FOUNDATIONS & FRUSTRATIONS
The Clinician's Series
The ultimate diagnostic course for shoulder disorders, with specialty practice techniques for the effective treatment of cuff tears and adhesive capsulitis.
Level 1 syllabus - shoulder FOUNDATIONS & FRUSTRATIONS
DAY 1 - MTS™ Level 1 - shoulder FOUNDATIONS
CLINICAL DIAGNOSTICS I
- KEY UPDATES - Applied Anatomy & Pathology of the Shoulder
- ACADEMIA - Important updates in shoulder research
- CLINICAL EXAMINATION
- Using pain descriptors to assist diagnosis
- Pain patterns of the shoulder
- Clinical shoulder examinations
- Understand examination combinations
Practical Session
CLINICAL DIAGNOSTICS II
- SPECIAL TESTS
- Recommended special tests of the shoulder
- Combining special tests
- Novel tests
- DIAGNOSTIC CASE EXAMPLES - Cuff tears & Capsulitis including radiology and interpretation
Practical / Demonstration Session
COPY CAT DISORDERS
- DIAGNOSTICS & DIFFERENTIALS - Understand differentials of the shoulder in MSK practice
DAy 2 - MTS™ Level 1 - shoulder FRUSTRATIONS
TOPIC 1 - ROTATOR CUFF INJURIES
- Clinical & Radiological Classifications
- Functional Grading
- Non-surgical vs surgical decisions
- Injection options
- Early - Mid - Late stage rehabilitation
- Recommended protocols based on cuff tear size
Practical Session
TOPIC 2 - ADHESIVE CAPSULITIS (Frozen Shoulder)
- Diagnosing adhesive capsulitis
- Copy cat disorders for adhesive capusilitis
- Capsulitis, Contracture and Diabetic Capsulitis
- Grading severity - decisions for injection vs rehab
- Patterns and variations in adhesive capsulitis
- Key principles of successful treatment
- MTS™ 8 week physiotherapy program
Practical Session
LEVEL 1 MTS™ Q&A
Shoulder Foundations
- Do posterior labral tears require surgery ?
- What is a Buford complex ?
- Why is the rotator cable so important ?
- What implications does the rotator interval have ?
- What are the key x-ray views for the shoulder and why?
- What relevance are the updates in cuff anatomy dissection ?
- Are SLAP tears capable of restricting motion ?
- What should be documented on an MRI ? An US ? How do I know if the report is accurate ?
Diagnostic Accuracy
- Can you separate a acute cuff tear from a bursitis ?
- How do you define a grade III vs grade IIIB vs grade V ACJ separation?
- What does a positive Yocum test, but negative spin test mean ?
- Are SSC tests accurate ?
- Does a 2.6cm AP SSP FT cuff tear make sense ?
- What are the sensitive measures for mild symptomatic GHJ OA ?
- What types of tendinopathy are painful ? How do I measure it ?
- What special tests are clinically useful ?
- What clusters should I use ? How accurate are they ?
Managing Cuff Tears & Maximizing Repairs
- How are tears graded surgically vs radiologically ?
- What are functional grades ?
- When should I start strength exercises ? Indirect or direct ?
- When should I refer for surgery ?
- What are the surgical indications, risks and late complications ?
- How do I treat a massive cuff tear ?
- What is a ceiling effect in non-surgical tears ?
- How long should I rehab a cuff tear for ?
- What are the ideal post surgical methods and principles ?
- Should I use rotator cuff exercises in the long term ?
Adhesive Capsulitis - Early Recovery
- What are the diagnostic signs and symptoms for capsultis ?
- What disorders copy a capsular pattern ?
- Does severity matter and how is it measured ?
- How do you treat a capsulitis in the initial stages ?
- When should I begin movement, in what direction and with how much force ?
- How do you achieve recovery in 8 weeks ?
- When do you decide to inject ?
- How many injections and at what dose / interval ?
- When is it safe to start manual therapy ?
LEVEL 1 - MTS™ CLINICAL CASE example
37 y/o construction worker, post traumatic injury due to fall
A patient sees you for advice and exercise regarding a recent shoulder injury sustained during a fall. He has restricted movement, strength and moderate pain on shoulder height movement. Dominant arm, night pain. Restrictions to work and sport.
He presents an US for you to read and based on the injury, devise a program of exercise progressions to help with regaining movement. He also wants to know if he should consider surgery and what are the factors to consider.
- US demonstrates a broad partial thickness (mid grade) articular sided tear to SSP, SASD bursitis and a 'wet' posterior GH joint line.
Some points to consider ?
- What is the difference of articular vs intrasubstance to bursal sided cuff tears ?
- How might this change your treatment for pain ? for movement ? for strength ?
- Should you expect movement loss due to a cuff tear ? When would this settle ?
- Is this a surgical problem ?
- Will they get worse with cuff exercises ?....
