Week 10 Lecture

Upward rotation 2 degrees (+/-6) Internal rotation 33 degrees (+/-9) Anterior tilt 8 degrees (+/- 4)

Sub-optimal scapula kinematics (impingement): Alteration may be due to Pain Soft tissue tightness Altered musculoskeltetal function of scapula force couple (reduced strength, endurance, altered timing) Sub-optimal thoracic postures May result in: Sub-optimal starting postures of scapula Altered axes of rotation of scapula during overheadactivity Compromised ideal scapula position during overhead activity leading to compromised SA space GHJ deprived of stable base upon which to move/Fx leading to compromised RC Fx Altered scapula m/s activation/timing doesn’t necessarily = altered scapula kinematics LIttle evidence of existence of ideal scapula position Uncertain if alterations in scapula kinematics are causiative (of pain) or compensatory (adaptive) in presence of pain Mus link apparent sub-optimal scapula mechanics to pain disorder in order to justifable ‘treat’ it. Summary: General belief that reduced upward rotation and posterior tilt during arm elevation could reduce available SA space and contribute to development or progression of impingement as well as contribute to a poorer environment for healing

Weeks 0‐6 • Sling – adjust for optimal position & comfort • No active movts of shoulder • Passive physiological movts by physio, No ER past neutral OR abduction or flexion past 90 – “Cradle” pendular movts progressing to straight elbow pendular movts • Gentle scar massage for softening when well healed • Encourage / facilitate good spinal & scapula postures Week 6 • Discontinue sling • Stress analgesic cover – pain common at this stage as movt / activity Week 6-8 • Progress to active‐assisted shoulder movts (Pulleys – Self‐assisted with unaffected side – Stick – Start short lever progressing to longer lever) Week 8+ Progress to active shoulder movts– short lever then long lever; Flexion 1st progressing to abduction PAMs introduced as required Gentle RESISTED MOVEMENTS may be introduced week depending on surgeon – Start with isometric (Some surgeons prefer no resistance to repaired tendon until 12/52 post op) Week 13 + • Graduated strengthening incl loading of repaired tendon – Isometric in elevation, through range resistance, through range resistance in elevation Pain can persist 6 – 8/12 post op At 3/12 expect ~60 – 70% function 6 – 12/12 post op return to work / sport

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