Discussion on shoulder topics including best evidence-based articles, evolution of the shoulder, red flags, role of biomechanics, 'frozen' shoulder, special tests, scapular dyskinesis, exercise prescription, clinical environment, timeline of recovery, and surgery.
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Quick takeaways
Scapular dyskinesis tests lack diagnostic accuracy for shoulder issues.
Scapular mechanics norms are outdated; movement patterns vary with factors like load.
Individualized recovery timelines are key in shoulder pain management.
Deep dives
Scapular Dyskinesis and Diagnostic Accuracy
Scapular dyskinesis assessments do not provide additional benefit in diagnosing shoulder pain or pathology, as studies show limitations in accurately discriminating between those with and without shoulder issues based on scapular physical examination tests.
Narratives and Normentivity
Narratives around scapular kinematics and two-to-one ratio conventions lack scientific support and are often based on outdated concepts. The idea of normative scapular mechanics is flawed, as factors like fatigue, load, and movement speed all influence scapular movement patterns, which exist on a spectrum rather than fixed norms.
Reliability and Bias in Scapular Assessment
Current assessments of scapular movement suffer from poor reliability and accuracy, with assessors showing inconsistency even when evaluating the same individual. Biases, especially when assessors are aware of a patient's shoulder pain, can lead to increased diagnosis of scapular dyskinesis, further complicating the validity of these assessments.
Avoiding Surgical Interventions for Multi-Directional Instability
Surgery for acute traumatic rotator cuff tears is supported by evidence, especially for individuals with continuous dislocations. In cases of multi-directional instability and frequent dislocations, surgical intervention may be warranted, especially when these issues hinder daily activities or desired athletic performance.
Managing Patient Expectations for Recovery
When addressing recovery timelines with patients experiencing multi-factorial shoulder pain, clinicians emphasize the individualized nature of the healing process. Setting short-term meaningful goals and managing patient expectations regarding improvement and functional progress over time are crucial. Avoiding rigid timelines and focusing on progress monitoring tailored to the patient's needs and goals ensures a comprehensive approach to recovery.
The Pain & Rehab team has returned to the studio for 2020 with their latest episode on the shoulder, fielding questions from social media and answering them to their best ability.
Time Stamps:
0:00 - Introduction and catching up
9:30 - Best evidenced based shoulder articles
11:20 - Evolution of the shoulder
13:40 - Red flags
17:20 - Philosophical banter
18:10 - Role of biomechanics in shoulder pain
22:35 - “Frozen” shoulder
27:30 - Structural findings & relevance to cases
32:20 - Special Tests
36:45 - Scapular Dyskinesis & Shoulder Impingement
50:45 - Exercise Prescription - Specific v. “Functional”
56:45 - Clinical Environment & Network
59:45 - Timeline of Recovery
1:02:50 - Surgery
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