Physical Therapy of the Shoulder: Module 2

Course Goals:      

This course is intended to instruct the student through self-paced study on the interrelationship of the spine, rib cage, and shoulder, neural tissue evaluation and treatment, neurovascular consequences of cumulative trauma disorders affecting the thoracic outlet, evaluation of treatment of brachial plexus lesions and evaluation and treatment of the shoulder in hemiplegia.

 Student Objectives:

At the end of this course the student will be able to:

1. Identify the musculoskeletal, biomechanical, postural, occupational, and neurologic relationships between the spine, ribs and shoulder.
2. Identify the risk factors for cumulative trauma disorder (CTD) in the workplace.
3. Identify ergonomic solutions to cumulative trauma disorder (CTD)
4. Differentiate between Type I, Type II, Type III and Type IV mechanoreceptors
5. Identify symptoms and signs for: omohyoid syndrome, levator scapulae syndrome, droopy shoulder syndrome and snapping scapula syndrome
6. Identify possible client symptoms resulting from nerve root involvement of C1-T1
7. Identify signs, symptoms and physician-ordered tests for disc disease, nerve root irritation and facet joint irritation in the cervical, thoracic and lumbar spine.
8. Identify signs, symptoms and physician-ordered tests for rib injuries that refer pain and dysfunction to the shoulder
9. Identify lumbar spine and pelvic tissues capable of referring dysfunction to the shoulder
10. Identify 2 types of referred pain
11. Identify 6 signs of neural tissue involvement
12. Identify test techniques for neural tissue provocation from distal to proximal and from proximal to distal.
13. Identify manual therapy treatments of neural tissue
14. Define stenosis
15. Identify challenges to treating a patient with thoracic outlet syndrome
16. Identify the bony components of the thoracic outlet and potential risk factors within those components that can cause thoracic outlet syndrome
17. Identify the muscular components of the thoracic outlet tunnel and potential risk factors within these components that can cause thoracic outlet syndrome
18. Identify dysfunctional reflexes that can affect the thoracic outlet tunnel diameter
19. Identify “multiple crush” situations and signs
20. Identify subjective and objective examination signs for a client with thoracic outlet syndrome
21. Identify the components of the Kabat Sign
22. Identify 5 objective tests for thoracic outlet syndrome
23. Identify components of the Edgelow Protocol in the treatment of thoracic outlet syndrome
24. Identify the 5 parts of instruction in teaching diaphragmatic breathing to clients
25. Identify the anatomy of the brachial plexus and nerve trunks
26. Identify 11 different lesions of the brachial plexus and their mechanism of injury.
27. Identify 4 musculoskeletal injuries that may have complications of brachial plexus injuries.
28. Identify 5 degrees of nerve injury, and the prognosis and relative time frame for recovery for each.
29. Identify the values of a radiographic assessment, myelography, electromyography and nerve conduction study and what each study may reveal about a patient’s condition.
30. Identify 5 neuromuscular impairments associated with hemiplegia.
31. Identify 3 different categories of hypertonicity.
32. Identify 3 different subluxations that may occur in the hemiplegic shoulder.
33. Identify 4 categories of shoulder pain in the hemiplegic shoulder.
34. Identify treatment strategies to decrease the occurrence of shoulder-hand syndrome.
35. Identify treatment considerations when working with a hemiplegic shoulder.