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Evaluation and Treatment of the Shoulder Complex: Summary
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.
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.
Joint Manipulations Grading Techniques Grade I
Small movement at beginning range Large movement at beginning range
Grade II
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
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