Shoulder complex

Shoulder complex

1. Anatomy

   • Joint
     • ACJ
     • GHJ
     • shoulder girdle
   • Muscles
     • stabilisers
       • Rotator cuff muscles
     • Prime movers

2. Differential diagnosis

   • myogenic
     • Rotator cuff related shoulder pain
       • RC tear
         • pain on...
         • treatment
           • ROM and strengthening
           • CSI injection
             • pain
           • Surgery - tendon reconstruction
           • Anterior deltoid programme
       • RC Weakness
         • abduction
         • flexion
         • internal rotation
         • external rotation
     • Biceps brachii tear
   • Arthrogenic
     • frozen shoulder
       • Treatment
         • ROM
           • Active
           • Active assisted
           • passive
         • +/- CSI
         • surgery
           • keyhole
           • manipulation under anaesthetic
     • Acromioclavicular joint
       • irritation
       • disclocation
         • Rockwood classification
           • Type I-II
             • conservative
               • strength and ROM
               • taping - zinc oxide
               • improving WB
           • Type III -VI
             • surgical and conservative
     • Cervical stenosis
     • Osteoarthritis
       • strengthening
       • general exercise principles
     • Dislocations
       • Bancart repair
         • Under 25s
         • Reoccuring dislocations
         • Look at protocols
     • Inflammatory conditions
       • RA
         • GP referral
         • Screend'em
       • Polymyalgia rheumatica
         • Steroids
         • Bilateral shoulder pain
     • Proximal humerus fracture
   • neurogenic
     • Cervical radiculopathy
     • Peripheral neuropathy
     • ? thoracic outlet syndrome

3. Subjective assessment

   • Red Flags
     • Night pain
       • constant
         • Cancer
       • sweats
     • Subluxation of shoulder/ major trauma
       • Dislocation
     • Weught loss
       • 5-10% of body weight in 3-6 months
     • Major weakness
       • RC tear
     • Signs of infection
   • THREADSOCS
     • Osteoporosis
       • Increased risk of fracture
     • Steroids
     • smoking
       • Increased risk of lung cancer
         • PMH of lung cancer?
           • Increased risk of spinal mets
     • Diabetes
       • Linked to OA
       • Decreased healing times
     • Thyroid
       • Hypo thyroid
         • Increased risk of frozen shoulder
   • HPC
     • WHIP
       • Clinical physio document and shoulder training doc on UWE word - more info
       • When
       • How
       • Intervention to date
       • Pattern since onset
   • Aggs and eases
   • 24 hour pattern
     • mechanical or non-mechanical
     • early morning stiffness
       • under or over 30 minutes
         • RA
         • OA

4. Objective assessment

   • Range of movement
     • AROM
       • Standing
       • movements
         • flexion
           • 160-180
         • external rotation
         • internal rotation
         • abduction
           • 160-180
         • extension
     • PROM
       • Supine
       • If movement is improved - muscular issue
       • If movement is the same - joint issue
   • Strength testing
     • sitting
     • static and through range
     • If painful...
       • short lever
     • movements
       • forward flexion
       • extension
       • internal rotation
       • external rotation
       • abduction
   • Special tests
     • ACJ
       • Scarf test
     • Rotator cuff tear
       • Lift off
       • Abduction hold
       • Belly press
     • Frozen shoulder
       • capsular pattern
         • ER - Abduction - IR
     • biceps tear/ rupture
       • resisted elbow flexion
   • Joint above and below
     • neck
     • elbow
   • Upper limb neuro
     • Reflexes
       • Brachialis
       • Triceps
       • Biceps
     • Myotomes
     • Dermatomes
       • Light touch
       • neurotip
         • more reliable
     • Flick sign

5. General treatment principals

   • pharmacology
     • Refer to GP for pain relief
   • Weak
     • strenghen weak muscles
       • painful
         • isometric exercises
       • not painful
         • isotonic exercises
           • static
           • through range
             • Add resistance
               • Add and increase load
         • Non WB - WB
   • stiff
     • Increase ROM
       • 1. Passively
       • 2. Active assisted
       • 3. Actively
   • return to sport
   • Goals
     • Patient goals
     • therapy goals
     • Functional and SMART
   • Onward referrals
     • If change in symptoms
       • GP/ consultant
     • If not improving
       • OIS/ consultant
     • If presence of red flags
       • GP/ specialist
       • A and E

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