The Complex Shoulder: Anatomy and Physiology (19:41)
This program will explore rotator cuff tears, shoulder impingement syndrome, instability, SLAP lesions, thoracic outlet compression, and arthroplasty; a lab will conclude the program. Many shoulder injuries begin from a greater glenohumeral external rotation gained by playing sports during young adolescence. Michael Gross reviews the normal shoulder anatomy.
Assessment: Impingement (15:48)
Gross asks the participants to make lists of examination and intervention items for glenohumeral impingement, glenohumeral anterior instability, and thoracic outlet compression syndrome throughout the day. Apply heat and a stretching regiment if a client appears to have excessive anterior tipping. There is less subacromial space in people afflicted with poor posture.
Moment Arm (13:24)
Gross explains how the deltoid pushes the humeral head up, the amount of force required to lift an arm, and provides examples. Deltoids cause the most impingements and destroy the humeral head. Address all other issues first, and then reintroduce the muscle.
Rotator Cuff: Anatomy and Physiology (13:30)
Supraspinatus, infraspinatus, teres minor, subscapularis, and the deltoid cause humeral elevations. Rotator cuff tears cause impingement; obtain an MRI to assess. Gross describes treatment plans and strengthening techniques for the supraspinatus.
Rotator Cuff: Infraspinatus and Teres Minor (12:19)
If the patient suffers from anterior instability, strengthen rotator cuff muscles and avoid using the pectoralis major. Clients need to keep items low and light.
Physiologic Joint Motions (10:30)
Gross explains general principles to inform patients how to evade arthrokinematic danger. Teach patients to avoid horizontal adduction, external rotation, and extension because of the posterior or anterior glides that accompany the motion.
Biceps Tendon (06:48)
The humeral head can pinch the biceps and cause pain. A SLAP lesion occurs where the tendon attaches to the glenoid labrum. Gross describes the benefits and drawbacks of a tenotomy or a tenodesis.
Scapulothoracic Articulation (19:11)
If patients do not have at least 65 degrees of upward rotation in the scapula joint, they may have trouble achieving full humeral elevation, weakened rotator cuff muscles, and have a greater risk of impingement. Gross describes how he assesses and treats hypo-mobile scapulas.
Sternoclavicular and Acromioclavicular Joints (19:55)
The sternoclavicular joint is more active, while the acromioclavicular joint fine-tunes the position of the scapula. The arthrokinematics for horizontal adduction includes an anterior roll and glide. Gross discusses using Joint Active Systems and Dynasplints to stretch shoulders.
Rotator Cuff Tears: Restorative Poses (22:55)
Examine photographs of supraspinatus ruptures in shoulder injuries. Gross describes how smoking and diabetes affects tendons in later life. Tendons wrap around a pulley mechanism; Rathbun and McNab studied how no blood reached the vessels in positions of adduction.
Rotator Cuff Tears: Testing (09:52)
Scientists determined the efficacy of assessments by studying individuals who were already diagnosed with a tear through imaging. Gross describes the benefits and drawbacks of the painful arc, dropped arm, cluster, and the modified empty can test. Fatty Infiltrate can hinder rupture repairs.
Rotator Cuff Tears: Surgery (21:47)
Call the doctor's office and request surgical reports. Gross reviews the procedures for normal and altered anatomy. Glenohumeral arthropathy occurs when the joint is destroyed because of a rotator cuff insufficiency. The acromion changes to adapt.
Shoulder Impingement: Assessment and Treatment (16:24)
Genetics influences primary impingement; functional issues are considered secondary. Gross describes a recent study by Cacchio that used ultrasound-guided injections. Patients suffering from this affliction will test positive for the Hawkins-Kennedy, the painful arc, infraspinatus, and Neer's tests.
Anterior Glenohumeral Instability: Causation (23:20)
Gross describes the anatomic restraints and etiologic factors. Patients suffering from this affliction can have a Bankart lesion, fracture of the glenoid rim, or Hill-Sach's lesion. Protect the anterior band of the inferior glenohumeral ligament to prevent instability.
Anterior Glenohumeral Instability: Bracing (10:12)
Doctors put athletes into braces to prevent arthrokinematic danger, but it will not stop anterior instability. Gross describes why patients should be braced in an external rotation position. The Slingshot three allows you to bring clients into varying degrees of adduction and abduction.
Anterior Glenohumeral Instability: Non-Anatomic Procedures (11:21)
Gross describes Bristow, Laterjat, and Putti-Platt surgeries. By making the tissues across the joint tighter, the shoulder is stabilized. Extensors will have to contract more if tissues on the other side of the joint are tight.
Anterior Glenohumeral Instability: Special Tests (12:12)
Gross describes how to educate patients to avoid further injury. Other procedures include a capsular shift. Assessments to determine anterior instability include apprehension, Jobe Relocation, release, anterior drawer, and push-pull test.
SLAP Lesions: Classifications (10:09)
Gross describes how to assess a superior labral tear from anterior to posterior. These types of injuries can occur as a result of a dislocation, falling on an outstretched hand behind them, and repetitive overhand throwing.
SLAP Lesions: Assessment and Treatment (21:14)
Gross describes surgical strategies for the different types of SLAP lesions. Special tests include the biceps load II and the anterior slide test. Do not engage the biceps for the first eight weeks post-operatively.
Adhesive Capsulitis: Assessment (14:54)
Determining what stage the patient is afflicted with helps inform treatment plans. Gross suggests Codman's exercises and recommends patients receive cortisol injections during the inflammatory stage.
Adhesive Capsulitis: Treatment: Treatment (12:30)
Corticoid Steroids in stage one reduces inflammation. Gross describes anterior, posterior, inferior glenohumeral mobilizations and scapulothoracic mobilizations. Create "creep" like stretches for the patient.
Thoracic Outlet Compression Syndrome: Causation (29:59)
This is a rare disorder. Gross describes etiological factors. It can be caused by a Pancoast tumor, elevated first rib, cervical rib, portions of a neurovascular bundle goes through the apex of the scalene triangle or pierces muscle belly, scalene muscle trouble, clavicle issues, poor posture, and sustained positions of rotation. (Audio Out)
Lab: Shoulder Impingement Assessment (11:58)
Participants clear the tables and chairs away to begin their lab. Gross demonstrates the Hawkins-Kennedy, painful arc, infraspinatus, and Neer tests.
Lab: Rotator Cuff Tears and Thoracic Outlet Compression Assessment (18:04)
Gross demonstrates the supraspinatus empty can, Addison, Military Bracing, and hyper-abduction tests. Participants divide into groups and practice on each other.
Lab: SLAP Lesions and Adhesive Capsulitis (14:25)
Gross demonstrates the biceps load II, anterior slide test, and mobilization techniques for adhesive capsulitis. Participants divide into groups and practice on each other.
Lab: Instability (12:51)
Gross demonstrates anterior instability mobilizations, scapulothoracic articulation, and Jobe Relocation, apprehension, and anterior drawer tests. Participants divide into groups and practice on each other.
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