Welcome to Scribd. Sign in or start your free trial to enjoy unlimited e-books, audiobooks & documents.Find out more
Standard view
Full view
of .
Look up keyword
Like this
0 of .
Results for:
No results containing your search query
P. 1
Physical Therapy Protocols for Conditions of Shoulder Region

Physical Therapy Protocols for Conditions of Shoulder Region

|Views: 93|Likes:
Published by Shruti

More info:

Published by: Shruti on Nov 23, 2010
Copyright:Attribution Non-commercial


Read on Scribd mobile: iPhone, iPad and Android.
download as PDF, TXT or read online from Scribd
See more
See less





Red Flags for Potential Serious Conditions in Patients with Neck and Shoulder Problems
Red Flags for the Neck and Shoulder Region
ConditionRed FlagData obtained duringInterview/HistoryRed FlagData obtained duringPhysical Exam
Cervical Fracturesor LigamentousInstabilities
Major trauma such as a motor vehicleaccident or a fall from a height withassociated immediate onset of neck painRheumatoid arthritis or Down’ssyndromeMidline cervical spine tendernessPositive ligamentous integrity tests:Sharp-Purser testAlar ligament integrity testApprehension with or inability to actively rotatehead < 45
Cervical CentralCord Lesion
Older ageHistory of a trauma (esp. MVA or fall)IncontinenceGait disturbances due to hyperreflexic lowerextremitiesUpper extremity (especially hand) sensory andmotor deficits, and atrophyPancoast tumor
Men over 50 with a history of cigarettesmoking.“Nagging” type pain in the shoulder andalong the vertebral border of thescapula – often progressing toburning pain down the arm into theulnar nerve distribution.
Wheezing with auscultation when tumor obstructsbronchusMay have Horner’s syndromePtosis (drooping eyelid)Constricted pupilSweating disturbances
 Septic Arthritis(A-C Joint)
Insidious onset of chest pain localized inthe S-C jointHistory of IV drug use, diabetes, trauma,infection (especially of centralvenous access)Tender S-C jointLimited shoulder movementSwelling over S-C jointFever
References:1. Aspinall W. Clinical testing for the craniovertebral hypermobility syndrome.
 J Orthop Sports Phys Ther.
1990;12:47-54.2. Panjabi M. (1992) in Swinkels R, Beeton K, Alltree J. Pathogenesis of upper cervical instability.
 Manual Therapy
. 1996;1:127-132.3. Hoffman JR. Mower WR. Wolfson AB. Todd KH. Zucker MI. Validity of a set of clinical criteria to rule out injury to thecervical spine in patients with blunt trauma. National Emergency X-Radiography Utilization Study Group.[erratum appearsin N Engl J Med 2001 Feb 8;344(6):464].
 N Engl J Med 
. 2003;343:94-99.4. Stiell IG, Clement CM, McKnight RD, Brison R, Schull MJ, Rowe BH, et al. The Canadian C-Spine Rule versus the NexusLow Risk Criteria in patients with trauma.
 N Engl J Med 
. 2003; 349:2510-2518.Niere KR, Torney SK. Clinicians”perception of minor cervical instability
. Manual Therapy
. 2004;9:144-150.Delfini R, Dorizzi A, Facchinetti G, et al.Delayed post-traumatic cervical instability.
Surg Neurol
. 1999; 51:588-95.7. Newey MI, Sen PK, Fraser RD. The long-term outcome after central cord syndrome: a study of the natural history.
 J Bone Joint Surg Br 
. 2000;82:851-855.8. Tow AM, Kong KH. Central cord syndrome: functional outcome after rehabilitation.
Spinal Cord 
. 1998; 36:156-160.9. Waters RL, Adkins RH, Sie IH, Yakura JS. Motor recovery following spinal cord injury associated with cervicalspondylosis: a collaborative study.
Spinal Cord 
. 1996;34:711-715.10. Spengler D, Kirsh M, Kaufer H. Orthopaedic aspects and early diagnosis of superior sulcus lung tumor.
 J Bone Joint Surg
.1973;55:1645-1650.11. Jett J. Superior sulcus tumors and Pancoast’s syndrome.
 Lung Cancer 
. 2000;42:S17-S21.12. Robinson D, Halperin N, Agar G, et al. Shoulder girdle neoplasms mimicking frozen shoulder syndrome.
 J Shoulder ElbowSurg
. 2003; 12:451-5.13. Ross JJ, Shamsuddin H. Sternoclavicular septic arthritis: review of 180 cases.
. 2004;83:139-148.
Joe Godges, DPT, MA, OCS KP So Cal Ortho PT Residency
 NAME: __________________________________________ DATE: _____________Medical Record #: _________________________Yes No
1. Have you recently experienced a blow to the head or a whiplash injury?2. Do you have rheumatoid arthritis?3. Are you currently taking steroids or have you been on prolongedsteroid therapy?4. Have you noticed any recent weakness, tingling, or numbness in youarms or legs?5. Have you noticed a
onset of difficulty with retaining your urine?6. Do you now smoke or have you been a smoker in the past?7. Do you administer medicine or drugs to yourself for which you need toinject using a needle?
Joe Godges, DPT, MA, OCS KP So Cal Ortho PT Residency
Shoulder Mobility Deficits
 ICD-9-CM codes
: 726.0 Adhesive capsulitis of the shoulder
 ICF codes
: Activities and Participation Domain codes:
Reaching (Using the hands and arms to extendoutwards and touch and grasp something, such as whenreaching across a table or desk for a book.)Body Structure code:
Joints of shoulder regionBody Functions code:
Mobility of a single joint
Common Historical Findings
Lateral shoulder pain - worsens with positions or activities which put stretch on theglenohumeral jointProgresses to stiffnessGradual, usually insidious, onset of symptoms
Common Impairment Findings
Related to the Reported Activity Limitation or Participation Restrictions:
 ROM limitations - external rotation and abduction are most limited, flexion and internalrotation are least limitedPain at end ranges--some motions are more painful than others (external rotation withabduction is typically the most painful)Limited glenohumeral accessory movements
Physical Examination Procedures
:Glenohumeral External Rotation ROM MeasurementPerformance Cues:Remember that glenohumeral ROM is different than shoulder ROM (shoulder ROM isthe sum of glenohumeral and scapular ROM)Stand in patient’s axillary regionStabilize scapula with forearmBe precise with stabilization of humeral abduction (to 90 degrees if possible) andhorizontal abduction (maintain 0 degrees)
Joe Godges, DPT, MA, OCS KP So Cal Ortho PT Residency

Activity (3)

You've already reviewed this. Edit your review.
1 hundred reads
bal13579 liked this
Onwaree Ing liked this

You're Reading a Free Preview

/*********** DO NOT ALTER ANYTHING BELOW THIS LINE ! ************/ var s_code=s.t();if(s_code)document.write(s_code)//-->