Injuries in Sports Conclusions Shoulder injuries are common in sports Numerous types of lesions Understanding the pathomechanics assists in diagnosis & treatment Also may assist in prevention programs Recognition is key to proper treatment Danke
Exploring the Rotator Cuff
Exploring the Rotator Cuff Improving one s performance in sports and daily activity is a factor of neuromuscular efficiency and metabolic enhancements. To attain proficiency, reaction force must be effectively
More informationThrowing Athlete Rehabilitation. Brett Schulz LAT/CMSS Sport and Spine Physical Therapy
Throwing Athlete Rehabilitation Brett Schulz LAT/CMSS Sport and Spine Physical Therapy Disclosure No conflicts to disclose Throwing Athlete Dilemma The shoulder must have enough range of motion to allow
More informationUpper Limb Biomechanics SCHOOL OF HUMAN MOVEMENT STUDIES
Upper Limb Biomechanics Phases of throwing motion 1. Wind up Starts: initiate first movement Ends: lead leg is lifted & throwing hand removed from glove COG raised 2. Early Cocking Start: lead leg is lifted
More informationAdvances in Rehabilitation of the Throwing Athlete
Advances in Rehabilitation of the Throwing Athlete Introduction It is a "whipping" action that brings the hand and eventually the ball to a speed of 90 to 100 mph. Elite level is 87 MPH (Football is 55
More informationThrowing Injuries and Prevention: The Physical Therapy Perspective
Throwing Injuries and Prevention: The Physical Therapy Perspective Andrew M Jordan, PT, DPT, OCS Staff Physical Therapist, Cayuga Medical Center Physical Therapy and Sports Medicine ajordan@cayugamed.org
More informationSLAP Lesions Assessment & Treatment
SLAP Lesions Assessment & Treatment Kevin E. Wilk,, PT, DPT Glenoid Labral Lesions Introduction Common injury - difficult to diagnose May occur in isolation or in combination SLAP lesions: Snyder: Arthroscopy
More informationER + IR = Total Motion
Treating the Thrower s Shoulder Michael M. Reinold, PT, DPT, ATC, CSCS Introduction Common site of injury» Repetitive forces / stresses Tremendous joint forces» Anterior shear forces 1-1.5 1.5 X BW» Distraction
More informationReturn to Play Criteria in the Overhead Thrower
in the Overhead Thrower Kevin E. Wilk, PT, DPT,FAPTA 2018 The Overhead Thrower Introduction Highly skilled athlete Requires flexibility, muscle strength, coordination, synchronicity & NM efficiency Proper
More informationI (and/or my co-authors) have something to disclose.
Shoulder Anatomy And Biomechanics Nikhil N Verma, MD Director of Sports Medicine Professor, Department of Orthopedics Rush University Team Physician, Chicago White Sox and Bulls I (and/or my co-authors)
More informationAddressing Core and Balance Deficits to Maximize Return to Sport in Overhead Athletes
Addressing Core and Balance Deficits to Maximize Return to Sport in Overhead Athletes Meg Jacobs P.T. Momentum Physical Therapy and Sports Rehab Hands on care for faster results www.wegetyouhealthy.com
More informationReview shoulder anatomy Review the physical exam of the shoulder Discuss some common causes of acute shoulder pain Discuss some common causes of
Review shoulder anatomy Review the physical exam of the shoulder Discuss some common causes of acute shoulder pain Discuss some common causes of chronic shoulder pain Review with some case questions Bones:
More informationUpper Extremity Injuries in Youth Baseball: Causes and Prevention
Upper Extremity Injuries in Youth Baseball: Causes and Prevention Biomechanics Throwing a baseball is an unnatural movement Excessively high forces are generated at the elbow and shoulder Throwing requires
More informationUCL: It Is Not Just the Forces; It Is the Time Spent In Each Position. Chuck Wolf, MS, FAFS Human Motion Associates
UCL: It Is Not Just the Forces; It Is the Time Spent In Each Position Chuck Wolf, MS, FAFS Human Motion Associates If You Continually Hit Your Thumb When Using A Hammer, Hammering Less Is Not the Answer
More informationReturning the Shoulder Back to Optimal Function. Scapula. Clavicle. Humerus. Bones of the Shoulder (Osteology) Joints of the Shoulder (Arthrology)
Returning the Shoulder Back to Optimal Function Sternum Clavicle Ribs Scapula Humerus Bones of the Shoulder (Osteology) By Rick Kaselj Clavicle Scapula Medial Left Anterior Clavicle Inferior View 20 degree
More informationREMINDER. Obtain medical clearance and physician s release prior to beginning an exercise program for clients with medical or orthopedic concerns
Understanding Shoulder Dysfunction REMINDER Obtain medical clearance and physician s release prior to beginning an exercise program for clients with medical or orthopedic concerns What is a healthy shoulder?
