The scapula plays a critical role in the association between the upper extremity and the axial skeleton. Ir in scapular plane as tolerated no ir behind back no cross body adduction grade 111 scapulothoracic and glenohumeral mobilizations notes. Rehabilitation programs for nonoperative humeral fractures dr. A scapula fracture usually occurs due to a direct blow to the shoulder blade, such as a motor vehicle accident, a hard ball impact in sports such as cricket or hockey, or a heavy.
The use of cervical exercises has been advocated in patients with. The intent of this protocol is to provide the physical therapist with a guidelinetreatment protocol for the postoperative rehabilitation management for a patient who has undergone a reverse total. Scapula fractures represent less than 1% of all broken bones and many of them can be treated without surgery. It is estimated that scapula fractures account for 3 %5 % of all fractures about the shoulder girdle, with the most frequent fractures encountered occurring in the. Background o the scapula is the base of support to shoulder joint and all movements of the upper extremity o poor scapular stabilization can contribute to a variety of upper quadrant syndromes such as. The shoulder blade scapula is located in the upper back, and sits on top of the ribs. Pdf rehabilitation of a patient with floating shoulder and. Hydrotherapy program is okay in provided the limits of no. Hydrotherapy program is okay in provided the limits of no active internal rotation and er limit to 400 are kept. The intent of this protocol is to provide the physical therapist with a guidelinetreatment protocol for the postoperative rehabilitation management for a. Highenergy, blunt trauma injuries, such as those experienced in a. Followed by completion of a doctor of physical therapy degree at the university of kentucky in 2011. He became board certified as a clinical specialist in sports physical therapy in 2014. Treatment for scapular disorders usually involves physical therapy designed to strengthen the muscles in the shoulder and restore the proper position and motion of the scapula.
Scapular retraction is movement of the scapula shoulderblade backwards towards the spine. Scapula, glenoid fossa, multifragmentary three or more fracture lines 14f2. The effectiveness of manual therapy in the management of musculoskeletal disorders of the shoulder. Jan 23, 20 among their findings was that rib fractures were present in 52. This book is distributed under the terms of the creative commons. Cervical spinal stenosis is a condition that most commonly affects individuals over the age of 50, and has the ability to lead to debilitating symptoms if. Fracture of the scapula or shoulder blade scapular fracture fracture of the clavicle or collar bone clavicular fracture fracture of the humerus or upper arm humeral fracture little league shoulder is a fracture of the proximal shoulder at the growth plate, usually from over head throwing. Immobilized at all times day and night off for hygiene and gentle exercise only 04 weeks.
Shoulder rehabilitation protocols shoulder surgery avon. Qualificationsare optional and applied to the fracture code where the. Bony posture or injury a resting posture of excessive thoracic kyphosis and increased cer. Correlation of psychomotor findings and the outcome of a physical therapy program to treat scapular dyskinesis. When it does, it is an indication that the individual was subjected to a considerable amount of force and that severe chest trauma may be present. Using a sling or shoulder immobilizer to prevent movement. Severity minor fractures do well with immobilization and physical therapy, while fractures that are more severe and require surgery or effect joint integrity take longer to recover.
Appointments begin physical therapy at 3 weeks post injury if cleared by md physical therapy 12 xweek. Use these handouts in conjunction with the protocol prescribed by the referring provider. Acromioclavicular ac joint reconstruction postoperative physical therapy protocol. Cervical spinal stenosis is a condition that most commonly affects individuals over the age of 50, and has the ability to lead to debilitating symptoms if its not treated properly.
Famous physical therapists bob schrupp and brad heineck present. Surgery may be required if a fracture displaces bones, forcing them out of their normal positions. As the name suggests a scapula fracture is a fracture of the scapula or the shoulder blade. Werner cm, ruckstuhl t, zingg p, lindenmeyer b, klammer g, gerber c. A simple test for scapular dyskinesis one of the simplest assessments you can perform for scapular dyskinesis is watching the scapula move during shoulder flexion. Among their findings was that rib fractures were present in 52. Repeat xrays are taken at each visit to make sure the fracture has not changed position, and to monitor bone healing, which can. When it does, it is an indication that the individual was subjected to. Scapular shoulder blade problems and disorders orthoinfo. Physical therapy standards of care and protocol the following standards of care and protocols are the property of bwh and should not be copied or otherwise used without the permission of the director of rehabilitation services.
