Physical Therapy of the Shoulder, 4th Edition (Clinics in Physical Therapy)

573 Pages·2003·123 MB·English

by  Robert Donatelli

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Physical Therapy of the Shoulder,ed 4 ISBN 0-443-06614-0
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Physical Therapy is an ever-changing field.Standard safety precautions must be followed,but as new
research and clinical experience broaden our knowledge,changes in treatment and drug therapy may
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Previous editions copyrighted 1997,1991,1987.
Library of Congress Cataloging-in-Publication Data
Physical therapy of the shoulder / edited by Robert A.Donatelli.– 4th ed.
p. ;cm.
Includes bibliographical references and index.
ISBN 0-443-06614-0 (alk.paper)
1. Shoulder–Wounds and injuries. 2. Shoulder–Wounds and injuries–Treatment.
3. Shoulder–Wounds and injuries–Physical therapy. I. Donatelli,Robert.
[DNLM: 1. Shoulder–injuries. 2. Shoulder Joint–injuries. 3. Physical Therapy
Techniques–methods.WE 810 P578 2004]
RD557.5.P48 2004
617.5¢72044–dc22
2003065163
Acquisitions Editor:Marion Waldman
Developmental Editor:Marjory Fraser
Publishing Services Manager:Pat Joiner
Project Manager:Rachel E.Dowell
Senior Designer:Mark A.Oberkrom
Printed in the United States of America
Last digit is the print number 9 8 7 6 5 4 3 2 1
Dedication
I
would like to dedicate this book to my family—my wife Georgi
Donatelli, my new son, Robby Donatelli, and my daughter, Rachel. They
have added a new meaning of joy and happiness to my life.
CONTRIBUTORS
Mollie Beyers, DPT Jeff Cooper, MS, ATC
Physical Therapist, Biomax Rehabilitation, Athletic Trainer, Philadelphia Phillies Baseball Team,
Effingham, Illinois Philadelphia, Pennsylvania; Consultant, Physiotherapy
Chapter 11: Frozen Shoulder Associates, Memphis, Tennessee
Chapter 3: Throwing Injuries
Peter Bonutti, MD, FACS, FAAOS,
FAANA Robert A. Donatelli, PhD, PT, OCS
Founder and Director, Bonutti Clinic, Founder and National Director of Sports Rehabilitation,
Director, Bonutti Technology, Effingham, Illinois; Physiotherapy Associates, Suwanee, Georgia
Assistant Clinical Professor, Department of Orthopaedic Chapter 2: Functional Anatomy and Mechanics;
Surgery, University of Arkansas, Fayetteville, Arkansas Chapter 4: Differential Soft Tissue Diagnosis; Chapter
Chapter 11: Frozen Shoulder 10: Impingement Syndrome and Impingement-Related
Instability; Chapter 14: Manual Therapy Techniques
Robert Cantu, MMSc, PT, MTC
Phillip B. Donley, PT, ATC, MS
Group Director, Physiotherapy Associates, Atlanta,
Georgia; Assistant Professor, University of St. Augustine Physiotherapy Associates, Chester County Sports
for Health Sciences, St. Augustine, Florida Medicine, West Chester, Pennsylvania; Consultant to the
Chapter 16: Myofascial Treatment Philadelphia Phillies Baseball Team, Philadelphia,
Pennsylvania
Deborah Seidel Cobb, MS, PT
Chapter 3: Throwing Injuries (Appendix)
University of St. Augustine for Health Sciences, St.
