Academy of Orthopaedic Physical Therapy

American Physical Therapy Association (APTA)

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Special Collection - Shoulder
Table of Contents

SHOULDER ARTHROPLASTY

Abstract:

CONTENT: This monograph covers the pathogenesis, evaluation, and surgical considerations involved in the replacement of the glenohumeral joint. Particular emphasis is placed on understanding the surgical technique for hemiathroplasty, total shoulder arthroplasty, and reverse total shoulder arthroplasty. Preoperative and postoperative rehabilitation guidelines are discussed based on an understanding of the bony and soft tissue status of the patient and the surgical procedure performed. Surgical precautions during treatments and appropriate rehabilitation assessments to determine proper progression during postoperative rehabilitation are well highlighted. The authors also make the reader aware of the potential surgical and postsurgical complications following shoulder arthroplasty. CASE ANALYSES: Two case studies complete the monograph. The first case describes management of a patient with osteoarthritis of the glenohumeral joint. The second case discusses the evaluation and rehabilitation of a patient following reverse total shoulder arthroplasty.

Keywords:​

joint replacement, arthritis, glenohumeral

References:

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SHOULDER INSTABILITY: A REVIEW OF ANATOMICAL AND BIOMECHANICAL CONSIDERATIONS, PREVALENCE, AND DIAGNOSIS AS WELL AS NONOPERATIVE AND OPERATIVE MANAGEMENT

Abstract:

CONTENT: The literature for shoulder instability is reviewed. Shoulder function is related to impairments and disabilities that occur when stability is lost. The authors formally define instability and distinguish this condition from joint laxity. The anatomy and biomechanics associated with shoulder stability and pathomechanics underlying types of instability are covered in detail. Traumatic and atraumatic etiologies are distinguished. Common classifications of shoulder instability are reviewed. A major section focuses on examination using appropriate clinical measures to distinguish normal and abnormal findings. A detailed section on rehabilitation is divided into nonoperative and operative management. Nonoperative management of shoulder instability and the implementation of an evidence-based rehabilitation program are addressed. Operative management and common surgical techniques, possible complications, postoperative precautions, and rehabilitation goals for primary types of shoulder instability are reviewed. Recommendations for safe return of postsurgical and nonsurgical patients to their prior level of function, occupation, and sport for varied types of shoulder instability are highlighted. Currently used outcome measures for shoulder instability are reviewed. CASE ANALYSES: Two case studies are presented. The first case involves the nonoperative management of a 12-year-old female swimmer who complains of gradual onset of bilateral shoulder pain with swimming. The second case involves operative management for a 21-year-old Division I hockey player who sustained an acute dislocation while playing. Both cases address evaluation, treatment and outcomes.

Keywords:​

shoulder function, rehabilitation, precautions

References:​

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UPDATE ON ANTERIOR CRUCIATE LIGAMENT INJURIES:
THE SHOULDER: PHYSICAL THERAPY PATIENT MANAGEMENT USING CURRENT EVIDENCE

Abstract:

The complexity of the glenohumeral joint lies in its amazing mobility and need for high levels of essential dynamic stabilization for optimal function. The key concepts of anatomy and biomechanics forms the basis for many of the most important examination methods. Due to a very high number of available special tests, clinicians must be well-versed in the performance and diagnostic accuracy of these tests to best select optimal testing sequences for specific patient populations. The high reliance of the shoulder on dynamic stabilization requires clinicians to employ evidence-based strategies to improve muscular strength and endurance and to optimize muscle balance. Fortunately, a plethora of studies are now available and are reviewed in this manuscript to enable clinicians to design specific programs for rotator cuff and scapular strengthening. These programs are essential parts of many treatment programs for shoulder pathology. Lastly, mobility is also of critical importance to this complex joint to ensure high levels of human function. Specific techniques can be employed to improve shoulder range of motion and improve function. These techniques, while technical, have strong foundations in the anatomy and biomechanics of the shoulder complex and are also presented in this monograph.

Keywords:​

glenohumeral, rehabilitation, exercise, mobilization

References:

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