2015 OPSC Annual Convention. syllabus. February 4-8, 2015 Hyatt Regency Mission Bay San Diego, California
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1 2015 OPSC Annual Convention syllabus February 4-8, 2015 Hyatt Regency Mission Bay San Diego, California
2 THURSDAY, FEBRUARY 5, 2015: 3:30pm - 4:30pm The Shoulder: 2 View or Not 2 View * Presented by Alexandra Myers, DO * California Pain / End-of-Life Care
3 PRESENTATION Learning Objectives and Self ASSESSMENT questions LEARNING OBJECTIVES 1. Feel confident in the evaluation shoulder pain from an osteopathic perspective 2. Determine which x-ray views to order when evaluating the shoulder 3. Develop a treatment plan which includes osteopathic manipulative treatment SELF ASSESSMENT QUESTIONS 1. Which of the following is not considered a rotator cuff muscle? a. Supraspinatus b. Subscapularis c. Infraspinatus d. Teres minor e. Deltoid 2. Damage to which nerve root would likely present as weakness of the biceps muscle? a. Trapezius b. Infraspinatus c. Teres minor d. Biceps e. Triceps 3. An 80 year-old patient complains of 5 years of left shoulder pain that has progressively worsened. No history of trauma to the shoulder, and the patient is otherwise healthy. Upon examination the patient s active and passive range of motion is severely limited in flexion and abduction. What is the best first image to order of the patient s shoulder? a. CT scan b. MRI c. Ultrasound d. Bone scan e. X-ray 4. A 30 year-old patient who plays baseball complains of instability of his shoulder. He has dislocated 5 times in the past 10 years and has pain when he throws. What is the best first step in the management of this patient? a. Referral to orthopedics b. Xray of the shoulder c. Thorough history and physical exam d. MRI of the shoulder e. Sub-acromial injection 5. Which of the following is not an indication to obtain imaging of the shoulder? a. Recent trauma b. Pain out of proportion to exam findings c. Severely restricted range of motion d. Tenderness over the biceps groove e. Pain that hasn t improved with conservative care 6. Which osteopathic manipulative technique is most helpful for glenohumeral arthritis? a. Scapular myofascial release b. Counterstrain of the teres minor c. Spencer technique d. HVLA to the thoracic spine e. Rib 1-4 muscle energy 7. Which of the following shoulder conditions would most benefit from physical therapy? a. Biceps tendonitis b. Rotator cuff tear c. Glenohumeral arthritis d. Fracture of the humeral head OPSC s 54th Annual Convention and Exposition Syllabus 295
4 THE SHOULDER: 2 VIEW OR NOT 2 VIEW Alexandra Myers Thursday, February 5, 2014 Osteopathic Physicians and Surgeons of California OPSC s 54th Annual Convention and Exposition Syllabus 296
5 OVERVIEW Discuss a basic musculoskeletal and osteopathic structural exam of the shoulder Review common causes of shoulder pain Review imaging modalities that may be useful in determining the etiology of shoulder pain Discuss treatment modalities that may be utilized for the treatment of shoulder pain OPSC s 54th Annual Convention and Exposition Syllabus 297
6 OBJECTIVES At the end of the lecture, each participant will be able to: Feel confident in the evaluation shoulder pain from an osteopathic perspective Determine which x-ray views to order when evaluating the shoulder Develop a treatment plan which includes osteopathic manipulative treatment OPSC s 54th Annual Convention and Exposition Syllabus 298
7 SHOULDER ANATOMY OPSC s 54th Annual Convention and Exposition Syllabus 299
8 SHOULDER EXAM Inspection Symmetry Atrophy Evidence of previous injury/surgery Palpation Overlying musculature AC joint Muscle origin/insertion OPSC s 54th Annual Convention and Exposition Syllabus 300
9 SHOULDER EXAM Range of Motion Active and passive Compare from side to side Strength Check bilaterally Check in different planes! OPSC s 54th Annual Convention and Exposition Syllabus 301
