Shoulder Continuing Education

Highlights of this Online Continuing Education Course

Course Objectives

Upon completion of this course, participants will be able to:

• Describe the different classification systems and schemes as an approach instead of a tissue specific approach to shoulder dysfunction.
• Explain the etiology of adhesive capsulitis, shoulder impingement, glenohumeral joint instability, and rotator cuff tears.
• Identify how to solve complex shoulder problems through greater appreciation of the intimate relationship between the thoracic spine and shoulder complex.
• Develop evaluation skills to be able to group different shoulder issues into subacromial pain syndrome, instability, adhesive capsulitis, AC joint problems post-op conditions and rotator cuff tears
• Perform clinical tests to identify the presence or absence of acromioclavicular joint pain, glenohumeral impingement, glenohumeral instability, glenoid labral injury, or rotator cuff tears.
• Perform a differential diagnosis examination to formulate a comprehensive rehab program.
• Perform manual therapy techniques for the thoracic spine to treat shoulder pain.
• Perform mobilization techniques for the scapula and glenohumeral joint to improve shoulder function.
• Formulate therapeutic exercise programs for patients with shoulder disorders using evidence on muscle activation during different exercises.

Learn from the Expert - Chris Durall, PT, DPT, SCS, LAT, CSCS

Dr. Chris Durall PT, DPT, SCS, LAT, CSCS is the Director of the Student Health Center Physical Therapy Department and a graduate faculty member at the University of Wisconsin-LaCrosse. A practicing outpatient orthopedic/sports clinician since 1993, Dr. Durall earned Baccalaureate and Advanced Masters degrees in Physical Therapy from UW-LaCrosse, and a Doctorate in physical therapy from Creighton University. He is a graduate of the yearlong Gundersen-Lutheran Sports Physical Therapy Residency program, a board-certified sports physical therapist, a licensed athletic trainer, and a Certified Strength and Conditioning Specialist since 1997. Dr. Durall has authored and co-authored numerous textbook chapters and published research and review articles in PT Magazine, Physiotherapy, the Journal of Manual and Manipulative Therapy, the Journal of Back and Musculoskeletal Rehabilitation, Isokinetics and Exercise Science, the Journal of Sport Rehabilitation, the Strength and Conditioning Journal, Critical Reviews in Physical Medicine and Rehabilitation, and the Journal of Athletic Training.

Philosophy of the Course

• Overview of what you should expect from this course
• Evidence in the form of literature-based research and clinical experience and judgement
• Critical thinking, how to determine if the literature is relevant
• Critical thinking -how to determine when to utilize specific tests
• Special tests: sensitive or specific tests
• Statistical tests to determine if a person has a specific condition
• Impairment and symptom classifications

Clear the Cervical Spine

• Logical format to examination
• Clear the cervical spine as a source of shoulder symptoms
• Cervical facet and disc referral pain pattern

Thoracic Spine

• Assess function of the thoracic spine
• Thoracic curvature and the effect on scapular position
• Scapular tipping
• Thoracic spine posture and mobility influence on scapular kinematics

Adhesive Capsulitis: Discussion

• Definition of adhesive capsulitis
• Adhesive capsulitis predictable stages
• Common findings
• How to categorize adhesive capsulitis
• Treatment suggestions
• Manual therapy
• Self management

Adhesive Capsulitis Examination and Treatment

• The systematic examination
• What is normal motion
• Pathology
• What are typical motion loss patterns
• Expected motion patterns from specific loss in different directions
• Mobilization techniques for glenohumeral joint
• Duration and intensity of mobilizations for optimal benefits
• Mobilization of the scapularis and the rotator interval
• Dynamic mobilization techniques
• Manual stretch techniques for inferior capsule
• Inferior humeral head glide
• How to determine the appropriate technique?
• Exercises to increase motion
• Summary of the examination and treatment options and estimated time frame for progression

AC Joint Pathologies

• Normal function
• Pathology
• Common injuries
• Common symptoms and complaints
• AC Joint sprains: pathology and clinical presentation
• AC joint DJD
• Distal clavicle osteolysis
• AC joint palpation
• Special tests to rule out AC joint pathology: sensitive or specific
• Accuracy of tests
• Manual therapy techniques-variety of techniques presented
• Taping techniques
• Exercises

Rotator Cuff Tears

• Classification of tears
• Common presentation of symptoms with specific tears
• Most common type of tear
• Testing the supraspinatus tendon
• Testing the infraspinatus and teres minor
• Testing the subscapularis
• Sensitivity and specificity
• Non operative care vs. operative
• Rehab considerations
• Conservative
• Moderately accelerated
• Accelerated
• Rotator cuff repair
• What if they have a shoulder immobilizer?
• Progression of exercises

Shoulder Instability

• Does instability = laxity?
• The role of the nervous system and laxity
• Goal of instability tests
• Type of tests and systematic sequence
• Apprehension test accuracy
• Relocation test accuracy
• Release test accuracy
• Jerk test accuracy
• Shoulder laxity/humeral head translation tests
• Instability tests
• Anterior laxity tests
• Test for the superior glenohumeral ligament
• Sulcus test -grading system
• Review of the tests and summary of how to develop a plan

Labral Tears

• How to diagnose
• Determine the location of the tear
• Common findings
• Types of tears and classification
• Clinical tests for tears-sensitivity and specificity
• Crank test
• Superior labrum tests-sensitivity, specificity and accuracy
• Active Compression (aka O?Brien’s Test)
• Anterior Slide
• Biceps Load I
• Biceps Load II
• Biceps Tension
• Additional tests also listed
• Exercises
• Improve stability and strength
• Improve scapular positioners
• Maximize neuromuscular control
• Improve proprioception
• oncavity compression retraining

Subacromial Pain

• Most common source of subacromial pain
• Shoulder impingement syndrome
• Intrinsic factors
• Extrinsic factors
• Thoracic mobility assessment techniques
• Assess thoracic rotation mobility relative to the shoulder
• Assess pectoralis minor
• Assess scapular function
• Static and dynamic tests
• Sensitivity, specificity
• Scapular muscle assistance test
• Classic impingement tests- How to perform, specificity and sensitivity
• Posterior shoulder tightness
• Sternoclavicular joint testing
• AC joint assessment
• Middle and lower trapezius testing

Manual Therapy

• Thoracic spine rotation mobilization
• Pectoralis minor stretch -specific
• Scapular mobilizations
• Thoracic extension mobilizations prone and sitting
• Glenohumeral joint mobilizations
• Demonstration
• Research to support treatment and expected outcomes

Exercises

• Exercises to elicit high levels of activation in targeted muscles
• Middle trap
• Lower Trap
• Manual therapy combined with exercise for mid trap
• Infraspinatus and teres Minor
• Resisted exercises-benefits
• Empty can-research validity
• Serratus anterior
• Exercises for higher level clients
• Progression of exercises

Course Test - Evaluate your knowledge

• Use the Healthclick proprietary online education system which provides the online student with:
• Worldwide access to high definition video, anatomical animations and images, and written information
• The highest quality film in the industry, you can see the difference!
• Stop and resume within a course, the Healthclick system will optimize your course based on your device, connection and remembers where you left off.
• Real-time course updates. We are always adding to each courses, updating content, adding animations, these are not static courses!
• Evaluate your knowledge with the course test on any device.
• Print your state course certificate for CE credit.
• Take the online test as many times as need in order to achieve a 70 % or greater score.