Shoulder Dysfunction - Biodex

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REHABILITATION PROGRAM CONSIDERATIONS The objective of rehabilitation for the conservative management of shoulder dysfunction, is to quickly and efficiently return the patient to the highest level of pre-injury activity, as is reasonably possible, with minimized risk of increased signs and symptoms, related complications, or predisposing the patient to re-injury. This program can be used as a preventative measure or as an injury treatment program. Prior to the rehabilitation of the patient with shoulder dysfunction, there are five common factors of functional assessment. It is imperative that the clinician understands the patient's goals and physiologic make-up prior to beginning the rehabilitation process. The five factors referred to in the literature are: 1. Severity of injury 2. Tissue damage and involvement 3. Tissue status of patient 4. Neuromuscular control Efficiency of force couples 5. Desired activity level Overhead activities Below shoulder activities DEFINITIONS: Goals: Specific improvements which must be met in order for patient to progress to next phase. Clinical Evaluation: Evaluations that are only to be performed by certified and/or licensed PT, OT or ATC, in association with supervising physician’s diagnosis. Clinical Treatment Options: Treatment options that should only be performed under the supervision of certified and/or licensed clinicians. Supervised Program: Rehabilitation program that should be done only under the direction of appropriately qualified personnel (e.g. Certified Strength and Conditioning Specialist). Home Program: Rehabilitation program that after proper instruction by supervising clinician, can be done by patient without supervision. Reports: Test reports are to be completed at the end of each phase to ensure progress to the next phase is indicated. 1-2 INTRODUCTION
GOALS: • Mentally prepare patient for rehabilitation PHASE I • Education of patient to understand the problems of shoulder dysfunction • Identify specific needs of the patient and potential problems • Decrease pain and inflammation • Maintain wrist and elbow Range of Motion (ROM) and strength • Develop voluntary and involuntary control of shoulder stabilizers • Correct biomechanical faults • Identify contributory factors • Increase shoulder strength and prevent disuse atrophy • Regain full pain free Passive Range of Motion (PROM) of involved shoulder in all directions • Proprioception: ER < 40% deficit bilaterally • Isometric strength: < 50% deficit bilaterally for all directions CLINICAL EVALUATION: • General patient history and observation: To assist in the rehabilitation process, the clinician/physician should complete a thorough subjective evaluation of mechanism of injury. This will allow the clinician to design strategies to correct the pathology through operative and/or non-operative means. 4 Muscle atrophy Scapular winging (scapular slide test) 10 • Visual Pain scale: 15 Location, quality, duration, and intensity • Edema: degree and character of swelling • Musculoskeletal evaluation 12 • Range of Motion (ROM): Involved extremity (PROM) Uninvolved extremity (AROM / PROM) • Special Tests: <strong>Shoulder</strong> instability tests 22 Apprehension: Apply’s scratch, anterior / posterior drawer, relocation test, etc. <strong>Shoulder</strong> impingement tests: Empty can, Hawkins, Neer, Speeds, etc. Glenoid labral tests: Clunk, O'Brien, Anterior slide tests 3 reduction of acute symptoms © BIODEX MEDICAL SYSTEMS, INC. 1-3
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Shoulder Dysfunction - Biodex

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