ann cools 1 clinical exam [compatibiliteitsmodus]
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“How I examine the overhead athlete….”
A clinical reasoning algorithm
Ann M. Cools, PT, PhDGhent UniversityDept of Rehabilitation Sciences & PhysiotherapyBelgium
Shoulder pathology?
� Impingement (SA & int)
(Anderson Radiol Clin North Am 2010, Lintner Clin Sports Med 2008, Seroyer Sports Health 2009 , Reeser BJSM 2006, Briner Sports Med 1997)
Ann Cools Wrightington nov 2012
Shoulder impingement
Impingement of soft tissue (tendon) between bony components
External
(Subacromial)
Impingement
(Neer 1972)Ann Cools Wrightington nov 2012
Shoulder impingement
Impingement of soft tissue (tendon) between bony components
Internal
(postero superior glenoid)
Impingement
(Walch 1990, Drakos JBJS 2009)Ann Cools Wrightington nov 2012
Shoulder pathology?
� Impingement
� Rotator cuff dysfunction,including suprascapularnerve entrapment
(Anderson Radiol Clin North Am 2010, Lintner Clin Sports Med 2008, Seroyer Sports Health 2009 , Reeser BJSM 2006, Briner Sports Med 1997)
Ann Cools Wrightington nov 2012
Shoulder pathology?
� Impingement
� Rotator cuff pathology
� Instability (traumatic & acquired)
(Anderson Radiol Clin North Am 2010, Lintner Clin Sports Med 2008, Seroyer Sports Health 2009 , Reeser BJSM 2006, Briner Sports Med 1997)
Ann Cools Wrightington nov 2012
Shoulder pathology?
� Impingement
� Rotator cuff pathology
� Instability
� SLAP lesions
(Anderson Radiol Clin North Am 2010, Lintner Clin Sports Med 2008, Seroyer Sports Health 2009 , Reeser BJSM 2006, Briner Sports Med 1997)
Ann Cools Wrightington nov 2012
Shoulder pathology?
� Impingement
� Rotator cuff pathology
� Instability
� SLAP lesions
� Scapular dyskinesis
(Anderson Radiol Clin North Am 2010, Lintner Clin Sports Med 2008, Seroyer Sports Health 2009 , Reeser BJSM 2006, Briner Sports Med 1997)
Ann Cools Wrightington nov 2012
Shoulder pathology?
� Impingement
� Rotator cuff pathology
� Instability
� SLAP lesions
� Scapular dyskinesis
� GIRD
(Anderson Radiol Clin North Am 2010, Lintner Clin Sports Med 2008, Seroyer Sports Health 2009 , Reeser BJSM 2006, Briner Sports Med 1997)
Ann Cools Wrightington nov 2012
Impingement symptoms
ExternalSubacromial impingement
Internal(posterior)
impingement
PrimaryImpingement
SecondaryImpingement
BicepsSLAP
Rotator cuffpathology
Scapular dyskinesis instability G.I.R.D.
(Cools et al. BJSM 2008)
Ann Cools Wrightington nov 2012
Impingement tests: Jobe, Hawkins, Neer
(Hegedus 2008)Ann Cools Wrightington nov 2012
Impingement symptoms
ExternalSubacromial impingement
Internal(posterior)
impingement
PrimaryImpingement
SecondaryImpingement
BicepsSLAP
Rotator cuffpathology
Scapular dyskinesis instability G.I.R.D.
Jobe +Neer + antHawkins +
Jobe –Neer + postHawkins –
(Cools et al. BJSM 2008)
Instability tests: Apprehension “Posterior ImpingementSign”– Relocation - Release
(Meister 2004)
Ann Cools Wrightington nov 2012
Impingement symptoms
ExternalSubacromial impingement
Internal(posterior)
impingement
PrimaryImpingement
SecondaryImpingement
BicepsSLAP
Rotator cuffpathology
Scapular dyskinesis instability G.I.R.D.
Relocation -Relocation+
Release +(pain)
Jobe +Neer + antHawkins +
Apprehension +(pain) ant
Jobe –Neer + postHawkins –Apprehension +(pain) post
Relocation+Release +(pain)
(Cools et al. BJSM 2008)
Rotator cuff tendinopathy?:Full can test
(Reinold et al. JOSPT 2009)
Ann Cools Wrightington nov 2012
Impingement symptoms
ExternalSubacromial impingement
Internal(posterior)
impingement
PrimaryImpingement
SecondaryImpingement
BicepsSLAP
Rotator cuffpathology
Scapular dyskinesis instability G.I.R.D.