More informationSHOULDER PAIN LESSONS FROM THE SPORTS FIELD MOVEMENT RESTRICTIONS. Steve McCaig
SHOULDER PAIN LESSONS FROM THE SPORTS FIELD MOVEMENT RESTRICTIONS 1 Steve McCaig Senior Physiotherapist England Development Programme, ECB, Loughborough, United Kingdom Throwing High forces upper limb
More informationRehabilitation of Overhead Shoulder Injuries
Rehabilitation of Overhead Shoulder Injuries 16 th Annual Primary Care Orthopaedic & Sports Medicine Symposium January 29, 2016 Jeremy Sherman, PT, MPT Disclosures No financial disclosures to note. Jeremy
More information11/6/2013. Keely Behning, PT, SCS, ATC MNPTA Fall Conference November 16, 2013
Keely Behning, PT, SCS, ATC MNPTA Fall Conference November 16, 2013 Upon completion of this course, attendees should be able to: Understand pertinent anatomy and biomechanics as they relate to specific
More informationA comparison of the immediate effects of muscle energy technique and joint mobilizations on posterior shoulder tightness in youth throwing athletes
Illinois State University ISU ReD: Research and edata Theses and Dissertations 11-7-2016 A comparison of the immediate effects of muscle energy technique and joint mobilizations on posterior shoulder tightness
More informationStephanie D. Moore-Reed, PhD, ATC California State University, Fresno California State University, Fresno S E S A P IX Lead/Stride leg
OBJECTIVES Corrective Exercise to Address Common Biomechanical Alterations throughout Each Phase of the Throwing Motion Stephanie D. Moore-Reed, PhD, ATC California State University, Fresno Six phases
More informationArm Pain in Throwing Athletes. Eric N. Hoeper, MD Primary Care Sports Medicine NorthShore University HealthSystem
Arm Pain in Throwing Athletes Eric N. Hoeper, MD Primary Care Sports Medicine NorthShore University HealthSystem I have no potential conflicts of interest to declare. What s the Big Deal? Between 26% and
More informationA COMPLETE KINEMATIC, KINETIC, AND ELECTROMYOGRAPHICAL ANALYSIS OF THE FOOTBALL THROW IN COLLEGIATE QUARTERBACKS
University of Kentucky UKnowledge Theses and Dissertations--Kinesiology and Health Promotion Kinesiology and Health Promotion 2016 A COMPLETE KINEMATIC, KINETIC, AND ELECTROMYOGRAPHICAL ANALYSIS OF THE
More informationREMINDER. an exercise program. Senior Fitness Obtain medical clearance and physician s release prior to beginning
Functional Forever: Exercise for Independent Living REMINDER Obtain medical clearance and physician s release prior to beginning an exercise program for clients with medical or orthopedic concerns. What
More informationAquatic Exercise. Rehabilitation after the SLAP lesion repair. I. Anatomy & Function SLAP 의가장흔한손상기전. Anatomy of the Shoulder (I)
Aquatic Exercise Rehabilitation after the SLAP lesion repair Sports Medicine Clinic Sky 임승길 ATC 2 SLAP 의가장흔한손상기전 SLAP Superior Labrum Anterior to Posterior 1. Compression force Attempting to catch a heavy
More informationShoulder: Clinical Anatomy, Kinematics & Biomechanics
Shoulder: Clinical Anatomy, Kinematics & Biomechanics Dr. Alex K C Poon Department of Orthopaedics & Traumatology Pamela Youde Nethersole Eastern Hospital Clinical Anatomy the application of anatomy to
More informationOutline. Training Interventions for Youth Baseball Athletes. 3 Rehabilitation Focus Points. What Training to Perform?
