Shoulder subluxation

[theshoulderguy]

Hi Sally, working with shoulders is great fun but sometimes a little daunting.

My advice would be to just focus on the fundamentals and be confident before you start the examination that you have done a full history the enables you to start the clinical reasoning process.

This will set you up for a great treatment plan based on specific information.

What I would want to know would most likely include:

*Age of patient and the nature of their activity, including training and playing volume, a what time in the game the injury occurred (fatigue)?

*History of the injury including mechanism of injury and direction of subluxation or dislocation?

*Was the injury a first time injury or do they have a previous history of similar events.

*Can you confirm that there is no pathology present i.e. a labral tear etc Have they been investigated - MRI?

*What is their ROM like now 2 weeks later - get them to demonstrate and you observe.

*Pain location and behaviour etc

*What positions or activity do they avoid at present?

*Does the shoulder feel unstable to them

That's a start anyway Sally.

On examination I always get the patient to show me how they move first, I observe and take note of overall build, thoracic kyphosis, posture control, scapula orientation & stability, muscle patterning errors and then I look at cuff activation through a gentle ER muscle test to see if the cuff (shoulder) initiates the movement or do other muscles compensate (which is usually the case).

Treatment Aims:

*Start Small but Aim Big!

*Focus on good cuff activation through abduction range first before moving to an upper body strength program.

*When initiating ER activation use the mid range of motion i.e. avoid end of range ER where control is likely to be deficient.

*Timeframe is likely to be 6 months for both local and higher cortical integration.

*Full functional ROM with excellent cuff and scapula control and the end of the day.

*Include lower kinetic chain involvement in your shoulder rehabilitation.

What to avoid?

*Missing signs and symptoms of underlying pathology

*Thinking that strengthening comes first.

*Not educating your patient about what is going on, what needs to be done and how long it is going to take

*Moving too quickly without adequate attention to posture, lower kinetic chain elements, core stability, quality scapula and cuff control.

*Giving too much tactile feedback - Less appropriate and targeted feedback is actually MORE

*Using loads that are way too heavy - light loads are harder to detect and control so always start there and only move on when they can perfect control of that.

*Using old school gym based exercises as the main stay of your strengthening program.

Well Sally I just had a bad case of verbal diarrhoea but I hope that helps you. Let me know?

Remember: Think Differently!

Cheers

Luke

PS: I have just started a FB Fan Page too so come and "LIKE" it if you found this post helped you.

The Shoulder Guy