Shoulder Injuries and Rehabilitation

Management and Treatment of Shoulder Injuries

• Shoulder pathology rehabilitation involves specific intervention strategies for different injuries, including rotator cuff syndrome, anterior glenohumeral joint instability, supralabral lesions, shoulder osteoarthritis, and adhesive capsulitis.

Rotator Cuff Syndrome

• Non-operative and post-operative management strategies are used for rotator cuff syndrome.
• Rotator cuff syndrome is a common condition, especially in older adults, and is often asymptomatic.

Anterior Glenohumeral Joint Instability

• Anterior glenohumeral joint instability is a common condition, especially in young adults, and is often caused by traumatic injuries.
• The FEDS classification system is used to classify anterior glenohumeral joint instability, considering factors such as frequency, etiology, direction, and severity.

Shoulder Osteoarthritis

• Non-operative and post-operative management strategies are used for shoulder osteoarthritis.
• Shoulder osteoarthritis is a common condition, especially in older adults, and is often caused by wear and tear on the joint.

Adhesive Capsulitis

• Adhesive capsulitis is a common condition, especially in older adults, and is characterized by inflammation and stiffness in the shoulder joint.
• Sleep disturbances are common in patients with adhesive capsulitis, and are often associated with increased pain and disability.

Holistic and Individualized Intervention

• A holistic and individualized approach to rehabilitation is essential, considering factors such as biopsychosocial assessment, mental health, cognitive function, behavioral characteristics, and sleep quality.
• Rehabilitation should focus on treating the whole person, rather than just the injured shoulder.

Rehabilitation Focus

• Rehabilitation focus should be based on psychosocial status, patient values, goals, and outcome expectations, as well as tissue irritability, impairment findings, and imaging findings.
• Tissue irritability guides the intensity of physical stress, and impairment level guides the intensity of intervention tactics.

Research Takeaways

• Research has shown that patients' perceptions of treatment options vary, with "rest" and "medication" being the most common perceptions, while "exercise" is often underrated.
• Saying "rotator cuff" and "surgery" is often associated with increased perceived severity of the condition.

Subacromial Pain Syndrome

• Subacromial pain syndrome is a common condition, characterized by pain and inflammation in the subacromial space.
• Diagnosis is often based on a combination of clinical examination, imaging, and patient history.
• Treatment involves a combination of education, manual therapy, and exercise, with a focus on restoring soft tissue and joint mobility, and addressing pain modulation.

Subacromial Impingement Syndrome

• Subacromial impingement syndrome is a common condition, characterized by inflammation and compression of the soft tissues in the subacromial space.
• Diagnosis is often based on a combination of clinical examination, imaging, and patient history.
• Treatment involves a combination of education, manual therapy, and exercise, with a focus on restoring soft tissue and joint mobility, and addressing pain modulation.

Cervicothoracic Spine

• The cervicothoracic spine plays a critical role in shoulder function and rehabilitation, and should be addressed in treatment.

Glenohumeral Joints

• The glenohumeral joints are a critical component of shoulder function, and should be addressed in treatment.

Acromioclavicular Joints

• The acromioclavicular joints are a critical component of shoulder function, and should be addressed in treatment.

Scapulothoracic Spine

• The scapulothoracic spine plays a critical role in shoulder function and rehabilitation, and should be addressed in treatment.

Common Impairment Areas

• Common impairment areas that should be addressed in treatment include thoracic extensor stiffness, inadequate scapular posterior tilt, pectoralis minor tightness, posteroinferior glenohumeral joint capsular stiffness, and restrictions.

Short-Term Benefits

• Short-term benefits of treatment include reduced pain and inflammation, improved range of motion, and increased strength.

Long-Term Benefits

• Long-term benefits of treatment include improved functional ability, reduced disability, and increased quality of life.

Anterior Shoulder Instability

• Anterior shoulder instability is a common condition, especially in young adults, and is often caused by traumatic injuries.
• The FEDS classification system is used to classify anterior shoulder instability, considering factors such as frequency, etiology, direction, and severity.

FEDS Classification

• The FEDS classification system considers factors such as frequency, etiology, direction, and severity to classify anterior shoulder instability.

Over 40% of Patients

• Over 40% of patients with anterior shoulder instability fall into the solitary, occasional, trauma, or anterior displacement category.

AMBRI and TUBS

• AMBRI (atraumatic multidirectional instability) and TUBS (traumatic unilateral Bankart lesion) are two common classification systems used to categorize anterior shoulder instability.

Risks

• Risks associated with anterior shoulder instability include being a younger male, and participating in overhead contact activities.

Treatment Options

• Treatment options for anterior shoulder instability include immobilization, rehabilitation, and surgery.

Rehabilitation

• Rehabilitation for anterior shoulder instability should focus on restoring range of motion, strength, and function, as well as addressing pain and inflammation.

Surgery

• Surgery is often necessary for anterior shoulder instability, especially in cases where the condition is severe or recurring.

Post-Operative Considerations

• Post-operative considerations for anterior shoulder instability include the type of surgery, the method of fixation, and the rehabilitation protocol.

Phase 1 and Phase 2 Rehabilitation

• Phase 1 rehabilitation (0-6 weeks) focuses on inflammation control, pain management, and range of motion exercises.
• Phase 2 rehabilitation (6-12 weeks) focuses on strengthening, proprioception, and functional activities.

Anterior Instability Rehab Precautions

• Precautions for anterior instability rehabilitation include preventing poor scapulohumeral rhythm, preventing internal rotation contractures, and avoiding active dislocation.

Weight Training Modifications

• Weight training modifications are necessary for patients with anterior shoulder instability, including avoiding heavy loads, using proper form, and incorporating exercises that strengthen the rotator cuff and scapular stabilizers.