Shoulder complex soft tissue conditions - physio

Question 1

what type of exercises should be prescribed to patients in the later stage of the conservative management of an AC injury

Answer 1

ROM exercises - gentle active and passive
Strengthening: isometric, progress depending on grade and pain
Joint mobs for pain and stiffness at later stage

Question 2

physiotherapy for pain predominant freezing stage

Answer 2

Gentle assist active movement
Joint Mobilisations (Gr II for pain)
Acupuncture-low evidence (Ben-Arie et al, 2020)

Question 3

physiotherapy for stiffness predominant injury

Answer 3

ROM exercise 
Passive stretching 
Joint mobilisations  (Gr III for stiffness)
AP/PA/inf glides 
AP good to increase LR

Question 4

conservative management of shoulder dislocation

Answer 4

Sling and immobilisation 3-6 weeks
In sling: ROM elbow/scapular movement.
Advise re washing and dressing
Pain is usually not a feature once reduced
Progressive strengthening an ROM on r/o sling
Sports Specific rehab

Question 5

conservative treatment on removal of sling after dislocation

Answer 5

Assisted active ROM
Progress to Active ROM
Avoid external rotation initially…why?
Ensure normal scapulohumeral rhythm re-established
Focus on Rotator cuff, LHB, scapular stabilisers, Deltoid strength
Combination of open and closed kinetic chain exercise
Functional retraining e.g. Sports-specific
Proprioception training