Index A Abduction arm motion, 170 dislocation in, 109 internal rotation standing plyometrics in neutral, 132 isometric shoulder, 83 prone, 84 shoulder position, 101, 119 Acromioplasty, 121 Active/passive exercises, 167 Acute stage, rotator cuff repair, 166, 168 170 Adduction arm motion, 170 horizontal, 127, 136 internal rotation standing plyometrics in neutral, 132 isometric contractions, 126 Anterior and posterior translation (drawer) tests, 119 Arm stretching elevation, 48 Arthritis glenohumeral, 35 iatrogenic, 73 posttraumatic, 72 73 rheumatoid, 68, 72 rotator cuff tear arthropathy, 74 Arthroplasty contraindications, 74 reverse shoulder, 78 acute fracture, 78, 79 cuff arthropathy, 78 deltopectoral approach, 78 fracture sequelae, 78, 79 latissimus transfer, 80, 90 superior approach, 78 trauma, 78, 79 shoulder, 68, 69 avascular necrosis, 72 complications, 90 contraindications, 74 historical background, 68 osteoarthritis, 69, 70 posttraumatic arthritis, 72, 73, 80 rheumatoid arthritis, 72, 73 surgical approaches, 74 75 total shoulder, 71, 76 77, 81 89 Arthroscopic Bankart ligaments restoration to bone, 114, 115 outcomes, 138 post-surgery, 114, 115 goals, 121 initial phase (weeks 2 6), 121 126 intermediate phase (weeks 6 12), 127 130 return to function phase (12 16 weeks), 130 137 repair, 113 115 shoulder reconstruction evaluation scapular evaluation, 116 117 special tests, 118 120 surgical procedures, 127 Arthroscopic shoulder surgery anterior Bankart repair, 191 192 capsular plication, 195 glenoid labrum procedures, 195 Athlete s shoulder injury instability classification, 185 nonoperative treatment, 184 patient variables and factors, 185 arthroscopic anterior Bankart repair, 191 192 arthroscopic capsular plication, 195 arthroscopic glenoid labrum procedures, 195 factors affecting program, 186 phases, 188 190 posterior Bankart, 193 194 postoperative treatment, 185 principles, 187 proximal biceps tendon procedures, 195 196 surgical treatment, 184 Avascular necrosis (AVN), 49, 54 of humeral head, 24 PHF sequelae with head, 15 shoulder arthroplasty, 72 Axillary nerve, 35, 49, 76, 78 B Balance stabilization exercise, 41, 45 Bankart lesion, 96, 104, 106, 114, 121 Bankart repair, arthroscopic, 191 192 Beighton Hypermobility Index, 120 Bench press, 127, 137, 193 range of motion limitation in, 136 Biceps tenodesis, 121, 195 Biceps tenotomy, 121, 195 Biodex Isokinetic Dynamometer, 134 Body blade exercises angles of elevation, 86, 89 in neutral at side, 86 stabilization, 41, 45 Springer International Publishing Switzerland 2016 G. Di Giacomo, S. Bellachioma (eds.), Shoulder Surgery Rehabilitation: A Teamwork Approach, DOI 10.1007/978-3-319-24856-1 197
198 Index Bone loss bipolar bone loss lesion, 103 105 glenoid bone loss, 97 98 Hill-Sachs lesion, 100 characteristic features, 99 incidence, 99 location, 102 non-engaging and engaging pattern, 101 off-track lesion, 104, 105 on-track lesion, 104, 105 size, 103 C Capsular plication/shifting, 121 Closed-chain precedes open-chain exercise, 24 Closed kinetic chain (CKC) exercises, 149, 157 Codman-Hertel classification system, 4, 8 9 Codman s pendulum exercises, 23, 25 Communication, physical therapists, 167 Compression fractures, 98 Core stability, 147 Corticosteroids, 70, 72 Criteria-based treatment approach, 185 D Deltopectoral approach, 28 29, 