Repeated Motion Testing Techniques for the Shoulder ANDY KRENTZ, ATC, CERT. MDT DAVID GALLEGOS, ATC, CERT. MDT

Transcription

1 Repeated Motion Testing Techniques for the Shoulder ANDY KRENTZ, ATC, CERT. MDT DAVID GALLEGOS, ATC, CERT. MDT

2 Goals Discuss connections in pathology and symptoms Introduce an alternative evaluation and diagnosis system Demonstrate evaluation / treatment techniques Practice in small groups repeated motions and affect on baselines

3 Shoulder Epidemiology Approx % in General Population 4 Million office visits per year for shoulder pain 1.5 Million surgeries per year Diagnostic Tests are inconsistent at best MRI is 88% effective at best Does shoulder pathology relate to symptoms? Must the shoulder have pathology in order to produce S/S

4 Connecting Signs & Symptoms with Diagnosis Left shoulder Pain with movements above 90 degrees Loss of strength Sense of Instability Decreased ROM What injury do you suspect? What information would you need to better diagnose? Would this diagnosis help set your treatment plan?

5 Mechanical Diagnosis through repeated Motion Testing Classification System that drives treatment plan. 3 Types Articular Dysfunction Intermittent pain consistently produced at a restricted end-range with no rapid change of symptoms or range Examples? Contractile Dysfunction Intermittent pain consistently produced by loading the musculotendonous unit, for instance with an isometric contraction against resistance Examples?

6 Mechanical Diagnosis through repeated Motion Testing Derangement Lasting abolition or decrease of symptoms, and/or an increase in restricted range of movement in response to repeated movements Examples of pathology that can act this way? Other refers to failure to classify as one of the above mechanical syndromes, recent trauma, post-surgery or chronic pain state. Examples?

7 Repeated Movements to Diagnose: Video Example Video of Shoulder Assessment ACw5M

8 Live Demonstration & Practice Establish Baselines MMT Special Tests, etc. Rule Out Cervical Spine Assess Affect of Repeated Movements on Upper Extremity Active Movement / at end-range Resisted Movement Patterns of Derangement (Handout)

9 QUESTIONS THANK YOU

10 Bibliography Dessaur WA, Magarey ME (2008). Diagnositic accuracy of clinical tests for superior labral anterior posterior lesions: a systematic review. JOSPT Hegedus EJ, Goode A, Campbell et al (2008). Physical examination tests of the shoulder: a systematic review with meta-analysis of individual tests. Br J Sports Med Hughes PC, Taylor NF, Green RA (2008). Most clinical tests cannot accurately diagnose rotator cuff pathology; a systematic review. Aus J Physio May S (2008). Shoulder pain an epidemiological review. Int J Mech Diagnosis Ther Picavet HSJ, Schouten JSAG (2003). Musculoskeletal pain in the Netherlands; prevalences, consequences and risk groups, the DMC3-study. Pain Schellingerhout JM, Verhagen AP, Thomas S, Koes BW (2008). Lack of uniformity in diagnostic labelling of shoulder pain. Time for a different approach. Manual Therapy Urwin M, Symmons D, Allison T, Brammah T, Busby H, Roxby M, Simmons A, Williams G (1998). Estimating the burden of musculoskeletal disorders in the community: the comparative prevalence of symptoms at different anatomical sites, and the relation to socal deprivation. Ann Rheum Dis Kelly E, May S, Ross J (2008). The reliability of the McKenzie classification system using extremity McKenzie assessment forms, Int J Mech Diag Ther May S (2006). Classification by McKenzie s mechanical syndromes; Report on directional preference and extremity patients. Int J Mech Diag Ther

11 Bibliograpsy Cont. May S, Ross J (2009). The McKenzie classification system in the extremities - a reliability study using McKenzie assessment forms and experienced clinicians. J Manip Physiolog Thera Aina A, May S: Case report A shoulder derangement. Manual Therpay 2005 Littlewood C, May S (2007). Case study. A contractile dysfunction of the shoulder. Manual Therapy Kaneko S, Takasaki H, May. Application of Mechanical Diagnosis and Therapy to a patient diagnosed with de Quervian s disease; a case study, J Hand Ther Mechanical Diagnosi & Therapy: Advanced Cervical & Thoracic Spine and extremities(upper Liimb) McKenzie R, (2006). Treat Your Own Neck. McKenzie R, May S, (2009). The Human Extremities Mechanical Diagnosis & Therapy.