Shoulder Injury Continuing Education

Course Objectives

Upon successful completion of this course the participant will be able to:

• Discuss the theory behind the upside-down approach to an overhead athlete therapy exam.
• Utilize specific standardized testing tools to assess pain and disability.
• Perform a comprehensive subjective analysis with questions specifically relating to baseball players.
• Recognize postural abnormalities specific to a baseball player.
• Perform cervical tests to rule out cervical radiculopathy.
• Recognize hypermobility in the upper extremity and identify specific hypermobility which can lead to increased pain and injury in the overhead athlete.
• Perform special shoulder tests as it relates to the overhead athlete.
• Discuss the importance of specific ROM ranges needed in the shoulder and elbow for the overhead athlete.
• Discuss the total range of motion as it relates to external and internal rotation.
• Identify return to play criteria and the seven positions of replication testing.
• Discuss the evidence research regarding external to internal rotation ratios and the importance of positioning with training.
• Discuss the research and be competent with setting up the parameters and analysis results for the following tests: Closed Kinetic Chain Upper Extremity Test, Upper Quarter Y Balance Test, One Armed Seated Shot Put Test, Lower Quarter Y Balance Test.
• Perform functional performance index tests to determine the accuracy of the patient’s throw.
• Develop a program that analyzes sport specific training return to play protocols.
• Describe the progression for therapy to include manual therapy, soft tissue mobilization, stretching, strengthening, return to play activities. And throwing drills.
• Discuss the literature for soft tissue mobilization and its impact on long-term changes.
• Identify the major muscles involved with the performance of the overhead athlete and properly assess for tissue length, mobility and trigger points.
• Determine the appropriate shoulder rotation ratios and perform joint mobilizations to improve mobility.
• Describe scapular and rotator cuff progression and develop a comprehensive program to properly progress patient through a safe program.
• Describe the effectiveness of plyometrics and tits place in rehab progression.
• Describe the six phases of throwing mechanics and develop a program to safely incorporate throwing progression activities into a return to play rehab program.
• Describe the mechanics involved in the upper extremity and body with throwing motion.
• Explain the role of proper warm-ups and throwing drills for the success of the overhead athlete.

Learn from the Expert Eric Bellm, PT, DPT, OCS

Eric Bellm, PT, DPT, OCS is a physical therapist within the Orthopedic and Sports Division of Cincinnati Children’s Hospital Medical Center.

Eric is a graduate of the Doctor of Physical Therapy Program from Saint Louis University and a graduate from the Ohio State University’s Orthopedic Residency program. Dr. Bellm is a board-certified specialist in orthopedic physical therapy from the American Board of Physical Therapy Specialties. He specializes in the evaluation and treatment of overhead athletes, particularly baseball pitchers.

He is the lead therapist for the Thrower’s clinic at Cincinnati Children’s Hospital where he utilizes slow-motion video software to perform 2-D video throwing analyses for injured patients and uninjured clients seeking enhanced performance as a throwing athlete. He also serves as a mentor for the orthopedic and sports residency at Children’s. He has lectured locally and nationally, including the APTA Pediatric conference, on a variety of shoulder and elbow topics specific to the upper extremity athlete. He is currently working on research within the college and pediatric overhead athletes regarding different strength tests and their implications on a injury.

Two world class high school athletes as Case Studies

• Dr. Belm teaches using two actual high school athletes with throwing related injuries
  • About 2-2 1/2 years ago, Mitchell started to notice a lot of elbow pain. When he would throw, he noticed a lot of aching pains all throughout my elbow and swelling, but he never thought it was too bad. He went to baseball showcase and was going all-out pitching at the showcase, and the next day, even that night, his elbow swelled up and in a lot of pain.
  • Griffin had a shoulder injury playing football. He could not go through a night without waking up in shoulder pain. At football practice every day, he would be in pain and every movement was painful

Case Study Demonstrating Evaluation and Treatment Techniques

• Begining with the evaluation
• What is his strength?
• What is his range of motion?
• What do his shoulder mechanics look like?
• Are we missing an underlying ligamentous issue?
• Nerve length testing
• It is cool experience to always have, when this kid comes walking in and he’s like, “I can throw again.”

Evaluation of the Overhead Athlete

• Evaluation, Upside down triangle version.
• Looking at the whole person.
• Outcome measures, observations, screening test, specific test patient interview.
• Red flag questions, specific questions.
• How to “rule in” a diagnosis.
• Specific questions to ask baseball players.
• Quick DASH, SPADI Pain Score, KJOC
• Posture and arm motion
• Movement assessment
• Rule out fractures
• Clear the cervical region.
• Clinical prediction rule for cervical disc
• Spurling’s Test
• Cervical distraction
• Upper Limb Tension Test

Evaluation of the Overhead Athlete: Baseball Specific

• Baseball specific tests. Hypermobility scale
• Baseball specific range of motion testing
• Retroversion
• Retrotorsion
• How to perform a manual test that best mimics an ultrasound test
• Total range of motion, what is pathological and what is normal?
• Special tests:
  • Active compression Rotation Test
  • Apprehension Test
  • Speeds Test
  • Relocation Test
  • Crank Test, BIcep Load II Test, Resisted External Rotation Test

Treatment: Scapular Progression

• Scapular progression for the lower trapezius
  • Moving into a W position
  • Rhomboids, mid trap
  • Getting athletes into the overhead throwing spot
  • Sports-specific tasks
• Progressing toward plyometric
• Starting with isometrics

Throwing Mechanics

• The Dynamic Warmup
• True Slow motion Analysis of the Pitch
• The six phases of the throwing motion
• It is not just the arm, elbow,and shoulder

Treatment: Rotator Cuff Progression

• Rotator cuff progression beyond isometrics
• Progression beyond Isotonic, baseball specific training
• Advanced strengthening phase of the rotator cuff

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.