Thus, scapula fractures occur at rates approaching those of distal tibia and humerus fractures. May 01, 2020 physical therapy is continued until rom and strength are maximized. Scapula stabilizing exercises will be required to recover complete range of motion of the shoulder when recovering from a scapular fracture. Total shoulder arthroplastyhemiarthroplasty protocol. Physical therapy standards of care and protocol the following standards of care and protocols are the property of bwh and should not be copied or otherwise used without the permission of the director of. Physical therapy is continued until rom and strength are maximized. Stand on the other side of the wall with your palm facing the wall. Clinical implications of scapular dyskinesis in shoulder injury.
Therefore, the bone is primarily held in place by the attached and surrounding muscles. Scapular dyskinesisaltered scapular positioning and motionis found in association with most shoulder injuries. Rehabilitation protocol for reverse shoulder arthroplasty. Scapular dyskinesis scapular dyskinesis1 is defined as observable alterations in the position of the scapula and the patterns of scapular motion in relation to the thoracic cage. Scapula strengthening exercises early shoulder rehab. Progress to rotator cuff strengthening after scapular strengthening is in progress. Acute shoulder injuries in adults are often initially managed by family physicians.
The effects of scapular stabilization based exercise therapy. Persons with associated conditions such as shoulder impingement, rotator cuff disease, labral injury, clavicle fracture, acromioclavicular joint injury, and multidirectional instability should be evaluated for scapular dyskinesis and. Patients typically start physical therapy after the 4 week appointment, as long as they are having a normal healing course. Patients may have residual motion and strength deficits, especially if the rotator cuff is involved. Physical therapy for fractures and orthopedic disorders prof. These include shoulder rolls, scapular squeezes, and shoulder shrugs done with dumbbells.
Background fractures of the scapula account for 3% to 5% of all fractures of the shoulder girdle3941 and make up less than 1% of all broken bones. It is mainly produced by the rhomboids mm and mediallower trapezius in this isolated movement. The specialist may give you further instructions regarding your rehabilitation and when you should be able to carry out more arduous tasks. The functional outcome after nonoperative management of displaced scapular body fractures was assessed by change in the dash disability of arm, shoulder and hand score. The rehabilitation protocol for total shoulder arthroplasty tsa hemiarthroplasty hhr is based on the latest research.
Followed by completion of a doctor of physical therapy degree at. General principles of rehabilitation for fractures treat the patient not the fracture move all joints that are not immobilized prevent disuse atrophy use gravity to assist in mobilizing a joint be aware of peripheral nerve palsy signs. Scapular fractures are uncommon, and displaced glenoid fractures are even. This physical therapy protocol is based on the best evidence demonstrating a beneficial effect for exercise in the treatment of rotator cuff.
Exercise in the treatment of rotator cuff impingement. Scapula fracture shoulder blade fracture physioadvisor. Dec 05, 2018 as the name suggests a scapula fracture is a fracture of the scapula or the shoulder blade. Strenqth o no cuff strengthening o continue scapular retraction and depression.
Persons with associated conditions such as shoulder impingement, rotator. The functional outcome after nonoperative management of displaced scapular body fractures was assessed by change in the dash disability of arm, shoulder. It is mainly produced by the rhomboids mm and mediallower trapezius in this isolated. Anatomy your shoulder joint is a ballandsocket joint. Shoulder rehabilitation protocol university of kentucky. Scapular dyskinesis and its relation to shoulder pain.