42, 76 Dislocation, 90, 97 99, 107. See also First-time anterior shoulder dislocation (FTASD) in abduction, 109, 111 ADD position, 111 chronic locked posterior, 77 fracture, 14, 15, 30, 34, 54, 56, 57 locked, 54, 56, 58 Distal clavicular excision, 121 Double press exercise, 24, 27 Dynamic hug exercise, 88 E Early closed-chain motion, table slides, 169 Education, 136 preventing shoulder movement pattern, 23 Elevation exercises, 196 Excessive tensile loading, 167 Exercise(s) closed-chain precedes open-chain, 24 closed-to open-chain, 174 177 Codman s pendulum, 23, 25 double press, 24, 27 dynamic hug, 88 isoinertial external rotation, 135 isometric, 27, 40, 43, 48, 124, 125, 154, 195 lawnmower, 124 light functional, 24 manual scapular resistive, 124 to muscle fatigue, 167 open-chain, 167 postoperative, 88 proprioception, 40 quadruped rhythmic stabilization, 128 rotator cuff, 129 scapular control, 23, 26 scapulothoracic, 40 serratus punch, 124 side-lying body blade oscillation, 129 supervised active/assisted shoulder, 24, 26 External rotation, 101, 106, 107, 111, 117, 121, 193 abduction, 132 active, 55, 84 gentle, 46, 47 isoinertial, 135 isokinetic training position, 134, 135 isometric shoulder, 83 lower and middle trapezius activation, 154, 155 90 of abduction, 129 oscillation, 129 passive mobilization in, 149, 150 passive stretching playing, 42 resisted, 86 rhythmic stabilization drills for, 189 ROM, 122 scapular retraction bilateral with elastic resistance, 128 side-lying, 84, 85 side with elastic resistance, 126 supine cane, 81 tubing exercises, 194, 195 External rotation exercises, 147 isoinertial exercise, 134, 135 F First-time anterior shoulder dislocation (FTASD) in contact sports participants, 106 direct trauma mechanisms, 106 107 Hill-Sachs lesion, 107 110 lesions in, 106 non-operative treatment, 106 recurrence rates, 106 Fixation method, 186 Flexion, 6, 7, 87 elbow, 127, 130 forward, 116, 121, 138 isometric shoulder, 82 passive shoulder flexion in pain-free stretching, 23, 25 pulley, 83 side-lying active-assistive, 85 submaximal isometric exercises, 81 supine active, 85 supine cane, 81 supine shoulder, 85 Force couple, 94 Fulcrum (humeral head), 18, 19 Functional stage, rotator cuff repair, 167, 178 180 G Gentle massage therapy, 24, 27 Glenohumeral (GH) joint, 118 120, 123, 126, 134 arthritis, 72, 138 different angles stress at, 97 inferior glide, 149, 150, 171, 175 mobilizations, 190 Glenohumeral joint capsule, 76, 184 Glenoid bone loss, 97 98 Glenoid track, 102 Greater tuberosity integrity of rotor cuff and tuberosities, 18 reabsorption of, 18, 19 vascular supply, 10
Index 199 H Hemiarthroplasty intact rotator cuffs, 72 and posttraumatic arthritis, 72, 73 proximal humeral fractures complications, 52 53 optimal timing, 34 in osteoporotic patient, 34, 36, 46 48 vs. reverse total shoulder arthroplasty, 34 35 tuberosities reabsorption, 34, 36 shoulder replacement, 74, 75 subscapularis protection to, 80 reinsertion with suture anchor, 76, 77 Hill-Sachs lesion, 100, 111 113 characteristic features, 99 incidence, 99 location, 102 non-engaging and engaging pattern, 101 off-track lesion, 104, 105 on-track lesion, 104, 105 size, 103 Hyaluronic acid, intra-articular injections, 70 I Immobilization abduction, 193 vs. early aggressive, 138 in overhead athlete, 187 period of, 20, 122 