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MDs may ask for a specific protocol. Here's a basic one, 3 phases, Goldestein's - the aims for each phase ...
- Phase I: restore alignment & muscle balance
- Phase II: good alignment + functional integration
- Phase III: good alignment, functional integration, + total body ("real life"activities and problem solving)
4 ways a pt can do auto-mobilization (specifically on the shoulder) - name the motion, and then a method of doing it
- distraction: wrap a scarf around your foot, hold it in your hand, pull (pulley, strap)
- elevation: fingers climb up a wall - can bend knees for more stretch when arm's already up
- rotation: hold a towel behind your head, one arm pulls the other down
- DTM: bicipital tendon friction (to break up scar tissue and help it flow freely)
2 intervention modalities in her notes
things to focus on in the education portion of an intervention
- in the acute/painful stage: activity modification
- later: maintain the exercise program!
hematoma/large bruise - should last how long?
sprain should last how long?
acute muscle strain (grades 2-3) w huge inflam + muscle tears, how long?
bone break or torn tissue - how long?
- 21-45 days, up to 9 weeks
- (you can have pt do exercise at site or at least at prox + distal points)
what's the sole bony strut connecting the shoulder girdle to the trunk?
SC joint is close packed where?
full elevation and shoulder protraction (per dutton & magee)
abd to 90 degrees (per Pivko)
AC joint close packed pos
- 90 degrees abd
- (per dutton & magee)
superior transverse ligament - where? does what?
- converts the scapular notch (medial to the base of the coracoid) into a foramen
- the suprascapular nerve runs thru this foramen
costoclavicular lig - where?
holds the clavicle to the first rib, which is just inf to it, at their medial ends
interclavicular lig - where?
connecting the sternal ends of both clavicles, and also attaching to the sup end of the manubrium
two pars of the coracoclavicular lig
basic dif btwn two parts of the coracoclavicular lig?
- conoid: is more medial, and tapers down to a narrow end
- trapezoid: lat to the conoid, guess its shape
connects the clav to the stern, running inferomed - it looks as tall as the clavicle
subclavius attachments & action
- first rib & cartilage --> inferolat clavicle
- runs almost horizontally
- draw clavicle down
- elevate first rib
- stabilize SC jt
pec major attch
Medial Half Of Clavicle, Sternum, Cartilage Of Ribs One Thru Six --> hum greater tubercle
actions of pec major
- As A Whole: Adduct, Medially Rotate The Shoulder Joint,
- May Assist In Elevating The thorax in forced inspiration
- Upper Fibers: Flex, Medially Rotate, Horizontally Adduct The Shoulder Joint
- Lower Fibers: Extend, Adduct The Shoulder Joint
sternohyoid muscle attch & act
- post med clavicle --> up to the hyoid bone
- depress the hyoid
2 big players that pass right behind the clavicle, and therefore are at risk of damage if the clavicle gets jarred?
- brachial plexus
- subclavian artery
what kind of joint is the SC? anatomically, mechanically, functionally?
- anatomically: complex - bc it has a disc!
- mechanically: bi-axial saddle jt
- functionally: ball and socket bc of a lax capsule & flexible disc
__ subdivides the SC jt into 2 secondary cavities
attachments of the SC jt disk?
- upper & post borders of the articular surface of the clavicle
- cartilage of the first rib, and circumferentially to the fibrous capsule
describe the articular surface of the sternal end of the clavicle
and the cavicular facet of the manubrium?
- sup/inf: convex
- ant/post: concave
- sup/inf: concave
- ant/post: convex
what surrounds the sternal end of the clavicle, with some fibers from SCM reinforcing it?
- jt capsule
- but it's lax enough to allow motion
attachments of ant sternoclavicular lig
upper ant sternal end of clavicle --> upper part of manubrium & first costal cartilage
attachments of posterior sternoclavicular lig
post aspect of sternal end of lig --> down and med to --> back of sup manubrium
which SC lig has two laminae?
what are they?
which way do they run?
what's between them?
- anterior fibers: run superolat
- posterior fibers: run superomed
- there's a bursa between them
degrees of freedom of the SC jt?
what motions are usually paired in the SC jt?
- elevation & retraction
- depression & protraction (the slump)
debated btwn her and magee - she says it's the opposite of above, but that we're not looking at conjoint motions for now anyway
clavicular elevation - how many degrees?
pro/retraction at the SC jt - how many degrees?
15 in each direction
rotation of clavicle about its own longitudinal axis - how many degrees?
what kind of rotation do you get of the clavicle when you elevate your arm in any direction?
SC jt restion pos?
arm at side
capsular pattern at SC jt?
pain at extremes of range/motion
what joints to include in passive movement testing?
- the joint, and
- the joints above and below the affected joint
hand placement for passive movement testing, be cautious around what 3 areas?
- areas of tenderness
- unstable bony segments (recent fractures, ORIF, etc)
strictly speaking, when you're doing inferior glide on the SC jt, what's the direction?
how to do a SC sup glide
- thumb on inf clavicle, index on sup, press up and med
- other hand's thumb is medial to the first, on the joint line
- yr standing beside the pt, pushing up
how to do SC mobs w pt seated
- pt's head resting against your arm & chest (else SCM will hold clavicle)
- pt seated in a "semi-reclined" position
- do thumb-on-thumb clavicular depression
- AP & PA glides w someone else holding the head
what monitors the movement in the SC glides?
angel btween scapular plane and clavicle?
should be 90 degrees