Arthroscopic labral repair and open capsular shift protocol. Postoperative laminectomy discectomy exercises these exercises will help you reduce pain and recover from your back surgery try to do these exercises every day for the next 6 weeks perform. Physical therapy prescription scapular stabilization protocol. Physical therapy intervention in a patient with open reduction. Scapula shoulder blade fractures the shoulder blade scapula is a triangularshaped bone that is protected by a complex system of surrounding muscles. Michael graduated from eastern kentucky university in 2008 with a bachelor of science degree in athletic training. Heavy physical use of the shoulder, such as athletic activity, is prohibited for 46 months. Manual therapy as therapeutic massage, mobilization, manipulation. Scapula stabilization rehab exercise prescription jason brumitt,mspt,scs,atc. Scapular clocks, shrugs, pinches, pnf cardiovascular exercises bike in sling, walking on treadmill in sling progression criteria xray evidence of healing clearance from md to begin pt phase ii 36 weeks dates. Shoulder the work of a tuberosity fracture the jackson clinics.
A scapular fracture is a fracture of the scapula, the shoulder blade. Scapula strengthening exercises early shoulder rehab youtube. Although formerly felt to be rare, scapula fractures have been shown to occur with a rate of 0. New method to assess scapular upward rotation in subjects. As rom progresses, strengthening exercises are added. Its only attachment to the rest of the skeleton is through the collarbone at the acromioclavicular joint. Shoulder movement that remains is contributed by scapular. Jul 09, 2017 scapular dyskinesisaltered scapular positioning and motionis found in association with most shoulder injuries. Rehabilitation programs for operative and nonoperative. Start rehabilitation with emphasis on leg, low back, trunk, abdominal strengthening. The shoulder blade has a ridge going along it known as the spine of the scapula. Department of rehabilitation services reverse total shoulder.
C5c5,d willamette falls hospital,oregon city,oregon erikmeira,pt,cscs elite physicaltherapy and sports medicine. Thoracic mobilization and manipulation for the treatment of. Background o the scapula is the base of support to shoulder joint and all movements of the upper extremity o poor. Start rehabilitation with emphasis on leg, low back, trunk, abdominal. The term scapula literally means skapulare to dig, because the greek anatomists who. Clinical implications of scapular dyskinesis in shoulder. Clavicle fracture rehabilitation protocol range of motion immobilizer exercises phase i 06 weeks 04 weeks. Proximal humerus fracture book twin cities orthopedics. The term scapula literally means skapulare to dig, because the greek anatomists who named it thought that the shoulder blade looked like a spade.
Jul 26, 2018 famous physical therapists bob schrupp and brad heineck present. This video shows four simple scapula strengthening exercises that can be done in early phases of postoperati. Movements of the upper limb these are important mucles. Severity minor fractures do well with immobilization and physical therapy, while fractures that are. A scapula fracture usually occurs due to a direct blow to the shoulder blade, such as a motor vehicle accident, a hard ball impact in sports such as cricket or hockey, or a heavy collision with another player in contact sports such as rugby or football. Outcomes of nonoperatively treated displaced scapular body.
Rate of recovery and the prognosis from scapular fracture will depend on a number of factors. Treatment of shoulder girdle fractures depends on severity of injury and displacement. Physical therapy toolkit treatment guides section 1 interventions balance fall risk assessment and prevention functional mobility gait therapeutic exercise conditions and diseases adhesive capsulitis alzheimers disease and related dementias mid stage. This protocol was adapted from the articles titled. Several factors may create these abnormal patterns and positions.
Light use of the shoulder is encouraged through postoperative week 12. Shoulder immobilizers may have additional straps and cuffs for the arm, wrist, and fingers for. Dec 01, 20 scapular retraction is movement of the scapula shoulderblade backwards towards the spine. Physical therapy toolkit treatment guides section 1 interventions balance fall risk assessment and prevention functional mobility gait therapeutic exercise conditions and diseases adhesive capsulitis. The scapula is sturdy and located in a protected place, so it rarely breaks. Electromyographic analysis of specific exercises for scapular control in early phases of shoulder rehabilitation. A standard ap or posterioranterior chest xray can reveal scapular fracture.
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