Shoulder Treatment Lab: Pt 1

Question 1

Manual therapy options for the shoulder

Answer 1

Passive accessory movements (PAM)
Passive physiological movements (PPM)
Mobilization of the scapulothoracic joint
Soft tissue mobilization
Muscle length interventions
Regional interdependence

Question 2

What joints are treated by passive accessory movements discussed in class?

Answer 2

Glenohumeral, AC, and SC joints

Question 3

When selecting accessory techniques for GHJ intervention, what should help guide your initial decision making?

Answer 3

The concave-convex rule

Question 4

Why should one be careful when applying the concave-convex rule when treating GHJ intervention

Answer 4

The selection of techniques may not follow the concave-convex rule.
(i.e. posterior glides have been shown to improve shoulder external rotation)

Question 5

Where does the treatment plane lie?

Answer 5

Over the concave articular surface

Question 6

Where does the treatment plane move?

Answer 6

In the same direction as the convex partner

Question 7

How does the treatment plane behave when the joint partner moves?

Answer 7

It remains stationary

Question 8

What are grades 1 and 2 used to treat?

Answer 8

Pain prior to reaching resistance

Question 9

What are grades 3 and 4 used to treat?

Answer 9

Resistance/joint restrictions when pain is not a limitation

Question 10

Objective of GH caudal glides in full flexion mobs

Answer 10

Mobilize inferior and posterior capsule to increase shoulder flexion

Question 11

Objective of GH caudal glides in abduction

Answer 11

Mobilize inferior capsule to increase shoulder abduction

Question 12

Objective of PA mobilization in abduction

Answer 12

Mobilizing anterior capsule. May be useful for patients with significant ER, extension, and horizontal abduction restrictions

Question 13

What are the precautions for PA mobilization in abduction?

Answer 13

Caution should be applied to patients with a history of GH instability, such as subluxation/dislocation

Question 14

Objective of AP mobilization in abduction?

Answer 14

Mobilize the posterior capsule to address flexion, internal rotation, and external rotation deficits

Question 15

Objective of mobilization progression in prone (FABER progression)

Answer 15

To progress through mob techniques in a stiffness dominant shoulder (e.g. stiffness > pain)

Question 16

Objective of AC joint PAMs

Answer 16

Improve overall movement of the clavicle

Question 17

Objective of SC joint PAMs

Answer 17

Improve overall movement of the clavicle, though less commonly used as the SC joint is generally hypomobile

Question 18

In regards to glenohumeral PPM’s, the test…

Answer 18

becomes the treatment

Question 19

Glenohumeral PPM’s areas of focus

Answer 19

Consider quality of movement and R1 and R2 and relationship to symptoms

Use grades of mobilization (e.g. grades 1-4)

Question 20

Intention of Low load prolonged stretch (LLPS)

Answer 20

Intended to apply gradual strain on fibrotic capsular and soft tissue structures

Question 21

When should LLPS be used?

Answer 21

Non-irritable, non-sever patients (i.e. stage 4 frozen shoulder)

Question 22

Parameters for LLPS

Answer 22

5-10 minute holds, multiple times per day (protocols vary in nature)

Question 23

Scapulothoracic mobilization options

Answer 23

Clocks
Distraction
Thrust technique

Question 24

2 examples of scapulothoracic self mobs

Answer 24

Sweeps

Bow and arrow

Question 25

Soft tissue restrictions intervention is also known as

Answer 25

Soft tissue mobilization

Question 26

Commonly addressed muscles for STM

Answer 26

Pec minor and major
Lats
Supraspinatus, Teres minor and infraspinatus
Subscapularis
Long head of the biceps

Question 27

What does posterior shoulder tightness (PST) result in?

Answer 27

Internal rotation loss and superior migration of the humeral head during elevation

Question 28

What can posterior shoulder tightness be due to?

Answer 28

May be due to limitations of the posterior capsule or muscles groups

Question 29

Manual treatment options for PST

Answer 29

PAM (caudal and posterior glides)
PPM IR
STM to posterior cuff
Manual stretching of the posterior capsule

Question 30

What is STM?

Answer 30

Cross, or deep, friction massage

Question 31

Intention of STM

Answer 31

Intended to promote collagen healing