Outline Training Interventions for Youth Baseball Athletes Tim L. Uhl PhD ATC PT FNATA Division of Athletic Training Department of Rehabilitation Sciences College of Health Sciences University of Kentucky
More informationDisclosures. Training for the Scapulothoracic Joint and Thoracic Spine. Scapular Muscles Stabilization & Rotation 9/7/2018
Disclosures Training for the Scapulothoracic Joint and Thoracic Spine mtrigger Litecure Russ Paine, PT Director -UT Physicians Sportsmedicine Rehabilitation Houston, Texas 21 academic institutions 14 hospitals
More informationTheodore B. Shybut, M.D.
Theodore B. Shybut, M.D. Orthopedics and Sports Medicine 7200 Cambridge St. #10A Houston, Texas 77030 Non-operative Shoulder Rehabilitation Protocol Basic shoulder program for: o Scapular Dyskinesis (proximally
More informationMaximal isokinetic and isometric muscle strength of major muscle groups related to age, body weight, height, and sex in 178 healthy subjects
Maximal isokinetic and isometric muscle strength of major muscle groups related to age, body weight, height, and sex in 178 healthy subjects Test protocol Muscle test procedures. Prior to each test participants
More informationR. Frank Henn III, MD. Associate Professor Chief of Sports Medicine Residency Program Director
R. Frank Henn III, MD Associate Professor Chief of Sports Medicine Residency Program Director Disclosures No financial relationships to disclose 1. Labral anatomy 2. Adaptations of the throwing shoulder
More informationLabral Tears. Fig 1: Intact labrum and biceps tendon
Labral Tears What is it? The shoulder joint is a ball and socket joint, with the humeral head (upper arm bone) as the ball and the glenoid as the socket. The glenoid (socket) is a shallow bone that is
More informationPresented by Matt Repa ATC,CES
Presented by Matt Repa ATC,CES mrepa@ibji.com Illinois Bone & Joint Institute CSL Symposium 1/11/11 } Throwing is a very complex and dynamic activity. } As clinicians, how can we step in and make a difference?
More informationMuscular Analysis of Upper Extremity Exercises McGraw-Hill Higher Education. All rights reserved. 8-1
Muscular Analysis of Upper Extremity Exercises 2007 McGraw-Hill Higher Education. All rights reserved. 8-1 Muscular Analysis of Upper Extremity Exercises Upper extremity - often one of body's weakest areas
More informationUPPER EXTREMITY INJURIES. Recognizing common injuries to the upper extremity
UPPER EXTREMITY INJURIES Recognizing common injuries to the upper extremity ANATOMY BONES Clavicle Scapula Spine of the scapula Acromion process Glenoid fossa/cavity Humerus Epicondyles ANATOMY BONES Ulna
More informationClinical pearls for the shoulder/arm exam and the treatment. What is seeing youare you seeing it
Clinical pearls for the shoulder/arm exam and the treatment What is seeing youare you seeing it W. Ben Kibler, MD Medical director Case 1 18 y/o R hand dominant high school pitcher, with 6 week hx gradual
More informationAPPENDIX: The Houston Astros Stretching Program
Vol. 35, No. 4, 2007 Glenohumeral Internal Rotation Deficits 1 APPENDIX: The Houston Astros Stretching Program Our Flexibility program consists of 5 positions. Four of the 5 have 2 variations of each position.
