83
Evaluation and Treatment of the Shoulder Complex: Summary
and short/fast, and the movements are worked into ROM barriers. Indications for gua sha include pain, decreased range of motion, and scar tissue. Therapeutic benefits include im-proving microcirculation, decreasing local pain, providing distal analgesic effects, improving ROM, and increasing stem cell circulation. Contraindications include open wounds, unhealed fractures, thrombophlebitis, uncontrolled hypertension, patient intolerance/hypersensitivity, hematomas, osteo-myelitis, myositis ossificans, and nickel allergies. Joint Mobilizations Manual therapy technique that requiress a continuum of skilled passive movement to joints and/or related soft tissues that are applied at varying speeds and amplitude, including a small- amplitude/high-velocity therapeutic movement.
Muscle-Selective Tissue Tension (MSTT) Musculotendinous Impairment Indication Strong/painless Normal tissue Strong/painful Tendinopathy Weak/painful Partial rear Weak/painless Complete tear Pain present = no formal manual muscle test (MMT) to avoid additional stress on painful tissue Accessory Motion Assessments • Posterior glide of humerus on scapula • Inferior glenohumeral glide • Scapula movement • Sternoclavicular inferior glide Muscle Length Tests • Pectoralis major • Biceps brachii • Latissimus dorsi • Supraspinatus/deltoid Orthopedic Tests • No longer considered special due to there being little information that supports their use • If going to use, best to use as a cluster Shoulder Complex Interventions Instrument-assisted soft tissue mobilization, joint mobilizations, joint manipulations, muscle energy techniques, kinesiology tape, thoracic mobility, shoulder flexion and internal rotation, shoulder extension and external rotation. Instrument-Assisted Soft Tissue Mobilization Gua sha is based on a traditional Chinese medicine. It uses an instrument with a flat edge that is moved along tissue by scraping or reddening until petechiae form, typically for one to two minutes. The patient should be positioned in a neutral comfortable position with the treatment area exposed while maintaining their modesty. The two main stroking techniques are long/slow
Joint Manipulations Grading Techniques Grade I
Small movement at beginning range
Grade II Large movement at beginning range Grade III Large movement from midrange to end range Grade IV Small movement at end range Grade V/ thrust High-velocity, small-amplitude movement at end range Effect of Joint Manipulations Neurophysiological • Pain control • Grades I and II through oscillations • Stimulates type 1 and type 2 receptors Mechanical • Stretches immature collagen cross-links and improves ROM • Grades III and IV through oscillations, sustained movements, and thrusts
Powered by FlippingBook