Effective Examination & Treatment of the Shoulder Complex Q&A
As an experienced and successful physical therapist, John O’Halloran, PT, DPT, OCS, ATC, CSCS, cert MDT, believes that therapists must respond by logic and thought when dealing with a patients’ problems rather than habit and routine. “Every treatment is a form of hypothesis testing”, he says. “The evaluation never ends.”
“A good, sound orthopedic screening examines the patient as a ‘whole’ versus as a ‘joint’ or “tissue” diagnosis”, explains O’Halloran, “and will allow the clinician the ability to address present and potential predisposing factors”.
Q: Why is it important to get the patient involved in their own examination?
A: Positive outcomes increase when you involve patients in their care. Even something as simple as asking them when they experience pain can improve outcomes by pinpointing which actions cause pain, and then correlating these motions to muscle groups and treatment options.
Q: Is it true that some patients can have a full thickness RTC tear without functional limitations?
A: Just because your patient has Rotator Cuff pathology does not mean that they have pain or dysfunction. Its not unusual to see some patients with full rotator cuff tears who can still elevate their arms normally. Over the age of 60, 60% of the population have rotator cuffs that are torn to some degree and this percentage increases as they continue to age. If everything else is in balance, they can still function almost normally.
Q: Do most therapeutic exercises for the shoulder start in a connected position?
A: No. If you put the shoulder in the right position good things will occur. Most therapeutic exercises for the shoulder start in a disconnected position. Meaning that the humerus is not positioned correctly in the fossa to allow for optimal force coupling and length tension relationship to maximize the elevation of the arm.
Q: Is scapula winging common in shoulder instability patients?
A: Yes. 36% of scapula winging occurs in shoulder instability.
Q: What would cause abnormal translation of the humeral head in the glenoid fossa?
A: Tight posterior capsule, weak rotator cuff, scapular and thoracic spine asymmetry all cause abnormal translation.
Q: What do you recommend when it comes to developing a treatment plan for the shoulder complex?
A: Get out of your comfort zone and engage your patient. The test-treat-test again model engages the patient and facilitates compliance.
Address your patients predisposing factors all the time! A lot of these post-op patients, their whole body needs to be rehabilitated.
Challenge yourself to continue to be more involved and read recent research, even if it’s just an hour a month. Continue to be a life long learner with regular continuing education.
And remember, evidence based practice is taking the best available evidence and incorporating it in the patients program, so if you can stay on top of the literature with your clinical experience, you’re going to make a huge impact with your patient.
John’s most current continuing education course in our library, “Effective Examination & Treatment of the Shoulder Complex“, focuses on examination and intervention of complex shoulder impairments as well as documentation tools and therapeutic treatment parameters, effective assessment, and treatments for common shoulder disorders.