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The Shoulder - Pre Module - Coggle Diagram
The Shoulder - Pre Module
Chronic injuries
Tendonopathy
Bursitis
Degenerative tears
Calcification
Adhesive Capsulitis
Traumatic injuries
AC Joint dislocation
Humeral fracture
Scapular fracture
Clavicle fracture
Glenohumeral Dislocation
Bankhart Lesion & Hill-Sachs
Tendon muscle rupture (traumatic)
Treatments
Surgical
Subacomial decompression
Arthroscopy
ORIF (Open Reduction Internal Fixation)
Shoulder replacement
Tendon repair
Many shoulder surgeries have significantly limiting early post op restrictions (6/52 NWB, no AROM, sling)
Post op Breast/ Mastectomy & XRT => shoulder range of motion limitations
Non-surgical
Exercise & functional rehab focusing on pt goals
TENS
Hydrocortisone Local Anaesthetic (HCLA)
Soft tissue massage
Education & patient expectations
Subjective Ax
Pain - location, severity, behaviour, pattern, onset, aggs & eases
Sensory changes & pattern/ distribution
Social Hx
Employment, hobbies, exercise, beliefs & patient goals, psychosocial influences
Past Medical & surgical Hx, medications, smoking Hx
Functional limitations
Mechanism of injury
Previous treatments
Previous shoulder injuries
Red flags - Neuromotor changes, recent trauma, systemic symptoms, weight loss, unrelenting pain
Objective Ax
General Posture
Scapula observation
Muscle bulk/ symmetry/ general observation of the area
Active & Passive range of motion (Neck, shoulder, elbow, wrist)
Muscle strength testing
Sensation testing (if applicable)
Special tests (poor specificity for many tests individually)
Upper Limb Neurodynamic testing
Antatomy
Glenoid labrum
Rotator cuff muscles & tendons
Biceps & assoc tendons
Key player in shoulder mechanics, can mask adhesive capsulitis
Acromion
Scapula
Humerus
Neural structures - brachial plexus+
Vascular structures
Bursa
Thoracic cage
MDT input - may require OT input for hand therapy depending on injury i.e. Cervical myelopathy => reduced arm & hand strength, humeral fracture => neuropraxia