10 SHOULDER EXAM Special Testing Neer s Hawkin s Speed s Apprehension Subscapular lift off Empty Can OPSC s 54th Annual Convention and Exposition Syllabus 302
11 SPECIAL TESTING Neer s Tests for subacromial impingement Positive if it is painful Neer to the ear OPSC s 54th Annual Convention and Exposition Syllabus 303
12 SPECIAL TESTING Hawkin s Tests for rotator cuff pathology Positive if it is painful OPSC s 54th Annual Convention and Exposition Syllabus 304
13 SPECIAL TESTING Speed s Tests for biceps tendon pathology Positive if it there is pain OPSC s 54th Annual Convention and Exposition Syllabus 305
14 SPECIAL TESTING Empty Can Tests for supraspinatus tendon pathology Positive if it there is pain or weakness OPSC s 54th Annual Convention and Exposition Syllabus 306
15 SPECIAL TESTING Apprehension Positive if there is apprehension when externally rotation the shoulder May also do relocation test at the same time Tests for glenohumeral joint stability OPSC s 54th Annual Convention and Exposition Syllabus 307
16 SPECIAL TESTING Subscapular Lift Off/Gerber s Positive if painful or weak Tests for subscapularis injury Also an easy way to check internal rotation in the abducted plane OPSC s 54th Annual Convention and Exposition Syllabus 308
17 SCAPULAR MOTION Monitor scapular motion from posterior view while the patient abducts and flexes the arm OPSC s 54th Annual Convention and Exposition Syllabus 309
18 OSTEOPATHIC STRUCTURAL EXAM Cervical and Thoracic Spine Lordosis/Kyphosis TART changes Perform AROM/PROM if above are abnormal Regional/Segmental diagnosis if planning a treatment Scapula Palpate the musculature around the scapula Compare landmarks on each side Inferlateral angle, acromion Glenohumeral Joint Palpate the joint motion while doing PROM OPSC s 54th Annual Convention and Exposition Syllabus 310
19 IMAGING Types of imaging Xray Most commonly available and useful for many cases Ultrasound Operator dependent, useful for many cases MRI Useful for soft tissue abnormalities, high cost CT Costly, useful only in specific cases OPSC s 54th Annual Convention and Exposition Syllabus 311
20 IMAGING When to xray Trauma Fracture, dislocation Severely restricted ROM Arthritis Pain out of proportion to exam Calcific tendonitis Pain that hasn t resolved with conservative care OPSC s 54th Annual Convention and Exposition Syllabus 312
21 X-RAY What types of xray to order? shoulder AP Internal and external rotation Y view Axillary view OPSC s 54th Annual Convention and Exposition Syllabus 313
22 X-RAY OPSC s 54th Annual Convention and Exposition Syllabus 314
23 X-RAY Y-view Evaluate placement of humeral head in AP plane Evaluate scapula OPSC s 54th Annual Convention and Exposition Syllabus 315
24 X-RAY VIEWS Axillary View Good for evaluating glenohumeral joint pathology Arthritis Bony defects from dislocation OPSC s 54th Annual Convention and Exposition Syllabus 316
25 SHOULDER CONDITIONS Common Shoulder Disorders Rotator Cuff Impingement Scapular Dyskinesia Recurrent Dislocation/Instability Labral Tear Biceps Tendonitis Arthritis Fracture Rotator Cuff Tear OPSC s 54th Annual Convention and Exposition Syllabus 317
26 SCAPULAR DYSKINESIA Definition Incidence/Prevalence PE Traditional Treatment OPSC s 54th Annual Convention and Exposition Syllabus 318
27 ROTATOR CUFF IMPINGEMENT Definition Incidence/Prevalence PE Traditional Treatment OPSC s 54th Annual Convention and Exposition Syllabus 319
28 BICEPS TENDONITIS Definition Incidence/Prevalence PE Traditional Treatment OPSC s 54th Annual Convention and Exposition Syllabus 320
29 OMT FOR THE SHOULDER Cervicals Thoracics Scapula Glenohumeral joint OPSC s 54th Annual Convention and Exposition Syllabus 321
30 RETURN TO TABLE OF CONTENTS OPSC s 54th Annual Convention and Exposition Syllabus 322
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