rotator cuff repair, 168 Impingement, 50, 126, 136 bony, 94 causes, 126 nail, 30 rotator cuff, 94 subacromial, 30, 123 suprascapular nerve, 116 Implant(s), 68, 76, 78, 90 humeral, 34, 54 infection of, 52 locking compression plate, 30 radiograph of, 75 resurfacing, 75 stemmed, 75 types, 28 Internal rotation exercises, 130, 147 isokinetic training position, 135 at 90 of abduction, 130, 138 paying attention to, 46, 47 plyometric ball dribbles, 130 preoperative plain x-ray studies in, 139 provocational plyometric in supine position, 132 rhythmic stabilization drills for, 189 in scapula plane, 195 standing plyometrics with 90 of abduction, 133 in neutral ab/adduction position, 132 strengthening, 130 Irreparable rotator cuff tears, 70, 74 Isoinertial external rotation exercise, 135 Isokinetic exercises, 130 Isometric exercises, 27, 40, 43, 48, 124, 125, 154, 195 Isotonic exercise patient toleration, 134 rotator cuff, 124, 125, 193 J Joint-mobilization techniques, 188 L Latarjet technique local bone graft, 140 mini wedged plate, 140 post-surgery, 140 assisted elbow flexion-extension without sling, 144 fitting arm sling before discharge, 143 healing progression criteria, 142 143 hydrotherapy, 142 protocols, 142 143 scapular retraction with sling, 144 skin incision and deltopectoral approach, 139 subscapular split, 140 triple effect of, 113 Lateral tans-deltoid approach, 28 29 Lawnmower exercise, 124, 149, 151 Laxity, 95, 119, 186, 195 Light functional exercises, 24 Loose-pack position, GH joint, 95 Loss of fulcrum (humeral head, aseptic necrosis), 18, 19 Loss of sclerotic glenoid line (LSGL), 139 Low-row exercise, 174 M Malunion, 24 complication, ORIF, 49 50 tuberosities factors associated with, 34 reabsorption, 34, 37, 50 severe, 54, 57, 60 Manual scapular resistive exercise, 124 Maximal volitional isometric contraction (MVIC), 131, 184 Multidirectional instability (MDI) sulcus test, 118 Muscular endurance training, 188 N Neer system, 4 Neuromuscular control, 157 early muscle reactivation, 145 exercises, 152 proprioceptive, 149 90/90 position, 129 of arm, 179 isoinertial exercise, 134 plyometric exercise, 131 Nociceptors, 49 Non-constrained arthroplasty (NCA), 55 Nonoperative treatment healing progression criteria, 22 early management, 23 intermediate management, 23 24 late management, 24, 25
200 Index Nonoperative treatment (Cont.) immobilization in sling, 20, 21 physiotherapy, 22, 22 stable configuration, 20, 21 Nonsteroidal antiinflammatory drugs (NSAIDs), 39, 70 Non-union, 24 complications, ORIF, 49 50 surgical neck, 54, 57 tuberosity, 34, 52, 55 O One week off therapy, 22 Open-chain exercise, 167 Open kinetic chain (OKC) exercises, 149, 151, 157 Open reduction internal fixation (ORIF), PHF, 22 complications, 47 51 internal fixation with locked plate, 32 with locked plate, 33, 39 45, 61 surgical solution, 59 Osteoarthritis, 68, 69 nonoperative management, 70 primary, 54, 55 shoulder arthroplasty, indications for, 70 71 Overhead athletes, 116, 187, 188, 191, 195 congenital laxity, 186 hypermobility index, 120 internal rotation strength, 134 isokinetic shoulder strength criteria, 190 plyometric and elastic resistance training, 131 shoulder joint pathology, 184 P Physician s philosophical approach, 186 Physioball motion program, 170 Physiotherapy, 22, 61, 142, 145 Plyometric exercise