Shoulder Triage

Speeds TestBicipital Tendonitis

Drop Arm TestSupraspinatus Involvement

Empty/Full Can TestSupraspinatus Involvement

External Rotation Lag Sign (ERLS)Infraspinatus Involvement

Lift Off TestSubscapularis Involvement

Adhesive CapsulitisA pathologic continuum initiated by synovial inflammation with resultant capsular fibrosisIts Inflammatory & FibrosingAdhesive CapsulitisPatient Profile:Females > Males> 40 years of ageCorrelated with DM Associated with Thyroid and Autoimmune DiseasesAssociated with CVA and MIHistory of prolonged immobilizationAdhesive Capsulitis4 Stages Include: (1 3 years)1 - First 3 months, pain limits rom2 - The freezing Phase, months 3 - 93 - The frozen Phase, months 9 -144 - The Thawing Phase, after month 14TypesPrimary idiopathicSecondary Acquired from a known causeAdhesive Capsulitis TreatmentMedication for pain Positioning for comfortEducation about the disease processGentle rom exercise in the early stages within established pain parameters Reassure , Reassure & ReassureConsiderations For ReferralTraumatic vs. InsidiousAcute vs. ChronicPatients Age & Activity LevelAcromion TypeStructural DeformitySeverity of LimitationsPatients Overall HealthCompliance History (In LCR)

Physical TherapyConsiderationsWhat is the movement system diagnosis (independent of the pathophysiologic diagnosis)?Are there movement abnormalities that are correctable?What corrective exercise/postural re-education would benefit this patient?Compensatory strategies?Is this patient compliant?BibiliographyDavies, George J., Wilk, Kevin, Ellenbecker, Todd, Et Al., Current Concepts of Orthopaedic Physical Therapy, 2nd Edition, The Shoulder: Physical Therapy Patient Management Utilizing Current Evidence. APTA, Orthopaedic Section, 2006.Magee, David J., Orthopedic Physical Assessment, Fourth Edition. Philadelphia, Saunders, 2002.Neumann, Donald A., Kinesiology of the Musculoskeletal System, Foundations for Physical Rehabilitation. St. Louis, Mosby, 2002.Sahrmann S. Diagnosis and Treatment of Movement Impairment Syndromes. St. Louis, Mosby, 2002.