ACJ location/ descriptors
ACJ- clicking pain instability
ACJ: Ax Clusters
- Step deformity + TOP
- Active H.Adduction
- Resisted shrug
ACJ Rx priorities
- Decrease pain - POLICE, PAMs
- Increase stability ACJ (acute)eg Taping, Bracing
- Promote healing- POLICE
- Promote dynamic stabilisation at the joint
- Increase coordination GHJ-Scap as required
- Increase ROM
- Progressive loading of upper limb and kinetic chain
Chronic type III AC dislocation causes scapular
dyskinesis in what % of pts
70.6%
SCJ: Ax Clusters
- Bony congruence?+ TOP
- Active Shrug/
protraction/retraction - Resisted shrug
SCJ Rx priorities
- Decrease pain- POLICE
- Increase stability SCJ (acute)- Bracing
- Promote healing- POLICE
- Promote dynamic stabilisation at the joint
- Increase ROM- gentle PAMs
- Strengthening (pecs, traps, scap stabilisers)
- Progressive loading of upper limb and kinetic chain
thoracic outlet syndrome (TOS) RF
- Demographics2. Co- morbidities- GHD, Autoimmune, Marfan’s
- Breadth of 1 st
- Diameter of tunnel
- Trauma history
- Functional/postural changes
- Dysfunctional breathing pattern (100% of pt have this)
- Chemotherapy treatment
TOS: Ax Clusters
- NV changes (neurovascular)
- NDT testing (neurodynamic)
- Breathing pattern review
TOS Rx priorities
- Decrease pain- POLICE
- Increase positional support- Bracing
- Improve neurodynamic tolerance
- Improve breathing patterns and correct techniques
- Shoulder girdle strengthening
- Progressive loading of upper limb and
kinetic chain - Encourage lifestyle changes and occupational modifications (ergonomics)
- Surgical review if no change with conservative Mx > 6 months or NV issues
Address Pain Issue options
o Advice and Education
o Manual therapy treatments
o Exercise
o Adjunct therapies- external physical device, taping, EPA
What do patients want and expect from MSK
treatment?
- Explanation of cause of pain
- Education
- Exercise
- Evaluation
How many and how often? should exercise be done
o Stage 1/2 individualise for patient needs- includes dosages
o Stage 2 and 3 – begin to work towards traditional dosages based on
aims (strength, power, speed etc)
- RCRSP (stage 3)Ax cluster
- Suspect full thickness tear
1. Age >65 years
2. + painful arc test
3. + drop arm test
4. + ER weak in neutral (infraspinatus)
5. Night pain
- RCRSP (stage 1+2)Ax cluster
- Age <45
- Cluster testing: + H-K test + painful arc + ER weak in Neutral (infraspinatus)
- IR weak (Gerbers, Bear hug, Belly press)
Pain + Weakness Rx priorities
- Decrease pain
- Increase cuff compression capacity
- Increase strength rotation
- Increase coordination GHJ-Scap
- Promote integration with kinetic chain
- Progressive loading of upper limb and kinetic chain
- Individualised exercise
- The exercise program should be a minimum of 12 weeks’ duration
Pain + Weakness// RCSP evedence
– Non-surgical Mx, with exercise as the champion, is equally as effective as Sx for RCRSP
– Manual therapy PLUS exercise is often NOT superior to exercise alone
– A corticosteroid injection would not be considered
– Ultrasound not effective
Upper and lower trapezius exercises
Shoulder shrugs
if patient can perform 10 reps x 3 sets(1 min rest)–with 3 kgs x 3 sets(1 min rest)–with 3 kgs
sufficient for functional strength
Frozen shoulder Ax cluster
- Age 45-60 years
- Female (3:1)
- Co-morbidities (diabetes/ thyroid)
- Increasing functional stiffness and pain
- Active = Passive ROM
- P.Acc’s Increased resistance and symptom
reproduction
OA Ax cluster
- Age > 65
- Previous occupation
- Co-morbiditiesdiabetes, physical inactivity
- Progressive reduction in range and functionslow
- 24/24 pain behaviour
- Pain relief with P.Acc’s (distraction)
Pain +Stiffness evidence
– Support for MWM’s and EROM mobilisations
pain and instability Ax clusters Anterior instability
- apprehension +reloc
- load and shift
pain and instability Ax clusters multi directional instability
- Sulcus
- +apprehension/ + reloc
- load and shift
pain and instability Ax clusters SLAP lesion
- apprehension/ + relocation
- O’Briens
- Biceps Load
- Speeds
Pain + Instability treatment priorities
- Increase stability-
- Increase scapular control
- Increase rotator strength
- Increase coordination GHJ-Scap
- Progressive loading of upper limb and kinetic chain