Xavier A. Duralde, MD
Augustine, Florida
Chapter 16: Myofascial Treatment Peachtree Orthopedics Clinic; Assistant Clinical
Professor of Orthopaedic Surgery, Clinical Instructor,
Struan H. Coleman, MD, PhD
Emory University School of Medicine, Atlanta, Georgia
Assistant Professor of Orthopaedic Surgery, Hospital Chapter 20: Total Shoulder Replacements
for Special Surgery—Cornell University Medical Center,
Peter I. Edgelow, MA, PT
New York, New York
Chapter 17: Shoulder Instability Senior Staff Therapist, Physiotherapy Associates,
Hayward, California; Assistant Clinical Professor,
David J. Conaway, DO
Graduate Program in Physical Therapy, University of
Associate Clinical Professor, Department of California, San Francisco, California; Graduate
Orthopaedics, West Virginia College of Osteopathic Residency in Orthopaedic Physical Therapy, Kaiser
Medicine, Lewisburg, West Virginia; Honorary Clinical Permanente, Hayward, California
Instructor, Graduate Program in Physical Therapy, Chapter 7: Neurovascular Consequences of
Division of Allied Health Professions, Department of Cumulative Trauma Disorders Affecting the Thoracic
Rehabilitation Medicine, Emory University School of Outlet: A Patient-Centered Treatment Approach
Medicine; Past Chairman, Department of Surgery,
Northlake Regional Medical Center; Staff Orthopaedic
Surgeon, Dekalb Medical Center; Northlake Regional
Medical Center; Eastside Medical Center; Atlanta,
Georgia; Orthopaedic Surgeon, Killian Hill Orthopaedic
and Sports Medicine Clinic, Lilburn, Georgia
Chapter 19: Shoulder Girdle Fractures
vii
viii
CONTRIBUTORS
Richard A. Ekstrom, PT, DSc, MS, Ola Grimsby, PT
OCS
Chairman of the Board, Ola Grimsby Institute, San
Physical Therapy Department, University of South Diego, California
Dakota, Vermillion, South Dakota Chapter 5: Interrelationship of the Spine, Rib Cage,
Chapter 15: Muscle Length Testing and and Shoulder
Electromyographic Data for Manual Muscle Testing and
Exercises for the Shoulder Toby Hall, PT
Clinical Consultant, School of Physiotherapy, Curtin
Todd S. Ellenbecker, MS, PT, SCS,
University of Technology, Perth, Western Australia,
CSCS
Australia
Clinic Director, Physiotherapy Associates-Scottsdale Chapter 6: Neural Tissue Evaluation and Treatment
Sports Clinic, Scottsdale, Arizona
Joseph Herrera, MD
Chapter 12: Etiology and Evaluation of Rotator Cuff
Pathologic Conditions and Rehabilitation Clinical Instructor, Department of Rehabilitation
Medicine, Hospital for Special Surgery—Cornell
Robert L. Elvey, PT University Medical Center, New York, New York
Senior Lecturer, School of Physiotherapy, Curtin Chapter 17: Shoulder Instability
University of Technology, Perth, Western Australia,
Jacob P. Irwin, DPT
Australia
Chapter 6: Neural Tissue Evaluation and Treatment Physiotherapy Associates, Suwanee, Georgia
Chapter 4: Differential Soft Tissue Diagnosis;
Blanca Zita Gonzalez-King, PT, CHT Chapter 19: Shoulder Girdle Fractures
Physical Therapist, Private Practice, Atlanta, Georgia Scot Irwin, DPT, CCS
Chapter 4: Differential Soft Tissue Diagnosis
Associate Professor, Department of Physical Therapy,
John C. Gray, DPT, OCS, FAAOMPT North Georgia College and State University, Dahlonega,
Georgia
Lead Clinical Specialist, Department of Physical
Chapter 1: The Guide to Practice
Therapy, Sharp Rees-Stealy, Clinical Instructor, Ola
Grimsby Institute; Credentialed Clinical Instructor, Marie A. Johanson, EdD, PT, OCS
American Physical Therapy Association; Associate Editor,
Instructor, Division of Physical Therapy, Department
Journal of Manual and Manipulative Therapy, San Diego,
of Rehabilitation Medicine, Emory University School of
California
Medicine, Atlanta, Georgia
Chapter 5: Interrelationship of the Spine, Rib Cage,
Chapter 4: Differential Soft Tissue Diagnosis
and Shoulder; Chapter 13: Visceral Referred Pain to the
Shoulder Michael Lee, MD
Clinical Instructor, Department of Rehabilitation
Bruce H. Greenfield, PT, PhD, OCS
Medicine, Hospital for Special Surgery—Cornell
Instructor, Division of Physical Therapy, Department University Medical Center, New York, New York
of Rehabilitation Medicine, Emory University School of Chapter 17: Shoulder Instability
Medicine, Atlanta, Georgia
Chapter 8: Evaluation and Treatment of Brachial Kathryn Levit, MA, OTR/L
Plexus Lesions; Chapter 10: Impingement Syndrome Private Practice/Consultant, Department of Applied
and Impingement-Related Instability Developmental Psychology, George Mason University,
Fairfax, Virginia.
