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Most Points in March Madness?

Most Points in March Madness?. Neither was Notre Dame's Austin Carr, who holds NCAA tournament records for most points in one game (61 vs. Ohio in 1970), most field goals in one game (25) and most field goals attempted in one game (44). Classification and Treatment of Scapular Pathology.

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Most Points in March Madness?

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  1. Most Points in March Madness?

  2. Neither was Notre Dame's Austin Carr, who holds NCAA tournament records for most points in one game (61 vs. Ohio in 1970), most field goals in one game (25) and most field goals attempted in one game (44).

  3. Classification and Treatment of Scapular Pathology

  4. Scapular position and movement • Closely related with arm motion to accomplished all shoulder functions

  5. Scapulohumeral rhythm (SHR) • Altered in shoulder injuries

  6. Normal Motion • Humerus to scapular ratio of 2:1 varies widely with arc of motion

  7. Scapular Dyskinesis • Alternation in normal dynamic scapular position or dynamic scapular motion • Affects AC distance in the subacromium space, • Relation with glenoid and the long axis of the humerus the GH angle • Amount of posterior impingement • Activation of the RTC muscles • Increase the clinical symptoms of the shoulder injury

  8. Roles in Shoulder Function • Upward rotation • The scapular must posterior tilt and externally rotated and • Scapula must stabilize in a position of relative retraction during arm use to maximize activation of all of the muscles that originate on the scapula • Allows the muscle to activate from a stable base

  9. Force Couples • Lower trapezius to stabilize the rotated scapula and add additional posterior as the arm is maximally elevated

  10. Force coupling • Middle trapes, serratus anterior working as external rotators of the scapula

  11. Coupling • Lower trapezius is couples with the latsdorsi to rotate the elevated arm on the stabilized scapula

  12. Scapular Dyskinesis • Found in a large percentage of shoulder injuries • Combination of decrease posterior tilt and decrease ER and decrease upward rotation • Prominent of the medial border of the scapula when the arm is at rest or on elevation

  13. Prominent medial Border of the Scapula • Type 1 – inferior border • Type 2 - Entire median border • Type 3 - Superior median border • I and 2 are seen instabilities and labral tears • 1 and 3 are seen with RTC injuries

  14. SA vsTrapes

  15. Scapula Dyskinesia • Scapular retraction is the key element in closed kinetic chain exercise • If lost – activation of the muscles takes the shoulder girdle forward • Excessive scapular protraction alters the scapular roles in shoulder function • Subacrominum space altered producing an hyperangulated joint and maximum muscle contraction may be lost • Due to AC, Instability biceps tendon, labral tear

  16. Shoulder Dyskinesia • Proximal and distal types

  17. Proximal Types • Direct alteration of muscle properties • Inflexibility (pect minor in impingement) • Weakness • Fatigue (SA or trapes in impingement) • Nerve injury (long thoracic or accessory) • Boney (kyphosis or scoliosis)

  18. Distal types • Anatomical injuries to the AC or GH joints • Frequently need surgery • GH instability associated with altered SA activation • Superior glenoidlabral tears are associated with dyskinesis in 94% of the cases

  19. GIRD Cases • Internal rotation loss by 25 degrees • Throwing side • Tight posterior capsule • Pulls scapula into a protracted, internally rotated and anteriorly tilted position

  20. Dyskinesia • Protraction • Increases tensile load on the anterior band of the inferior GH ligament which allows more anterior translation

  21. Exam • Presence or absence of scapular dyskinesia • Evaluate proximal and distal causation facters • Maneuvers that correct dyskinesia on impingement

  22. Posterior Aspect for Complete Visualization • Inferior medial or medial border prominence • Use markings and compare side to side

  23. Dynamic scapular motions • Move the arms ascend and descend 3 to 5 times • See weakness and dyskinesis • Do it 3 to 5 lbs weights • Alteration of the medial border of the scapular in any plane is positive

  24. Scapular Assistant test (SAT)

  25. Scapular retraction test (SRT) • Examiner dynamically assists upward rotation and posterior tilt as the patient elevated the arm • Minimal pressure is exerted

  26. Scapular Retraction Test (SRT) • Stabilizes the scapula in a retracted position and rechecks MMT of the posterior inpingement symptoms

  27. Lateral scapular slide (LSS) • Measure of scapular control • Measurement of the inferior angle medial scapular tip and the spine • Arms are in 80 to 90 degrees of abduction and maximally internally rotated • Side to side asymmetries of >1.5 cm correlate to excessive scapular IR

  28. GIRD • Arm 90 abduction • Measuring full ROM • Comparing IR

  29. Coracoid Inflexibility • Palpation of a taut or flexible pectoralis minor or biceps short head

  30. Proximal Muscle stability • One leg stand • One leg squat • Trunk flexibility sit and reach • Wall push ups and watch for dyskinesia

  31. Distal Factors • Tests for GH and AC • RTC strength

  32. Treatment – two pathways • Any proximal or distal causation factors

  33. Summary

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