So, hoping to get any tips or tricks on how to prevent exessive shoulder hiking when trying to elevate the arm, specifically after a rotator cuff repair.
I have one of these now, and I get these occasionally, but I have a pt with decent MMT rotator cuff strength, but hikes the shoulder up so bad when trying to elevate their arm that their functional standing flexion is limited to 50-60 degrees. They have 160 available actively in supine. G/H mobility and scapular mobility WNL.
What sort of things do you guys look for, work on, and address that help restore the proper way to raise that turkey wing up in the air? Any help would be appreciated. This is an area I've struggled with. Thanks folks.
< Message edited by Tom Peterson -- May 3, 2011 2:46:15 PM >
Joined: January 13, 2009
From: Long Island, NY
I have a similar situation with a pt who had a L humeral head fx in late DEC. she was in asling for about 6 weeks and I have gotten here FF to about 160 pasive and 130 AROM. abd is about 95 active/passive. when i try to go higher she just hikes the shoulder.
I have tried GH and scap mobs, distraction, METs, PNF diagnals, trigger point release all around shoulder, bicep, pecs, rib mobs, T/S manip.
I can't get it any better.
I sent her back to the doctor just to get it checked.
The other therapist I work with who sees her sometimes was kinda upset I didn't talk to him about it first before sending her back to th doctor, but neither one of use have seen progress in 1.5 mos. I honestly don't think anything he was doing did anything to make adifference either
Anyone think it was wrong to send her back to the ortho to r/o frozen shoulder or something else just so its on record? I mean aren't we required to report back to the doctor once a plateau is reached?
I find K-tape works really well for those who cannot override their tendency to hike up post-surgically. Use longer strip, have shoulder actively depressed and mildly retracted, anchor tape (non-stretched) on anterior shoulder about 2 inches long, then split and one segment pulled at maximum tension down past the middle of the scapula (direction of T6-7), the other segment pulled at maximum tension towards T2-3. (Make sure you anchor the ends with an inch of non-stretched K-tape). I find this gives the patient a lot of skin proprioception to help them re-organize their motor pattern. Skin is so kinesthetically sensitive that it provides a ton of feedback when the tape gets stretched with the "hiking" occurs.
Just a non-research tidbit. And hey, maybe its just my charming personality that does the trick here.....
Joined: February 14, 2003
From: Madison WI USA
If you have beat your head against the wall and tried everything you know, dont forget that it may still be a failing supraspinatus, or a very weak supraspinatus. As you all know, its job in ABDuction is to provide the spin needed to get into overhead ABDuction. If it doesnt work (is torn), or is insufficient, you will see a great deal of improvement when gravity is taken out of the picture. If the passive motion is gone, the active will of course not be there, and then you can consider capsular issues. Get the motion back and then see what actually works in the cuff. I know I am restating the obvious, but sometimes you arent getting results after a reasonable time frame because the cuff is not intact, or is simply not intact enough to work. With that said, it is possible that you need to set up something that allows them to work in a gravity neutral plane at the shoulder, as gravity is too tough, and supine is too easy.
Tom-I try to start in sidelying working on ER to engage the cuff and post shld groups. In this position with the post shld groups firing, I'll then progress into scaption/abduction. I also like to passively take them to 120 and have them eccentrically control the shld without hiking, with a progression into concentric control and good mechanics.
John-I find these patients extremely difficult. I feel many of them have cuff tears, poor length-tension, poor rotational alignment that leaves them with an insufficient cuff. Probably not Ad Cap with passive motion to 160. I think these patients get streamlined to the fracture treatment when the first x-ray shows a break and the soft tissue is forgotten by physicians. Good luck
Have to tried just having the patient depress the shoulder and then try to perform shoulder flexion. They may only be able to achieve a moderate amount of motion but it may allow the patient to keep the patient in the correct position.
Joined: April 23, 2001
From: colorado springs, co, usa
I sometimes try "placement isometrics" with my persistent shoulder hikers. It's a technique i learned in a class. Basically with the pt sitting you take them (passively or acitive assistively) 10-15 degrees past the point where they hike actively. The patient trys to hold this position for 5-10 seconds then slowly lowers the arm down. As the motion improves you just continue to perform this at higher degrees of elevation.
It works fair to good expecially with my adhesive caps that have difficulty getting back there active despite good passive. Just be careful with how quickly you begin the eccentric phase after a RTC repair.
Or you could try some supine flexion/scaption with theraband to bridge the gap between passive and full gravity assisted in sit/stand.