Shoulder Dysfunction - Biodex

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HOME PROGRAM: • Control pain and swelling: P.R.I.C.E. • Range of Motion (ROM) exercises: Pendulum swings Weight: Begin with no weight and progress as tolerated Sets and Reps: 2 x 25 clockwise and 25 counterclockwise Shoulder bar Shoulder flexion to 90°, ER (neutral) to 45° Sets and Reps: 1 x 5-6 Duration of hold: 20 seconds • Strengthening: Shoulder 4-way isometrics: FLEX/EXT, IR/ER, ABD/ADD with arm in scapular plane Sets and Reps: 2 x 15 Contraction duration: 2 seconds Recommendation: Utilize doorway to perform exercises. All exercises should be performed in modified neutral. Elbow FLEX/EXT (isotonics) Sets and Reps: 3 x 15 Weight: Begin with last plate of Phase I and progress as tolerated Wrist FLEX/EXT, SUP/PRON Isotonics Sets and Reps: 3 x 15 Weight: Begin with last weight used in Phase I and progress as tolerated Wall push-ups progress to pushups with a plus by the end of the Phase 23 Arm height below 90° of shoulder flexion No pain and/or scapular winging should be present IR/ER, seated rows, protraction/retraction, shoulder extension, shrugs and scaption latex tubing exercises: Sets and Reps: 3 x 15 Recommendations: Begin with moderate tubing a progress as tolerated • Proprioception Closed chain quadruped and tripod stabilization techniques • Cardiovascular training 20-30 min of moderate activity 3-4 times per week REPORTS: • Passive and Active Range of Motion: FLEX/EXT, ER/IR and ABD/ADD • Pain scale • Level of cardiovascular fitness: Establish: distance traveled, speed attained and duration of exercise • Biodex bilateral proprioception for ER/IR at 90º/90º • Biodex bilateral isometric comparison for FLEX/EXT, ER/IR modified neutral and ABD/ADD • Biodex bilateral isokinetic comparison for ER/IR in modified neutral 1-14 PHASE II: RANGE OF MOTION & INITIAL STRENGTHENING
GOALS: • Full pain free PROM and AROM • No pain or inflammation • No complaints of palpable tenderness • Increase wrist and elbow ROM and strength • Continue to develop voluntary and involuntary control of shoulder stabilizers • Increase cardiovascular conditioning • Increase functional activity levels with no complaints of pain • Proprioception: ER/IR 90/90 < 20% deficit bilaterally • Isometric strength: < 10% deficit bilaterally for all directions • Isokinetic strength: ER/IR @ modified neutral < 20% deficit bilaterally CLINICAL EVALUATION: • Verify home program compliance • General observation: Muscle Hypertrophy Scapular winging (scapular slide test) • Pain: Location; quality, duration, radiation, and severity: Evaluate pain throughout the ROM and note at end ranges of motion • Range of Motion (ROM): Involved extremity (AROM / PROM) Uninvolved extremity (AROM / PROM) * Should have full ROM • Neurological assessment: Myotomes, Dermatomes and Reflexes for C-3 to T-2 PHASE III initial and intermediate strengthening TEST: Bilateral Isometric comparison ER/IR 90/90: NOTE: Must have non-painful contractions and the decision to test supported by clinical judgment. Device: Biodex Multi-Joint System Pattern: Shoulder external/internal rotation (ER/IR) modified neutral Report: Bilateral isometric comparison Setup: Neutral rotation/plane of the scapula Mode: Isometric Duration: 5 seconds Sets and Reps: 1 x 5 reps Rest between repetitions: 10 seconds Recommendations: Have the patient perform the test with as maximal tolerable effort as possible. Use pain and substitution as a guide. © BIODEX MEDICAL SYSTEMS, INC. 1-15
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Shoulder Dysfunction - Biodex

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