golf, 132, 133 internal rotation standing variation, 132, 133 90/90 prone plyometric ball drops, 131 90/90 prone plyometric reverse catches, 131 side-lying plyometric ball drops, 130 side-lying plyometric reverse catches, 130, 131 tennis, 132, 133 Plyometric training drills, 188 Postsurgical program, 186, 187 Power position, 178, 179 Power position with step back, 178, 180 90/90 prone plyometric ball drops, 131 90/90 prone plyometric reverse catches, 131 Proprioception, 147 Proximal humeral fractures (PHF) biomechanics, 16 19 causes, 2, 3 classification AO system, 4 Codman-Hertel system, 8 9 greater tuberosity, 4, 5 humeral head, 4, 5 impaction/distraction, 4 Lego System, 4 lesser tuberosity, 4, 5 Neer system, 4 shaft, 4, 5 varus /valgus/neutral fractures, 4 7 vascular pattern, 12 15 vascular supply, 10 11 comorbid diseases, 2 conservative treatment healing progression criteria, 22 27 physiotherapy, 22, 22 displacement forces, 5 feedback, 62 frequency in age groups, 2, 3 incidence, 2 medial displacement of shaft, 33 occurrence, 2 open reduction, 32 in osteoporotic patient, 36 hemiarthroplasty, 46 48 information strategy, 61 ORIF, 39 45 post-surgery rehab protocols, 61 risk factors, 2, 3 sequelae cephalic collapse/necrosis, 54, 56, 58 fracture, 15 locked dislocation and/or fracture dislocation, 54, 56, 58 reabsorption of greater tuberosity, 19 surgical neck non-union/mal-union, 54, 57, 59 severe tuberosities comminution, 37 surgical treatment complications, 49 53 decision-making, 28 deltopectoral approach, 28 29 hemiarthroplasty, 34 38 lateral tans-deltoid approach, 28 29 tuberosities and intramedullary fixation, 31 Push-ups, 193 shoulder and core musculature stability, 191 traditional, 137 Q Quadruped rhythmic stabilization exercise, 128 R Range of motion (ROM), 26, 95, 145 assessment of, 116 external rotation, 122 external rotation limitation, 121, 122 passive, 39 41, 46 progressive, 186, 187 protected, 121 recovery of, 23 restoration of, 149, 191, 193, 195 shoulder, 188, 191, 193 total rotation, 95 Recovery stage, rotator cuff repair, 167 inferior glide, 175 lawn mower exercise, 172 lawn mower with lateral step, 176 low-row exercise, 174 low row with posterior step, 175 robbery exercise, 173 robbery exercise with posterior step, 177
Index 201 Remplissage, 113, 127 Return to activity (sport), 188, 196 arthroplasty, 80 contact sports, 132, 195 following rotator cuff repair, 181 tennis program, 136, 137 traumatic anteroinferior instability, 157 Reverse shoulder arthroplasty (RSA), 55, 68 acute fracture, 78, 79 complications, 90 cuff arthropathy, 78 deltopectoral approach, 78 fracture sequelae, 78, 79 latissimus transfer, 80, 90 superior approach, 78 trauma, 78, 79 Rheumatoid arthritis, 68, 72 Rhythmic stabilization, 123, 194, 195 drills, 188, 189, 191 internal rotation plyometric ball dribbles, 130 physioball with, 95 progression, 84, 87 quadruped, 128 with therapist, 84, 86, 88 Rim avulsions, 97, 98 Robbery exercise, 149, 151, 173, 177 Rotator cuff debridement, 121 exercise, 129 130 isometric exercises, 95 Rotator cuff repair, goal, 166 orthopedic surgeon role communication with clinician, 167 controlling repair loading, 167 healing stages and progression, 166 167 optimizing tissue anatomy, 166 protocols acute stage, 168 170 functional stage, 178 180 recovery stage (see (Recovery