Academy of Orthopaedic Physical Therapy

American Physical Therapy Association (APTA)

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28.2 THE SHOULDER
Table of Contents

CLINICAL KINESIOLOGY OF THE SHOULDER COMPLEX:
FOUNDATIONS FOR THERAPEUTIC EXERCISE

Abstract:

The complexity of the shoulder and high prevalence of dysfunction can provide challenges in rehabilitation. Therapeutic exercise is the most common and effective physical therapy intervention for shoulder rehabilitation, both for conservative and postoperative patients. The functional exercise progression (FEP) provides a framework for therapeutic exercise prescription based on anatomical, biomechanical, neurological, and physiological foundations in clinical kinesiology. This monograph reviews the relevant biomechanical and electromyography (EMG) aspects of shoulder pathomechanics and exercise prescription in a 4-stage progression of rehabilitation based on motor control sequencing. This framework supports evidence-based clinical decision-making in shoulder rehabilitation.

Keywords:​

functional progression, electromyography, biomechanics, pathomechanics, clinical decision-making, muscle imbalance

References:

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EVALUATION AND TREATMENT OF THE ROTATOR CUFF

Abstract:

Rotator cuff tears have dramatically increased over the past several years. The costs associated with rotator cuff pathology has a significant economic impact, thus, the ability to evaluate, diagnose, and treat in an efficient manner is critical in the current health care environment. Successful outcomes in the management of rotator cuff pathology have been achieved with both conservative and surgical interventions. Numerous factors including patient expectations, tendon quality, atrophy, tear size, and location all help to dictate which intervention may be appropriate for each patient. Long-term follow-up studies have shown successful outcomes following both intervention strategies, but the risk of re-tear following surgical repair must be considered. Emerging surgical techniques provide hope for enhancing tissue stability and increasing patient function as a means to improve quality of life.

Keywords:​

shoulder pain, tear, function, degeneration

References:

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EVALUATION AND TREATMENT OF THE STIFF SHOULDER

Abstract:

This monograph discusses the etiologies and pathology involved with adhesive capsulitis. It provides the rationale for the classification of patients into primary or secondary shoulder stiffness. It includes information regarding the stiff shoulder examination and how to select the most effective treatment strategies. This monograph also addresses medical and surgical interventions for adhesive capsulitis. Two intriguing case studies are presented. Each case highlights the clinical reasoning for the selection of treatments for the patient with shoulder stiffness. The first case involves a 63-year-old female who developed shoulder stiffness after having a cervical fusion. The second case involves the progression of shoulder stiffness postoperatively in a 41-year-old male.

Keywords:​

frozen shoulder, adhesive capsulitis, hypomobility

References:

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MANAGEMENT AND TREATMENT OF THE ANTERIOR SHOULDER INSTABILITY

Abstract:

This monograph discusses the management and treatment options for anterior shoulder dislocation, including contact athletes. This topic continues to be controversial because of the significant advances in our understanding of the risk factors, pathophysiology, and biomechanics of glenohumeral instability. The monograph provides the rationale and considerations for further injury and pathology, treatment options, and indications for surgery. A detailed nonoperative and postoperative criterion rehabilitation program is presented. Key surgical management considerations and techniques are described. Two case studies are presented highlighting critical clinical time points and progression decisions. The first case involves a 16-year-old female swimmer diagnosed with multi-directional instability. The second case describes a 20-year-old male postoperative patient following Remplisage and Laterjet reconstruction. These cases emphasize the key strategies and decisions required for successful rehabilitation following nonoperative or postoperative rehabilitation of anterior shoulder instability.

Keywords:​

instability, contact athlete, surgery clinical decision- making

References:

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RETURN TO PERFORMANCE: BASEBALL ATHLETES AND THROWING PROGRAMS

Abstract:

This monograph documents the similarities and differences between preparing for and returning throwing athletes to sport based on considerations of age, positions played, pathology, treatment, the level of competition, and the existence of external pressures. A multifactorial decision-making process is presented based on the considerations of all members of the team (athlete, parents, coaches/team personnel, physician, and rehabilitation providers). Factors of communication, longitudinal monitoring, and patterns of recovery are critical components to consider to maximize the timing and successful return to participation. The monograph also addresses the use of current evidence for best practices used within the sport of baseball and from other sports regarding functional performance tests, progressive loading, and physiologic recovery to assist in modifying the return to sport program for each particular athlete.

Keywords:​

rehabilitation, pitching, readiness

References:

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A FUNCTIONAL TESTING ALGORITHM FOR RETURNING PATIENTS BACK TO ACTIVITY

Abstract:

The decision to discharge patients and return them back to their specific activities is an important part of a patient’s plan of care. Unfortunately, there is a limited amount of credible decision-making evidence with predictive validity to return patients back to activities. The criteria to return patients back to activity should be tiered and based on the demands of that activity. This monograph presents a review of the literature to aid the clinical decision-making needed for return to activity with primary emphasis on return to sport (RTS). A quantitative and qualitative functional testing algorithm (FTA) is described as an example of a systematic approach used to guide clinical reasoning and decision-making needed to progress a patient through a rehabilitation program and back to activity. The FTA consists of basic measurements and patient-reported outcomes, strength and power testing, and functional performance testing. Although limited, the psychometric properties of the tests included in the FTA will also be provided. Specific objective criterion-based data are included as guidelines for clinicians to use in their clinical reasoning and decision-making for RTS.

Keywords:​

shoulder, performance testing, return to sport

References:

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The Shoulder

This series addresses the biomechanical, pathological, and evaluative aspects of treating the shoulder. Specific emphasis is placed on the rotator cuff, shoulder instability, and special concerns for the overhead athlete.

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