More informationCSM 2018 Outline. Educational Session Title: Shoulder Pathomechanics in the Throwing Athlete - Causes, Surgery, Outcomes, & Rehab
CSM 2018 Outline Educational Session Title: Shoulder Pathomechanics in the Throwing Athlete - Causes, Surgery, Outcomes, & Rehab Speakers: Dr. Rafael F Escamilla, Department of Physical Therapy, California
More informationAnterior Stabilization of the Shoulder: Distal Tibial Allograft
Anterior Stabilization of the Shoulder: Distal Tibial Allograft Name: Diagnosis: Date: Date of Surgery: Phase I Immediate Post Surgical Phase (approximately Weeks 1-3) Minimize shoulder pain and inflammatory
More informationTHESIS. Presented in Partial Fulfillment of the Requirements for the Degree Master of Science in the Graduate School of The Ohio State University
Glenohumeral Stiffness in Overhead Athletes Following Pitching THESIS Presented in Partial Fulfillment of the Requirements for the Degree Master of Science in the Graduate School of The Ohio State University
More informationMotion of Left Upper Extremity During A Right- Handed Golf Swing
Motion of Left Upper Extremity During A Right- Handed Golf Swing Description of Movement While the movement required for a golf swing requires many muscles, joints, & ligaments throughout the body, the
More informationDavid McHenry DPT, COMT, SCS. Therapeutic Associates PACE
David McHenry DPT, COMT, SCS Therapeutic Associates PACE www.portlandpace.com Quarterback at Penn State 1995-1999 BS in kinesiology DPT from Slipper Rock University in 2002 Therapeutic Associates: Portland
More informationShoulder Biomechanics
Shoulder Biomechanics Lecture originally developed by Bryan Morrison, Ph.D. candidate Arizona State University Fall 2000 1 Outline Anatomy Biomechanics Problems 2 Shoulder Complex Greatest Greatest Predisposition
More informationMs. Ruth A. Delaney, MB BCh BAO, MMedSc, MRCS
Ms. Ruth A. Delaney, MB BCh BAO, MMedSc, MRCS Consultant Orthopaedic Surgeon, Shoulder Specialist. +353 1 5262335 ruthdelaney@sportssurgeryclinic.com Modified from the protocol developed at Boston Shoulder
More informationShoulder Injury Evaluation.
Shoulder Injury Evaluation www.fisiokinesiterapia.biz Basic Anatomy & Kinesiology 3 Bone Structures Clavicle Scapula Humerus Evaluation Principles Always follow a standard progression Determine the target
More informationIMPINGEMENT-TESTSTESTS
«thinking about.» DIFFERENTIAL DIAGNOSIS: Looking for the causes of Which special tests do you use in your shoulder examination? Ann Cools, PT, PhD Ghent University - Belgium Dept of Rehabilitation Sciences
More informationRehabilitation Guidelines for Labral/Bankert Repair
Rehabilitation Guidelines for Labral/Bankert Repair The true shoulder joint is called the glenohumeral joint and consists humeral head and the glenoid. It is a ball and socket joint. Anatomy of the Shoulder
More informationAnterior Stabilization of the Shoulder: Latarjet Protocol
Robert K. Fullick, MD 6400 Fannin Street, Suite 1700 Houston, Texas 77030 Ph.: 713-486-7543 / Fx.: 713-486-5549 Anterior Stabilization of the Shoulder: Latarjet Protocol The intent of this protocol is
More informationTendinosis & Subacromial Impingement Syndrome. Gene Desepoli, LMT, D.C.
