Management of non-traumatic shoulder pain Flashcards
RC and scapula: Scapula dyskinesis
Scapula asymmetry is normal and not a pre-cursor for pain.
However an injured shoulder / painful shoulder / fatigued cuff / stiff shoulder can alter scapula movement in order
to assist upper limb function – however does not mean you need to treat this independently.
Scapula dyskinesis can also be affected by anxiety and avoidance behaviour – deliberately use different muscles to
create functional movement.
Therefore address fears and beliefs rather than trying to treat the dyskinesis
Scapula assistance test
Immediate improvement of pain and movement in the scapula assistance test (facilitate movement in to upward rotation
and protraction) suggests an 80 – 85% chance of responding to rehab (Coombs, 2018).
However, that doesn’t mean treat the scapula independently!
The scapula assistance test offloads the rotator cuff and makes it easier for the shoulder to do its job. It helps to restore
normal movement.
RC assessment
Subjective history forms 60-70% if informatuon we need in non-traumatic shoulder pain
age of patient and mechanism of injury are the key indicators to prognosis
What are patients functional ability/limitations?
what are movement restrictions? What is current ROM? What is strength like?
RC assessment- improvement test
Scapula assistance test- fix clavicle with one hand and facilitate Scapula movement with other hand (reduced pain= RC weakness)
reduce load- short level or support limb
add kinetic chain
RC assessment- Isolated cuff assessment
Prone cuff assessment= posterior cuff
- passive GHJ ROM
- Active GHJ ROM
- Supported active GHJ ROM
- Active GHJ ROM+ load
common compensations- wrist extension, elbow depression, scapula elevation
RC assessment- Improvement test exercises
aim to enhance sensorimotor input, fascilitate local recruitment and increase drive of motor cortex functional patterns
e.g. resisted ER with theraband into shoulder flex
reduce load- shoulder against wall
Treatment
Use BESS exercises as treatment for subacromial shoulder pain
RC treatment: early rehab
stand facing smooth wall holding a towel, thumbs facing you. Place resistance on the towel and slide it upwards
8 repetitions of 3 sets
Variations: perform a step forward towards the wall to recruit the kinetic chain, perform the exercise without the support of the wall, use a small weight
RC treatment- early rehab in posterior cuff
the posterior cuff is most exposed through ER at 90:90- seated with towels on table and rest arm on it
Motor learning: 5 mins per day: 20-70 reps 2x per day
don’t work through fatigue
progress to 20 reps of ER with 3 sets, then add resistance
RC treatment- early rehab push up
wall push up, 8X3
move further away from wall to increase load, perform the movement on a table or bench
RC treatment- other considerations
acute- 12 weeks- 6 months, chronic= >6 months
history of shoulder pain increases recovery time
bio-psychological factors
