The quality assurance volume contains tools to optimize the diagnosis and evaluation of patients with shoulder disorders. An example is demonstrated with a patient having multidirectional glenohumeral instability.
By clicking on the links within each main category, you can follow the patient trough diagnosis, evaluation and treatment.
EXERCISE OVERVIEW
All the exercise figures are shown in miniature along with their codes so that they can be found easily.
EXERCISE INSTRUCTIONS
The patients are taught about the objective of the different exercises and are informed about rehabilitation in general. This information can be copied on the therapist's own stationery.
EXERCISE LOG
The exercise log allows the patient to record the number of repetitions of each exercise performed during each exercise session at home. This enables the therapist to assess patient compliance. The program can then be adjusted as necessary. An excellent tool for quality improvement.
DIAGNOSTIC AIDS WITH EVALUATION AND TREATMENT SUGGESTIONS
Suggestions are given on managing the individual patient. The diagnoses are:
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Glenohumeral instability anterior / posterior |
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Glenohumeral instability multidirectional |
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Acromio-clavicular dislocation grade I-V |
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Sterno-clavicular dislocation anterior / posterior |
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Clavicular fractures / acromial / middle / sternal part |
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Proximal humeral fractures - surgical neck / 3-4 parts |
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Subacromial impingement |
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Rotator cuff tears partial / full thickness |
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Acromio-clavicular osteoarthritis |
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Sterno-clavicular osteoarthritis |
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Glenohumeral osteoarthritis / avascular necrosis / cuff arthropathy |
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Frozen shoulder |
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Diabetic shoulder |
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Biceps tendinopathies |
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Suprascapular nerv entrapment |
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Long thoracic nerv disorder |
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Axillary nerv disorder |
|
Accessory nerv disorder |
CLASSIFICATION OF PATHOANATOMICAL
CHANGES IN THE SHOULDER
Standardizing the classification of the various pathologic conditions of the shoulder will
facilitate communication and interchange within the global shoulder community.
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Acromio-clavicular dislocation according to Rockwood |
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Lateral clavicular fractures according to Neer |
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The shape of the acromion according to Bigliani / Morrison |
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The classification of the rotator cuff tears |
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Carter / Wilkinson hypermobility scheme |
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Glenohumeral osteoarthritis according to Samilson / Prieto |
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Cuff arthropathy according to Neer |
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Osteonecroses according to Creuss |
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RA-activity according to ARA |
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X-ray classification of RA according to Larsen-Dale-Eek, Neer and Hirooka et al |
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Winging of the scapula according to Vastamäki |
REHABILITATION PROTOCOLS
Suggested rehabilitation protocols for the most common diagnoses including non-surgical
conditions as well as preoperative and postoperative protocols for each diagnosis.
We have subdivided the postoperative protocol into 4 phases according to our defined goals
for each phase.
| Phase I | - | The early phase. |
| Phase II | - | The build-up phase. |
| Phase III | - | The recovery phase-normal average patient. |
| Phase IV |
- | The recovery phase-specific, for the athletic patient. |
By clicking on the preoperative
and postoperative rehabilitation protocol you can follow
the treatment for multidirectional glenohumeral instability.
RANGE OF MOTION
Range of motion standardization is needed to make the results as objective as possible.
The different motions are shown with illustrations and explanatory text. These are:
Flexion
Elevation / scaption
Abduction
Horizontal flexion / Cross body adduction
External rotation with arm abducted 0 degrees
External rotation with arm abducted 90 degrees
Internal rotation posteriorly
STRENGTH
Guidelines for strength measurement according to the American Shoulder and Elbow Surgeons. The
European Society for Surgery of the Shoulder and the Elbow uses the Constant / Murley scoring system, are explained.
SPECIFIC SHOULDER TESTS
The most common shoulder tests are described with illustrations and text. These are:
| Acromio-clavicular joint | |
| Palpation, direct / indirect Painful arch 160°-180° Horisontal adduction test |
|
| Subacromial impingement | |
| Neer sign/test Hawkins impingement sign/test Painful arch 80°-120°, pronation/supination |
|
| Rotatorcuff | |||
| External rotation strength | - | Infraspinatus / teres min | |
| Drop sign | - | Infraspinatus | |
| Jobe's sign | - | Supraspinatus | |
| External rotation lag sign | - | Supraspinatus | |
| Internal rotation lag sign | - | Subscapularis | |
| Lift off sign | - | Subscapularis | |
| Biceps | |
| Palm up sign Speed sign |
|
| Glenohumeral instability | |
| Apprehension sign anterior / posterior Relocation test Sulcus sign Carter & Wilkinson hypermobility scheme |
|
SCORING SYSTEMS
Reporting results and documenting outcomes are important and often a difficult
undertaking. Shoulder associations around the world recommend a variety of systems of
classification for this purpose. Individual doctors and physical therapists have also
developed scoring systems for specific conditions and patient groups. Presented here are
some of the most well accepted classification systems along with their conversion tables.
Axelina will allow you to easily compute the results when using individual or combined
scoring systems. Patient questionnaires are available for photocopying. The different
scoring systems are:
|
American Shoulder and Elbow Surgeons |
|
Constant-Murley score |
|
Rowe shoulder score 1988 |
Examples are shown of how range of motion and strength
are calculated in different scoring systems.