Relocation -Relocation+
Release +(pain)
Jobe +Neer + antHawkins +
Apprehension +(pain) ant
Jobe –Neer + postHawkins –Apprehension +(pain) post
Relocation+Release +(pain)
Full Can +
(Cools et al. BJSM 2008)
Scapular involvement?Scap Ass Test – Scap Retr Test(Rabin et al. JOSPT 2006, Kibler et al. AJSM 2006, Tate et al. AJSM 2008)
Ann Cools Wrightington nov 2012
Impingement symptoms
ExternalSubacromial impingement
Internal(posterior)
impingement
PrimaryImpingement
SecondaryImpingement
BicepsSLAP
Rotator cuffpathology
Scapular dyskinesis instability G.I.R.D.
Relocation -Relocation+
Release +(pain)
Jobe +Neer + antHawkins +
Apprehension +(pain) ant
Jobe –Neer + postHawkins –Apprehension +(pain) post
Relocation+Release +(pain)
SAT +SRT +
Full Can +
(Cools et al. BJSM 2008)
Glenohumeral laxity?Load&shift, Sulcus, posterior subluxation test
Ann Cools Wrightington nov 2012
Glenohumeral laxity?Load&shift, Sulcus, posterior subluxation test
Ann Cools Wrightington nov 2012
Impingement symptoms
ExternalSubacromial impingement
Internal(posterior)
impingement
PrimaryImpingement
SecondaryImpingement
BicepsSLAP
Rotator cuffpathology
Scapular dyskinesis instability G.I.R.D.
Relocation -Relocation+
Release +(pain)
Jobe +Neer + antHawkins +
Apprehension +(pain) ant
Jobe –Neer + postHawkins –Apprehension +(pain) post
Relocation+Release +(pain)
Laxity tests +Appr + (appr)Relocation + (appr)
SAT +SRT +
Full Can +
(Cools et al. BJSM 2008)
Biceps pathology or SLAP?O’ Brien, Speed’s, Biceps Load II
(Hegedus et al. BJSM 2008, Oh et al. AJSM 2008)
Ann Cools Wrightington nov 2012
Impingement symptoms
ExternalSubacromial impingement
Internal(posterior)
impingement
PrimaryImpingement
SecondaryImpingement
BicepsSLAP
Rotator cuffpathology
Scapular dyskinesis instability G.I.R.D.
Relocation -Relocation+
Release +(pain)
Jobe +Neer + antHawkins +
Apprehension +(pain) ant
Jobe –Neer + postHawkins –Apprehension +(pain) post
Relocation+Release +(pain)
O’Brien+Speeds+Biceps load II+
Laxity tests +Appr + (appr)Relocation + (appr)
SAT +SRT +
Full Can +
(Cools et al. BJSM 2008)
GIRD?Internal Rotation ROM in 90° abduction
(Trakis et al. AJSM 2008, Cools BJSM 2010, Borstad JOSPT 2011)
Ann Cools Wrightington nov 2012
Impingement symptoms
ExternalSubacromial impingement
Internal(posterior)
impingement
PrimaryImpingement
SecondaryImpingement
BicepsSLAP
Rotator cuffpathology
Scapular dyskinesis instability G.I.R.D.
Relocation -Relocation+
Release +(pain)
Jobe +Neer + antHawkins +
Apprehension +(pain) ant
Jobe –Neer + postHawkins –Apprehension +(pain) post
Relocation+Release +(pain)
IRROM↓
O’Brien+Speeds+Biceps load II+
Laxity tests +Appr + (appr)Relocation + (appr)
SAT +SRT +
Full Can +
(Cools et al. BJSM 2008)
Measurement of GH ROM
� Digital inclinometer (Acumar) (Cools et al.
Submitted JAT 2012)
Ann Cools Wrightington nov 2012
Measurement of GH and ST strength
� HHD (compuFET, Biometrics)(Cools et al. BJSM 2010; Cools et al. Submitted JAT 2012)
Ann Cools Wrightington nov 2012
More information?
In general: “ we urge caution if a diagnostic test is only been studied once, and if the originator of the test is the author of the paper” (Hegedus et al. BJSM 2008)
Ann Cools Wrightington nov 2012
29
EUSSER is proud to announce, in collaboration with Ghent University and the Flemish Society of
Shoulder and Elbow Surgeons:
THE SHOULDER IN THE OVERHEAD ATHLETE: CHALLENGES FOR SCAPULAR REHABILITATION
AND RETURN TO PLAY AFTER INJURY
FRIDAY 29th MARCH 2013
Invited international speakers:Kajsa Johansson (Sweden)
Klaus Bak (Denmark)Jo Gibson (UK)
Het Pand, Gent, Belgium
Future congress:
Ann Cools Wrightington nov 2012
Thank you!!(Gent- Belgium)