Shoulder Pain

Mentoring Minutes: Exercises for Post Op Rotator Cuff Repair

Source:

A Systematic Review of Electromyography Studies in Normal Shoulders to Inform Postoperative Rehabilitation Following Rotator Cuff Repair Journal of Orthopaedic; Sports Physical Therapy 2017 47:12, 931-944 

Notes:

  • This review identified passive and active-assisted exercises that may beappropriate in the early stages after rotator cuff repair

  • Investigate EMG activity during shoulder exercises to identify those with < 15% MVIC to limit excessive loading in early postoperative stages because retears in the first 3-6 months can be up to

  • A successful outcome after surgery often depends on the size of the tear; tissue quality; the location, type, and chronicity of the tear; previous and/or concomitant surgery; and individual patient factors such as smoking, body mass, and physical activity

  • Used 20 studies (out of 2000)- included 43 different passive or active assisted exercises, and limited it to 9 that met cut off for loading supra and infra under 15%;

  • The bulk of passive ROM exercises demonstrated activation levels below the cutoff, and active-assisted exercises using the asymptomatic limb to move the operated limb also generated low-level activation in both the supraspinatus and infraspinatus. However, active-assisted exercises using a bar or a pulley to elevate the operated limb tended to generate over 15% MVIC, suggesting that their use early in rehabilitation may be inappropriate. The pendulum exercise, a passive exercise commonly employed early in rehabilitation, demonstrated low levels of supraspinatus and infraspinatus activation, suggesting that it may be appropriate for inclusion as an early-stage exercise after rotator cuff repair. However, it has been shown that incorrectly performed pendulums, especially large pendulums, generated more supraspinatus muscle activity in the shoulder than smaller, correctly performed pendulum exercises

  • Supine and incline press-ups did not generate muscle activation levels above our cutoff of 15% MVIC, 

  • Supra: Bar assisted ER (supine or stand), wall assisted ER; supine press up (opp arm assist) , washcloth press up (hands close apart); towel slides (flex, scap); pendulums (small); prone scap retraction; scap protraction on ball

  • Infra: forward bow, towel slides, scap protraction on ball, supine self assisted; prone scap retract, washcloth press up (hands close apart), pendulums, supine bar assisted ER.

Clinical Pattern Recognition - Shoulder Pain

From anatomy to discovering the patient!

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  • Primary shoulder dislocation peaks in the second and sixth decade

  • 98% of cases, shoulder displaces anteriorly

  • 70% of people who have dislocated can expect to dislocate again within 2 years of the initial injury

  • Sub-acromial pain syndrome accounts for 44% to 60% of all conditions that cause shoulder pain and is the most frequent cause of visits to a physician’s office

  • See more prevalence information in the Clinical Pattern Recognition: Orthopaedics app here

Meet the 5 common shoulder pain patients from the Shoulder Pain and Mobility Deficit Clinical Practice Guidelines and more!


Clinical Pattern Recognition

Click on the pain pattern to learn about the patients and develop your clinical patterns!

1. Adhesive Capsulitis or Frozen Shoulder Shoulder pain and mobility deficits (1-minute video)

2. Labral tears, SLAP lesions, Bankart lesions, Anterior or Multidirectional Instability - Shoulder pain with movement coordination impairments (1-minute video)

3. Sub-Acromial Pain Syndrome (previously Shoulder Impingement) - Shoulder pain and muscle power deficits (1-minute video)

4. Acromioclavicular Joint Sprain Shoulder pain and movement coordination impairments (1-minute video)

5. Thoracic Outlet Syndrome (TOS) Shoulder pain with radiating pain (1-minute video)

Adhesive Capsulitis (Frozen Shoulder)

Shoulder Pain with Mobility Deficits

  • The exact cause of adhesive capsulitis is not completely understood; however, it has been divided into primary and secondary categories; primary being idiopathic and secondary being related to systemic, extrinsic or intrinsic pathology. If your patient has a history of diabetes mellitus, thyroid dysfunction, or a history of contralateral frozen shoulder along with symptoms similar to 1 of the 4 clinical stages they may be suffering from adhesive capsulitis!

  • If you do not know the common clinical findings no problem! Click here



Sub-Acromial Pain Syndrome (Shoulder Impingement)

Shoulder Pain with Muscle Power Deficits

  • The Sub-acromial pain syndrome is perhaps the most common cause of shoulder pain in patients and a frequent cause of primary care physician visits. Patients will often present with sharp shoulder pain exacerbated in mid ranges of shoulder movement and repetitive activities. Take a look at some ways to assess and treat this common pathology!

  • If you do not know the common clinical findings no problem! Click here



Labral Tear, SLAP Lesions, Bankart Lesions, Anterior or Multidirectional Instability

Shoulder Pain with Movement Coordination Impairments

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  • Many labral tears are caused from shoulder dislocations. Anterior dislocations are most common and are often caused from a forceful collision, fall on an outstretched arm, or a sudden wrenching movement. The patient may present with apprehension at end ranges of motion.

  • If you do not know the common clinical findings no problem! Click here