Week 2: Primary care management of shoulder conditions

Question 1

What are the 5 management options?

Answer 1

• education and advice
• acute management
• exercise
• EPA’s
• Manual therapies

Question 2

What does conservative Rx of clavicle fracture involve?

Answer 2

• advice about analgesics
• self-assisted ROM (<90deg. elevation) to prevent stiffness
• braces/slings

Question 3

What are some conservative Rx’s for NOH fractures?

Answer 3

• strengthening exercises as able
• maintenance of ROM in associated jj.
• EPA’s and manual therapy as needed

Question 4

What is the Rx for impingement caused by narrowing of subacromial space?

Answer 4

• restore scapula control (strength and endurance)
• increase ROM in restricted mm.
• address T/sp, C/sp, rib restrictions
• sometimes may req. surgery

Question 5

What is Rx for RC tendinopathy?

Answer 5

• pain management initially
• education re. abusive loading
• gradual reloading of tendon
• increase strength and endurance

Question 6

What is Rx for RC tear?

Answer 6

• Small tear: acute care management followed by RC rehab

* Full tear: surgery

Question 7

What does the acute phase of RC rehab involve?

Answer 7

• promote tissue healing
• reduce pain
• re-establish non-painful ROM below 90deg. abduction
• prevent m. atrophy
• address scapula control
  address kinetic chain as needed

Question 8

What does the recovery phase of RC tear rehab involve?

Answer 8

• Achieve norm AROM and PROM
• Progress scapula control
• restore strength and agonist/antagonist balance
• progress exercises

Question 9

What does the functional phase of RC tear rehab involve?

Answer 9

• restore/develop power and endurance

* integrate sport-specific activity

Question 10

What does conservative Rx for SLAP, non-SLAP, degenerative labral tears involve?

Answer 10

• gradual progression program of ROM
• RC strength
• scapula coordination exercises
• • careful w/biceps activity

Question 11

What does conservative management of joint instability involve?

Answer 11

• strengthening of dynamic stabilisers (RC + scapulothoracic mm.)
• closed-chain before open-chain

Question 12

What does Rx for adhesive capsulitis involve?

Answer 12

• corticosteroid injection for short-term symptomatic relief
• graded mobilisation and stretching & strengthening exercises assist recovery process when pain is controlled

Question 13

What is the Rx for AC j. injury?

Answer 13

• initial ice and protection in sling

* strengthening and ROM exercises as pain allows