Friday, November 7, 2008

Dislocated Shoulder comments

JH asks, "I would be curious to see how his dislocations have effected his scapular positioning and movement. Speaking of which, have you developed or seen a post op principle based shoulder program that starts at the scapula and thoracic spine instead of at the glenohumerous?"
JH, your questions are always more than meets the eye. He does have scapular mal-position (depressed), but it doesn't seem to transfer over to dyskinesis. The long thoracic nerve seems to have been spared in the injury.
I'm sure one can find protocols on the internet that meet those requirements. However, I feel you should treat it like you see it. With my swimmer with instability, I'm doing more "peltrunkula" work. But in this case it will not be my primary focus. I will aggressively go after his GH capsule, as it is biting down already. A tight capsule sounds like it might add stability to the joint, but nothing can be further from the truth. Usually (not always) a GH positional fault occurs, where the humeral head sits anterior in glenoid. This sets you up for your next dislocation or labrum tear. Will I use traditional mobes? Mulligans? FMR? ART? Not sure yet.
Simultaneously, I'll work on restoring his neuromuscular control. Stay tuned. This is a challange.


cj_atc said...

I would love to see more posts about "peltrunkula" exercises.

JH said...

Keep us posted on this one.

the reason I asked about the protocols, is because we are still seeing post op shoulder protocols which don't address the scap until later in the rehab or maybe even not at all. the assumption i think is that if you move the arm the scap will naturally follow but i have found that the scap and humerous is more of a synergistic relationship as opposed to an if-then relationship.