Tendinosis & Subacromial Impingement Syndrome Gene Desepoli, LMT, D.C. What is the shoulder joint? Shoulder joint or shoulder region? There is an interrelatedness of all moving parts of the shoulder and
More informationGlenohumeral Joint. Glenohumeral Joint. Glenohumeral Joint. Glenohumeral Joint. Glenohumeral Joint. Glenohumeral Joint
The Shoulder Joint Chapter 5 The Shoulder Joint Manual of Structural Kinesiology R.T. Floyd, EdD, ATC, CSCS McGraw-Hill Higher Education. All rights reserved. 5-1 Shoulder joint is attached to axial skeleton
More informationWEEKEND 2 Shoulder. Shoulder Active Range of Motion Assessment
Virginia Orthopedic Manual Physical Therapy Institute - 2016 Technique Manual WEEKEND 2 Shoulder Shoulder Active Range of Motion Assessment - Patient Positioning: Standing, appropriately undressed so that
More informationFunctional Movement Screen (Cook, 2001)
Functional Movement Screen (Cook, 2001) TEST 1 DEEP SQUAT Purpose - The Deep Squat is used to assess bilateral, symmetrical, mobility of the hips, knees, and ankles. The dowel held overhead assesses bilateral,
More informationHarold Schock III, MD Rotator Cuff Repair Rehabilitation Protocol
Harold Schock III, MD Rotator Cuff Repair Rehabilitation Protocol The following document is an evidence-based protocol for arthroscopic rotator cuff repair rehabilitation. The protocol is both chronologically
More informationRehabilitation Guidelines for Anterior Shoulder Reconstruction with Arthroscopic Bankart Repair
UW HEALTH SPORTS REHABILITATION Rehabilitation Guidelines for Anterior Shoulder Reconstruction with Arthroscopic Bankart Repair The anatomic configuration of the shoulder joint (glenohumeral joint) is
More informationJoint G*H. Joint S*C. Joint A*C. Labrum. Humerus. Sternum. Scapula. Clavicle. Thorax. Articulation. Scapulo- Thoracic
A*C Joint Scapulo- Thoracic Articulation Thorax Sternum Clavicle Scapula Humerus S*C Joint G*H Joint Labrum AC Ligaments SC Ligaments SC JOINT AC Coracoacromial GH GH Ligament Complex Coracoclavicular
More informationEvaluation & Treatment of the Scapula in Athletes: How Important is the Scapula Kevin E Wilk, PT, DPT,FAPTA
Evaluation & Treatment of the Scapula in Athletes: How Important is the Scapula Kevin E Wilk, PT, DPT,FAPTA Kevin E Wilk, PT, DPT,FAPTA 2016 Baseball Sports Medicine Conference Faculty Disclosure: Theralase
More informationUCL Sprain/Tear MEDIAL ELBOW PAIN. Moving Valgus Stress Test. Valgus Instability/Ulnar Collateral Ligament Sprain. Property of VOMPTI, LLC
UCL Sprain/Tear MEDIAL ELBOW PAIN Kristin Kelley, DPT, OCS, FAAOMPT Orthopaedic Manual Physical Therapy Series Charlottesville 2017-2018 Valgus Instability/Ulnar Collateral Ligament Sprain History Acute
More informationGlenohumeral Capsule Tears in Baseball Pitchers
Glenohumeral Capsule Tears in Baseball Pitchers Christopher S. Ahmad, MD Professor Orthopedic Surgery Chief Sports Medicine Head Team Physician New York Yankees New York City Football Club Disclosure 1.
More informationOBJECTIVES. Therapists Management of Shoulder Instability SHOULDER STABILITY SHOULDER STABILITY WHAT IS SHOULDER INSTABILITY? SHOULDER INSTABILITY
Therapists Management of Shoulder Instability Brian G. Leggin, PT, DPT, OCS Lead Therapist, Penn Therapy and Fitness at Valley Forge Adjunct Assistant Professor, Department of Orthopaedics, University
More informationWelcome to. Not to be copied without the express permission of EDUCATA. Copyright 2014 EDUCATA. All rights reserved. 1. How to Navigate EDUCATA
Welcome to Copyright 2014 EDUCATA. This presentation is not to be copied in whole or in part without the express permission of EDUCATA. How to Navigate EDUCATA The Shoulder Complex Mechanics, Muscle Function
More informationPhase I : Immediate Postoperative Phase- Protected Motion. (0-2 Weeks)
Phase I : Immediate Postoperative Phase- Protected Motion (0-2 Weeks) Appointments Progression Criteria 2 weeks after surgery Rehabilitation appointments begin within 7-10 days of surgery, continue 1-2
More informationShoulder Labral Tear and Shoulder Dislocation
Shoulder Labral Tear and Shoulder Dislocation The shoulder joint is a ball and socket joint with tremendous flexibility and range of motion. The ball is the humeral head while the socket is the glenoid.
