Shoulder Eval and Treat

articulations in the shoulder joint

glenohumeral, acromioclavicular, sternoclavicular, scapulothoracic

contributions to shoulder abduction

2:1 GH abduction to scapulothoracic upward rotation

history questions specific to shoulder evals

specific pain location, phase of activity where pain is present, catching, stiffness/weakness

why should we look at thoracic motion in a shoulder eval

shoulder cannot go as far if hunched over

problems with shoulder diagnosing

special tests do not isolate specific tissues so the diagnosis does not identify impairments and inform on appropriate treatment

CPGs out for shoulder diagnoses

mobility deficits, movement coordination impairments, muscle power deficits, OA, RTC tendinopathy

parts of staged approach for rehab classification (STAR)

screening, pathoanatomic diagnosis, rehab classification based on irritability and impairments

what is involved in the screening part of the STAR classification system

subjective screening to determine if the patient is appropriate for therapy

what is involved in the pathoanatomic diagnosis part of the STAR classification system

origin of symptoms (subacromial, adhesive capsulitis, GH instability)

irritability

tissue’s ability to handle stress or the degree of inflammatory activity present

main reason that identifying impairments is important

pts with the same diagnosis and irritability may require different interventions

intervention focus of high irritability

activity modification, monitoring impairments, pain control

intervention focus of moderate irritability

address impairments, functional activity restoration, progressive manual therapy, motor control

intervention focus of low irritability

stretching, end range manual therapy, resistive exercise, higher level functional training