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Evaluation and Treatment of the Shoulder Complex: Summary
Shoulder Flexion and Internal Rotation Interventions • Gua sha • Superior scapular mobilization • Posterior tilt scapular mobilization • Posterior glenohumeral mobilization • Inferior glenohumeral mobilization • MET • KT Shoulder Extension and External Rotation Interventions • Gua sha • Sternoclavicular superior glide • MET • KT Shoulder Complex: Home Exercise • Lateral scapular mobilization • Sternoclavicular inferior glide Always reinforce what was addressed in clinic and provide exercises that will challenge the patient at their limit. To improve compliance, it is important to keep exercises simple and relevant. Areas to address: rotator cuff, scapula stabilization, glenohumeral stabilization, thoracic mobility.
Psychological • Patient expectations, that is, patient hopes treatment procedures produce positive response Indications include pain, decreased range of motion, and scar tissue. Contraindications include osteopenia, osteoporosis, neurological signs , aortic aneurysm, bleeding into joint, and positioning not able to be achieved because of pain or resistance. Muscle Energy Techniques (MET) MET is intended to treat somatic dysfunction due to muscular inhibition and through postisometric relaxation. Indications include shortened muscles, myofascial trigger points, and hypotonicity. Precautions include osteoporosis, arthritis, joint restrictions, and acute inflammation. Complete MET by first moving the soft tissue to the barrier and holding for 6 to 30 seconds against the clinician’s pressure. Then move the soft tissue to a new barrier and repeat the hold duration against the clinician’s pressure. Kinesiology Tape (KT) KT is intended to increase joint proprioception, provide a tactile cue to alter muscle tone, and provide tactile cutting to improve movement. It is most appropriately utilized through a mechanical approach. To stimulate muscles, utilize a proximal to distal pull. To stimulate skin, utilize a distal to proximal pull. Indications include pain, loss of motion, poor movement patterns, and local fatigue. Contraindications include active malignancy, active cellulitis, skin infection, open wounds, and deep vein thrombosis (DVT). Thoracic Mobility It is always important to assess thoracic mobility when addressing shoulder impairments. Interventions that can be utilized to address secondary thoracic mobility limitations include gua sha and joint mobilizations.
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