More informationSecrets and Staples of Training the Athletic Shoulder
Secrets and Staples of Training the Athletic Shoulder Eric Beard Corrective Exercise Specialist Athletic Performance Enhancement Specialist EricBeard.com AthleticShoulder.com Presentation Overview Rationale
More informationThe baseball pitch places tremendous stress upon the
68 Bulletin Hospital for Joint Diseases Volume 61, Numbers 1 & 2 2002-2003 The Shoulder in Baseball Pitching Biomechanics and Related Injuries Part 1 Samuel S. Park, M.D., Mark L. Loebenberg, M.D., Andrew
More informationShoulder Instability. Fig 1: Intact labrum and biceps tendon
Shoulder Instability What is it? The shoulder joint is a ball and socket joint, with the humeral head (upper arm bone) as the ball and the glenoid as the socket. The glenoid (socket) is a shallow bone
More informationP ERFORMANCE CONDITIONING. Inside the Bermuda Triangle of Chronic Shoulder and Elbow Pain- Part IV
P ERFORMANCE VOLLEYBALL CONDITIONING A NEWSLETTER DEDICATED TO IMPROVING VOLLEYBALL PLAYERS www.performancecondition.com/volleyball Inside the Bermuda Triangle of Chronic Shoulder and Elbow Pain- Part
More informationTHE OLDER TENNIS AND GOLF ATHLETE: INJURY MANAGEMENT AND PREVENTION
THE OLDER TENNIS AND GOLF ATHLETE: INJURY MANAGEMENT AND PREVENTION William Micheo, MD Professor and Chairman Physical Medicine, Rehabilitation, and Sports Medicine Department University of Puerto Rico
More informationBiceps Tenotomy Protocol
Biceps Tenotomy Protocol A biceps tenotomy procedure involves cutting of the long head of the biceps just prior to its insertion on the superior labrum. A biceps tenotomy is typically done when there is
More informationElbow Injuries in Young Athletes!
Elbow Injuries in Young Athletes! Andrew Martin DO, MBA, CAQSM! Director Sports Medicine Campbell University! Head Team Physician, Associate Professor Sports Medicine Disclosures None based on the content
More informationThe Shoulder. Anatomy and Injuries PSK 4U Unit 3, Day 4
The Shoulder Anatomy and Injuries PSK 4U Unit 3, Day 4 Shoulder Girdle Shoulder Complex is the most mobile joint in the body. Scapula Clavicle Sternum Humerus Rib cage/thorax Shoulder Girdle It also includes
More informationSterile gauze used at incision site. Check brace for rubbing or irritation. Compression garment at elbow to be used with physician s authorization
ULNAR COLLATERAL LIGAMENT RECONSTRUCTION GUIDELINE Functional Outcome Measure KJOC (Appendix 1) should be completed at initial evaluation and at all identified times through guideline, Phase 1 Immediate
More informationBIOMECHANICS OF PITCHING. The Bennett Institute for Spons Medicine OfThe Children's Hospital Baltimore, Maryland, USA
BIOMECHANICS OF PITCHING K. R. Campbell The Bennett Institute for Spons Medicine OfThe Children's Hospital Baltimore, Maryland, USA INTRODUCTION Baseball pitching is a complicated movement involving a
More informationSHOULDER JOINT ANATOMY AND KINESIOLOGY
SHOULDER JOINT ANATOMY AND KINESIOLOGY SHOULDER JOINT ANATOMY AND KINESIOLOGY The shoulder joint, also called the glenohumeral joint, consists of the scapula and humerus. The motions of the shoulder joint
More informationSHOULDER PAIN. A Real Pain in the Neck. Michael Wolk, MD Northeastern Rehabilitation Associates October 31, 2017
SHOULDER PAIN A Real Pain in the Neck Michael Wolk, MD Northeastern Rehabilitation Associates October 31, 2017 THE SHOULDER JOINT (S) 1. glenohumeral 2. suprahumeral 3. acromioclavicular 4. scapulocostal
More informationBiceps Tenodesis Protocol
Biceps Tenodesis Protocol A biceps tenodesis procedure involves cutting of the long head of the biceps just prior to its insertion on the superior labrum and then anchoring the tendon along its anatomical
More informationBradley C. Carofino, M.D. Shoulder Specialist 230 Clearfield Avenue, Suite 124 Virginia Beach, Virginia Phone
Subpectoral Bicep Tenodesis Protocol (Spreadsheet) Weeks 1-2 Modalities Treatment Restrictions Goals No active elbow flexion (6weeks) Full PROM shoulder and elbow PROM: Shoulder, elbow, forearm No active
More informationIndex. radiologic.theclinics.com. Note: Page numbers of article titles are in boldface type.
