The Codman exercise is an exercise that’s been around for a long time, and it’s designed to to help the shoulder remember that it’s supposed to move. It’s a very basic exercise and there are two forms of it: the passive and the active. The passive form is when the arm stays completely relaxed, and the body moves swinging the arm underneath the body like a pendulum. The active form is when the body stays still, but the arm moves in circles being driven by the shoulder muscles.
The person needs to lay on their back to do these stretches. The good hand/arm holds the injured or surgery wrist/arm and moves it through a range-of-motion: 0 degrees of external rotation and 90 degrees of forward elevation. All the work is done with the good arm. The injured or surgery arm remains completely relaxed during the stretching session. Under the direction of a therapist, the person will increase their range of motion passively to 40 degrees of external rotation and 140 degrees of forward elevation.
These stretches need the person to lay on their back. The good hand/arm grabs the injured or surgery wrist and moves it through a range-of-motion: 40 degrees of external rotation and 140 degrees of forward elevation. All the work is done with the good arm. The injured or surgery arm remains completely relaxed during the stretching session.
40/140 is used for a person who starts with gentle passive range of motion, such as Codman Exercises (Pendulum Exercise). The person is advanced, under the guidance of a therapist, to the range of motion of 40 degrees of external rotation and 140 degrees of forward elevation.
The 4 quadrant stretching program is made to stretch all parts of the shoulder. These parts include: 1) the front part by the arm pit (anterior inferior) 2) the back part by the arm pit (posterior inferior) 3) the upper part in the back (posterior superior) and 4) the upper part in the front (anterior superior).
The doorway stretch is used to help loosen a shoulder that is affected with capsulitis from injury or surgery or just out-of-the-blue. It attempts to stretch all quadrants of the shoulder (see 4 quadrant stretches) all at once. It is generally reserved for people who live active lives and will find it difficult to do the 4 quadrant program which requires laying down for some stretches. The doorway stretch attempts to copy the motion of the crank test.
The clenched fist protocol is designed to fight against hand and wrist stiffness.
Hand and wrist stiffness can occur following injury or surgery to the shoulder or elbow. It can happen because following an injury or surgery swelling can happen. The swelling is pulled down the arm by gravity and settles in the hand and wrist. The swelling itself does not cause stiffness. But if the person stops using their hand because they think they should because of the swelling, then stiffness will happen. And it will happen very fast.
In some cases the hand and wrist become so stiff that the person cannot hold or grab things with that hand. This is known as the “claw”. Once the “claw” has happened it can take years to regain function. The clenched fist protocol is an effort to stop the “claw” from happening.
The Early Strengthening Program is a strengthening program that is designed to rehabilitate the muscles of the shoulder after an injury or a surgery. Often after an injury or a surgery the person will be asked not to use their shoulder for 6 weeks. After this time, the person will be allowed to use their shoulder but they are usually very weak. This is when the Early Strengthening Program is most helpful. This program is designed to have the “good” (normal shoulder and arm) help strengthen the shoulder that had surgery.
The person is immediately seen and placed in a locked-elbow-immobilizer with the elbow/arm at 90 degrees, but allowing full flexion. The elbow is kept at 90 degrees for 2 weeks.
After 2 weeks the elbow range-of-motion is checked. If the elbow is stiff and doesn’t move much then the range-of-motion is increased. If the elbow is loose and moves a lot then the brace is kept at 90 degrees. This happens every week until the 6 week mark. At this point the brace is remove and elbow strengthening begins, which consists of a light weight, high repetition strengthening program.
The elbow stretching program is used to keep the elbow loose after an injury or a surgery. It usually starts immediately after surgery or shortly after an injury.