Dr. Kevin Yip

Dr Kevin Yip
Orthopaedic Surgeon
MBBS(UK), FRCS(EDIN), FAM(SING), FHKCOS(ORTHO)

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Shoulder and upper extremity

There are several common issues to be remembered when dealing with shoulder rehabilitation, despite thewide variety of injuries that may be sustained by the shoulder complex.

– The shoulder girdle is a series of complex joints and articulations that function together to providesmooth, rhythmic, and coordinated movement. The complexity of this combination of joints and its heavy reliance on soft tissues to provide both dynamic and static stability often make the shoulder a difficult rehabilitation challenge.
– The rotator cuff and the periscapular muscles must be rehabilitated together to maintain the dynamic stability of the shoulder girdle.
– Weakness in the stabilizers of the scapula changes the biomechanics of the shoulder girdle: there is abnormal stress in the anterior capsule, greater compression of the rotator cuff, and decreased activity of the rotator muscles.
– Normal range of motion of the shoulder girdle must be achieved to maintain rhythmic scapulothoracic and glenohumeral motion. This should include both capsular motions and muscular soft tissue flexibility.Increased thoracic curvature (kyphosis) results in decreased glenohumeral mobility.

Shoulder range-of-motion exercises

Pendulum exercises

The goals of pendulum exercises are threefold: to improve muscular relaxation; to establish a limited arc of pain-free, relaxed motion; and to prepare the shoulder complex for additional activity. Stand, holding on to a stable object with the uninvolved arm. Bend over slightly at the waist and let the involved arm hang straight down, relaxing all the shoulder muscles.Swing the arm gently

(a) forward and back,
(b) side to side,and
(c) in circles, first clockwise and then counterclockwise, increasing the diameter of the circle.

Using the momentum of the swing, keep the muscles as relaxed as possible. Repeat 10–15 times each way.Their pain-relieving and relaxation-enhancing qualities make pendulum exercises a good choice also for ‘cooling down’ exercises.

Cane-assisted exercises

Using a cane, a stick or a broom handle, use the uninvolved arm to assist the involved arm in increasing the range of motion.

Forward flexion

Lying on your back, grasp the cane with both hands, shoulder width apart, palms down. Start with the cane resting across the hips. Lift the cane with straight arms out in front of you, as high as you can until a stretch is felt (assisting the involved arm with the uninvolved arm). Pause at the top for 5 seconds, then return to the starting position. Repeat 10 times.

Abduction

Lying on your back, grasp the cane with both hands, palms down, shoulder-width apart. Start with the cane resting across the hips. Using the cane, push your involved arm out to the side, as high as you can. Pause at the top for 5 seconds, then return to the starting position. Repeat 10 times.

Internal/external rotation

Lying on your back, grasp the cane with both hands, elbows bent to 90°, hands shoulder-width apart. Using the cane, keep your elbows tucked in to your waist, and rotate the involved arm out to the side as far as you can. Hold for 5 seconds, then return to the starting position. Repeat 10 times. Repeat the exercise, rotating your arm across your body in the other direction.

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