Index Note: Page numbers of article titles are in boldface type. A Acromioclavicular joint injuries in football players, 318, 319 ALPSA. See Anterior labroligamentous periosteal sleeve avulsion. Anterior
More informationEligibility The NCSF online quizzes are open to any currently certified fitness professional, 18 years or older.
Eligibility The NCSF online quizzes are open to any currently certified fitness professional, 18 years or older. Deadlines Course completion deadlines correspond with the NCSF Certified Professionals certification
More informationOverhead Athlete Rehabilitation Guidelines
Overhead Athlete Rehabilitation Guidelines This document is designed to be used as a guideline in the rehabilitation of the athlete playing overhead sports, mainly baseball and softball, but also including
More informationRehabilitation Guidelines for UCL Repair
UW HEALTH SPORTS REHABILITATION Rehabilitation Guidelines for UCL Repair The elbow is a complex system of three joints formed from three bones; the humerus (the upper arm bone), the ulna (the larger bone
More informationThe Shoulder Complex. Anatomy. Articulations 12/11/2017. Oak Ridge High School Conroe, Texas. Clavicle Collar Bone Scapula Shoulder Blade Humerus
The Shoulder Complex Oak Ridge High School Conroe, Texas Anatomy Clavicle Collar Bone Scapula Shoulder Blade Humerus Articulations Sternoclavicular SC joint. Sternum and Clavicle. Acromioclavicular AC
More informationThe Biomechanics of the Human Upper Extremity. Dr Ayesha Basharat BSPT, PP.DPT. M.PHIL
The Biomechanics of the Human Upper Extremity Dr Ayesha Basharat BSPT, PP.DPT. M.PHIL Sternoclavicular Joint Provides major axis of rotation for movement of clavicle and scapula Freely permitted frontal
More informationRehabilitation Guidelines for Large Rotator Cuff Repair
Rehabilitation Guidelines for Large Rotator Cuff Repair The true shoulder joint is called the glenohumeral joint and consists humeral head and the glenoid. It is a ball and socket joint. Anatomy of the
More informationAfter Arthroscopic Subacromial Decompression Intact Rotator Cuff (Distal Clavicle Resection)
After Arthroscopic Subacromial Decompression Intact Rotator Cuff (Distal Clavicle Resection) Rehabilitation Protocol Phase 1: Weeks 0-4 Restrictions ROM 140 degrees of forward flexion 40 degrees of external
More informationTHE EFFECT OF THROWERS TEN PROGRAM ON SHOULDER MOBILITY IN OVERHEAD-THROWING ATHLETES. Giovanna Nuanes, B.S.
