Rehabilitative Techniques for the Shoulder in an Athletic Population

1
Rehabilitative Techniques for the Shoulder in an
Athletic Population

• Michael W. Goforth MS, ATC
• Director of Athletic Training

2
Historical Progression

• Player Changes
• Rule Changes
• Equipment Changes

• Diagnostic Changes
• Surgical Changes
• Rehabilitation Changes

3
Considerations Player Changes

• Personal
• Sport
• Position
• Year in school
• Time of the season
• Future Earnings

• Player Profile
• Size of the athlete
• Weight Room
• Core Strength
• Technique

4
Rule Changes
5
Diagnostics

• Clinical tests
• Plain radiographs
• Stress radiographs
• CT Arthrograms
• Ultrasound
• Injections

• Arthroscopy
• MRI
• MRI Arthrogram
• EMG
• Isokinetic Testing
• Biomechanical Testing

6
Clinical Tests

• Drop Arm
• Neer Impingement
• Hawkins Impingement
• Empty Can
• Yergasons
• Speeds (Biceps Tendon)
• Ludingtons
• OBreins
• Mimori
• Biceps Load Test II

• Apprehension
• Kibler Anterior Slide
• Crank
• Relocation (Jobe)
• Posterior Apprehension
• Sulcus
• Active Compression
• Surprise

7
Conditions

• SLAP (type I-VII)
• Posterior SLAP
• Interval Damage
• GHL Trauma
• Capsular Trauma

• Bankart
• Reverse/Posterior Bankart
• Hill Sachs
• Reverse Hill Sachs

8
Surgical Procedures

• Past
• Magnusen-Stack
• Putti-Platt
• Boyd-Sisk Transfer
• Bristow
• Modified
• Latarjet

• Current
• Bankart
• Open
• Closed
• Capsular Shift
• Thermal Shrinkage
• Capsular Plication

SURGERY SHOULD MATCH THE PATHOLOGY AND REHAB
SHOULD MATCH THE SURGERY!
9
Rehabilitation

• Codmans vs Modified Codmans
• Bio-feedback
• Proprioceptive taping
• Force Couples
• Scapular Plane
• Joint Mobilizations
• Rhythmic Stabilization
• Core Stability

10
Protective Equipment

• Custom
• Off The Shelf
• Rigid
• Soft Goods
• Taping/Wrapping

11
The Present

• 15 schools were surveyed.
• 70 cases were reported.
• 4.6 cases per school were reported.
• 3 schools reported no injuries.
• 5.8 cases per school (less the three schools that
  did not report any cases).
• 8 cases used thermal shrinkage.

12
INJURIES BY POSITION
20
18
16
14
O
D
12
10
8
6
4
2
0
WR
OL
FB
HB
TE
DL
DB
LB
P
13
Division I vs NFL by position
35
30
25
20
Division I
NFL
15
10
5
0
WR
OL
FB
HB
TE
DL
DB
LB
P
14
MANAGEMENT
NON-SURGICAL
34
SURGICAL
66
15
Type of Procedure
NOT STATED
2
MINI-OPEN
11
OPEN
46
ARTHROSCOPIC
41
16
DIAGNOSIS
25
20
15
10
5
0
HILL SACHS
REVERSE HILL SACHS
BANKART
REVERSE BANKART
SLAP
POSTERIOR SLAP
17
Labral Pathology
Posterior
38
Anterior
62
18
VT Data

• 8 total cases.
• 5 surgical, 3 non-surgical.
• 2 DB, 4 DL, 1 OL, 1 RB.
• 3 open, 2 arthroscopic.
• 2 were pre-existing.

19
Future

• Closer examination of rule changes.
• Closer examination of recruits.
• Closer examination of weight room techniques.
• Equipment improvements.
• Development of prophylactic devices.
• Improved diagnostic imaging.
• Shift in attitudes towards surgical management.