stage, rotator cuff repair) ) return-to-activity stage, 181 Rotator cuff tear arthropathy, 74, 78, 79 S Scapula anterior scapula tilting, 39 isometric exercises, 95 in kinetic chain, 43 lower trapezium contraction, 26 placement, 43, 167 plane of, 95 retraction, 85, 126 Scapular clock exercises, 145 146 Scapular control exercises, 23, 26, 43, 44, 48, 88 Scapular protraction, 46, 128, 145 Scapular retraction, 23, 43, 44, 81 83, 88, 123, 125, 128, 142, 144 146, 149, 151, 168, 174, 175 Scapular retraction exercise, 151 Scapular stabilization exercises, 128 Scapular stabilizer, 95, 116, 129 Scarred deltoid, 54 Sequential kinetic chain activation, 145 Serratus punch exercise, 124 Shoulder dis-association test, 118 Shoulder instability bone loss (see (Bone loss) ) classification, 185 fi rst-time anterior shoulder dislocation in contact sports participants, 106 direct trauma mechanisms, 106 107 Hill-Sachs lesion, 107 110 lesions in, 106 non-operative treatment, 106 recurrence rates, 106 loose-pack position, 95 muscular force couples, 94 95 open capsular shift, 113 passive-active elevation (9 12 weeks), 154 156 physical examination at outset core stability evaluation, 147 148 posture, 145 range of motion, 145 scapular control, 145, 146 range of motion (3 9 weeks), 149 153 scapular plane, 94, 95 sports integration phase (12 weeks), 157 159 traumatic anteroinferior instability arthroscopic Bankart (see (Arthroscopic Bankart) ) stability mechanisms, 96 Shoulder replacement arthroplasty, 68, 69 contraindications, 74 historical background, 68, 80 reverse (see (Reverse shoulder arthroplasty) ) surgical approaches, 74 75 hemiarthroplasty, 76 77 non-arthroplasty management and, 70 total shoulder arthroplasty, 76 77, 81 89 Side-lying active-assistive flexion, 85 Side-lying body blade oscillation exercise, 129 Side-lying plyometric ball drops, 130 Side-lying plyometric reverse catches, 131 Side-lying position, lower and middle trapezius activation, 154, 155 Sleeper stretch exercise, 157, 158 Slide ball exercise, 43 Sling, 81, 82, 193, 195 altered posture after wearing, 145 assisted elbow flexion-extension without, 142, 144 effect, 113 fi tting arm, 142, 143 immobilization period, 20, 21 scapular retraction with, 142, 144 uses, 39 45, 121 Sports-specific golf plyometric, 133 Sports-specific programs, 188 Stemmed implant, 75 Strengthening exercises, 41, 126, 171, 186, 188, 190, 191, 193 Stretching exercises, 25, 42, 48, 81, 146, 157, 195 Subscapular split, 140, 147, 148 Subscapular tenotomy, 147, 148 Superior labrum anterior posterior (SLAP) repair, 121 Supervised active/assisted shoulder exercise, 24, 26
202 Index T Tenotomy, 76, 121, 195 Theraband resistance exercise, 41, 43 Thrower s Ten Program, 188, 191, 195, 196 Throwing motion, 184 Total shoulder arthroplasty, 70, 71 anatomic, 74, 75 and hemiarthroplasty, 76 77 intact rotator cuffs, 72 postoperative (weeks 0 4), 81 83 postoperative (weeks 4 8), 84 87 postoperative (weeks 8 12), 88, 89 postoperative (weeks 12+), 88, 89 sling, 81 reverse, 34 35, 52 Trendelenburg sign, 147 148 U Unilateral serratus anterior punch, 157, 159 Unsupported pendulum (Codman) exercises, 167 V Valgus type fractures, 6, 7 Varus distraction fractures, 4 Varus impaction type fractures, 4, 5 Varus-type fractures, 4 W Wall push-up plus, 156, 157 Wall slide exercise, 157, 158