THE EFFECT OF THROWERS TEN PROGRAM ON SHOULDER MOBILITY IN OVERHEAD-THROWING ATHLETES by Giovanna Nuanes, B.S. A thesis submitted to the Graduate Council of Texas State University in partial fulfillment
More informationThe Causes of Early Hip Extension in the Golf Swing
The Causes of Early Hip Extension in the Golf Swing Hypothesis: Our hypothesis for this research is when a golfer fails any of Leg Lowering, Toe Touch, or Overhead Deep Squat tests early hip extension
More informationFOUR FOUNDATIONS OF FUNCTIONAL MOVEMENT FOUR FOUNDATIONS OF FUNCTIONAL MOVEMENT FOUR FOUNDATIONS OF FUNCTIONAL MOVEMENT
FOUR FOUNDATIONS OF FUNCTIONAL MOVEMENT #1. Dynamic Stability Static Stability: is the ability to maintain proper alignment and muscle activation in a given joint or structure through a defined range of
More informationSLAP Lesions Rehabilitation Concepts
SLAP Lesions Rehabilitation Concepts Kevin E. Wilk, PT, DPT, FAPTA Glenoid Labral Lesions Introduction Classification of SLAP tears Andrews & Carson: AJSM 85 Snyder: Arthroscopy 90 (Type I IV) Maffet et
More informationMUSCLES OF SHOULDER REGION
Dr Jamila EL Medany OBJECTIVES At the end of the lecture, students should: List the name of muscles of the shoulder region. Describe the anatomy of muscles of shoulder region regarding: attachments of
More informationAnterior Labrum Repair Protocol
Anterior Labrum Repair Protocol Stage I (0-4 weeks): Key Goals: Protect the newly repaired shoulder. Allow for decreased inflammation and healing. Maintain elbow, wrist and hand function. Maintain scapular
More informationAnatomy GH Joint. Glenohumeral Instability. Components of Stability. Components of Stability 7/7/2017. AllinaHealthSystem
Glenohumeral Instability Dr. John Steubs Allina Sports Medicine Conference July 7, 2017 Anatomy GH Joint Teardrop or oval shape Inherently unstable Golf ball and tee analogy Stabilizers Static Dynamic
More informationHow Baseball Players Can Safely Enhance Performance While Reducing Injuries. No Financial Disclosures
How Baseball Players Can Safely Enhance Performance While Reducing Injuries, DPT, SCS, CSCS No Financial Disclosures MikeReinold.com 1 Baseball Pitching Injuries Rising at an Alarming Rate Injuries on
More informationActive-Assisted Stretches
1 Active-Assisted Stretches Adequate flexibility is fundamental to a functional musculoskeletal system which represents the foundation of movement efficiency. Therefore a commitment toward appropriate
More informationShoulder Impingement Rehabilitation Recommendations
Shoulder Impingement Rehabilitation Recommendations The following protocol can be utilized for conservative care of shoulder impingement as well as post- operative subacromial decompression (SAD) surgery.
More informationPost-Operative Instructions Glenoid Reconstruction using Fresh Distal Tibial Allograft
Day of Surgery Post-Operative Instructions Glenoid Reconstruction using Fresh Distal Tibial Allograft A. Relax. Diet as tolerated. B. Icing is important for the first 5-7 days post-op. While the post-op
More informationDIFFERENTIAL DIAGNOSIS: Looking for the causes of impingement
DIFFERENTIAL DIAGNOSIS: Looking for the causes of Ann Cools, PT, PhD Ghent University - Belgium Dept of Rehabilitation Sciences & Physiotherapy Ann.Cools@UGent.be «thinking about.» Which special tests
More informationShoulder Joint Examination. Shoulder Joint Examination. Inspection. Inspection Palpation Movement. Look Feel Move
Shoulder Joint Examination History Cuff Examination Instability Examination AC Joint Examination Biceps Tendon Examination Superior Labrum Examination Shoulder Joint Examination Inspection Palpation Movement
More informationElectromyographic Analysis and Phase Definition of the Overhead Football Throw*
0363-5465/102/3030-0837$02.00/0 THE AMERICAN JOURNAL OF SPORTS MEDICINE, Vol. 30, No. 6 2002 American Orthopaedic Society for Sports Medicine Electromyographic Analysis and Phase Definition of the Overhead
More informationFootball and netball season A review of the apophysis and the acute shoulder: assessment. Simon Locke Sport and Exercise Physician
Football and netball season A review of the apophysis and the acute shoulder: assessment Simon Locke Sport and Exercise Physician Apophyseal injuries; How to diagnose and manage? Goals for tonight Recognise
More informationThe Upper Limb. Elbow Rotation 4/25/18. Dr Peter Friis
The Upper Limb Dr Peter Friis Elbow Rotation Depending upon the sport, the elbow moves through an arc of approximately 75⁰ to 100⁰ in about 20 to 35 msec. The resultant angular velocity is between 1185
More information