1. Rehabilitation exercise NWB upper limb FsSc FISM Janis Leach 14/01/10

2. Objectives Manage injury to the upper limb Show progressions from the early stage to the later stages of NWB To design a NWB exercise programme for the upper limb

3. Aims of rehab for shoulder Important to establish stability of the joint Maintain strength of the rotator cuff muscles Maintain fitness levels

4. Clavicle fracture The arm should not be raised above 70 degrees in any direction – up to 4 weeks post injury First week – Cryotherapy Avoid lifting Wear a sling Awareness of biomechanics

5. Fracture repair  The figures below illustrates the four major events of the repair of bones: Blood vessels are ruptured when the bone breaks. As a result, a mass of clotted blood called a____________ Within 2-3 days new capillaries grow into the hematoma and phagocytes clean up the debris. Over time connective tissue cells form a mass of repair tissue called the ___________________ forms. Bones cells deprived of nutrition die. hematoma fibrocartilaginous callus, which splints the broken ends of the bone

6. Fracture repair Osteoblasts invade the area and the fibrocartilage is transformed into a __________ This process continues until the bone is united completely a few months later. The bone is gradually remodelled to resemble the original shape and alignment. bony callus within 3-4 weeks. Healed fracture

7. Fracture repair Osteoblasts invade the area and the fibrocartilage is transformed into a __________ This process continues until the bone is united completely a few months later. The bone is gradually remodelled to resemble the original shape and alignment. bony callus within 3-4 weeks. Healed fracture

8. Clavicle fracture rehab Exercise routine- early stage  Pendulum exercises  Clockwise/anti-clockwise/letters  Grip strength  What can you use?  Isometric exercise  Triceps, biceps

9. Clavicle fracture rehab Progression Isometric shoulder exercises  Abduction, adduction, flexion and extension with arms at the sides

10. Clavicle fracture rehab Weeks 2-4  Passive exercises (wall crawl) within pain range  Assisted movements (broom handle) – very low ROM  Maintaining overall fitness Walking Stair climbing Stationary cycling

11. Clavicle fracture rehab Weeks 4-8 Light resistance exercises Increasing assisted movements Avoid shoulder elevation and rotation From week 8 depending on pain, begin ROM exercises

12. Rotator cuff rehabilitation EXERCISE Lie prone on a plinth Put one arm out at shoulder level with the elbow flexed to 90 degrees and your hand down Keeping the elbow flexed, slowly raise the hand Stop when your hand is level with the shoulder Lower the hand slowly Repeat 10 times Perform with opposite arm

13. Rotator cuff rehabilitation EXERCISE 2 Standing Bend elbow to 90-degree angle, hand facing frontward and elbow close to body. Slowly rotate hand toward the middle of the body. Return to starting position. Repeat 10 times. Repeat exercise on other side Progress using resistance bands

14. Rotator cuff rehabilitation EXERCISE 3 Stand with the arms slightly posterior to the midline Raise arms up to 90 degrees to the body and rotate inwards Lower the arms slowly Repeat 10 times Complete exercises as previously shown for clavicle fracture

15. Shoulder dislocation Phase 1 – Seated- support arms as if folded rock them gently into flexion and extension/ ab and adduction (within pain limit) Assisted lateral rotation (no further than 90 degrees to the body)

16. Shoulder dislocation Progression  Isometric contractions for all movements of the shoulder  Scapular stabilisation- trapezius and serratus Prone lying – bring scapular down Supine – elbow flexed 90 degrees – lift arm to ceiling Hold these movements for 5 seconds

17. NWB exercise plan Devise a plan to begin rehab for a client in the early stages of upper limb injury Include elbow, wrist and hand exercises The sessions can be broken up into 3 or 4 short routines Show a progression to the later stages of NWB upper limb