Shoulder Pain

Exercises for Post Op Rotator Cuff Repair

Want to know the 9 best exercises for the early stages of post op rotator cuff repair. A Systematic Review from 2017, looked at EMG activity of over 45 different exercises and narrowed it down to these 9 with the least amount of rotator cuff EMG activity. Hint: not all pendulums are the same, and pulleys were not on the list.

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 

  • Identified passive and active assisted ROM exercises, using EMG, that would be most appropriate in the early/acute states following RC repair, to limit retear rates. Authors were looking for exercises that had <15% MVIC

  • Retear rates are dependent on 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.

  • A total of 43 different exercises were evaluated, with 9 meeting the cut off criteria of <15% MVIC.

  • Most active assistive 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.

  • For Supraspinatus: ER bar assisted (supine or standing) or wall assisted; supine press up (opp arm assist) , washcloth press up (hands close together); towel slides (flexion and scaption); pendulums (small); prone scapular retractions; scapular protraction on a swiss ball

  • For Infraspinatus: forward bow, towel slides (flexion and scaption), scapular protraction on a swiss ball, supine self assisted; prone scapular retraction, washcloth press up (hands close together), pendulums (small), supine bar assisted ER (supine or standing).

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