Chapter 9: The Shoulder in Hemiplegia
ix
CONTRIBUTORS
Timothy J. McMahon, PT Lori Thein Brody, MS, PT, SCS, ATC
Outpatient Program Supervisor for Orthopaedics Associate Lecturer, Department of Kinesiology,
and Sports Medicine, The Rehab Results Group, University of Wisconsin School of Education; Senior
Decatur, Georgia; Clinical Adjunct Faculty, Division of Clinical Therapist, Sports Medicine Center; University
Physical Therapy, Department of Rehabilitation of Wisconsin Clinics Research Park, Madison, Wisconsin
Medicine, Emory University School of Medicine, Chapter 10: Impingement Syndrome and
Atlanta, Georgia Impingement-Related Instability
Chapter 14: Manual Therapy Techniques
Vijay B. Vad, MD
Craig D. Morgan, MD
Assistant Professor of Rehabilitation Medicine,
Orthopedic Surgeon, The Morgan Kalman Clinic, Hospital for Special Surgery—Cornell University
Wilmington, Delaware; Clinical Professor University of Medical Center, New York, New York
Pennsylvania, Philadelphia, Pennsylvania Chapter 17: Shoulder Instability
Chapter 3: Throwing Injuries (Appendix)
Joseph S. Wilkes, MD
Roy W. Osborn, PT, MS, OCS
Associate Clinical Professor, Department of
Physical Therapy Department, University of South Orthopaedics, Emory University School of Medicine;
Dakota, Vermillion, South Dakota Orthopedist, Southern Orthopedics; Medical Director,
Chapter 15: Muscle Length Testing and Piedmont Hospital Sports Medicine Institute, Atlanta,
Electromyographic Data for Manual Muscle Testing and Georgia; Orthopedic Consultant, United States Luge
Exercises for the Shoulder Association, Lake Placid, New York
Chapter 18: Rotator Cuff Repairs
Susan Ryerson, PT
Michael J. Wooden, MS, PT, OCS
Partner, Making Progress, Alexandria, Virginia;
Adjunct Clinical Faculty, Boston, Massachusetts; General Instructor, Division of Physical Therapy, Department
Hospital Institute of Health Professions, Boston, of Rehabilitation Medicine, Emory University School of
Massachusetts; Coordinator/Instructor, Medicine; National Director, Clinical Research,
Neurodevelopmental Treatment Association, Inc, Physiotherapy Associates, Memphis, Tennessee
Chicago, Illinois Chapter 19: Shoulder Girdle Fractures
Chapter 9: The Shoulder in Hemiplegia
Michael S. Zazzali, DSC, PT, OCS
Dorie B. Syen, MS, OTR, CHT
Co-Director and Partner, Physical Therapy Associates
Rehabilitation Projects Coordinator, Georgia Baptist of New York, New York, New York
Medical Center, Atlanta, Georgia Chapter 17: Shoulder Instability
Chapter 8: Evaluation and Treatment of Brachial
Plexus Lesions
PREFACE
The first edition of Physical Therapy of the Shoulder was published in 1987, and now we are
writing the fourth edition 15 years later. I would like to thank my readers for their support
throughout the years that has made this book successful. The fourth edition has kept up with the
tradition of Physical Therapy Specialization. The shoulder joint is a complicated structure con-
sisting of three synovial joints, the scapula thoracic articulation, and 17 muscles. The shoulder
complex hangs off the rib cage and is connected to the cervical and thoracic spine. The com-
plexity of the shoulder makes many rehabilitation students and clinicians uncertain in assessing
shoulder pathomechanics and in establishing treatment approaches for different shoulder
pathologies.
In keeping up to date with new and innovative treatment techniques, surgical procedures, and
evaluation methods for the shoulder, this fourth edition of Physical Therapy of the Shoulder has
been updated appropriately. There are a dozen new authors and seven new chapters. The fourth
edition is divided into five sections; Mechanics of Movement and Evaluation, Neurologic Consid-
erations, Special Considerations, Treatment Approaches, and Surgical Considerations.
In keeping with the new Guide to Physical Therapist Practice, Scot Irwin has given us an
overview of the Guide,and all the case studies have been rewritten in the Guideformat. Chapter
2 was updated with new anatomic and biomechanical information on how the shoulder moves.
Seven fresh cadaver slides have been added to the color plates in the center of the textbook.
Chapter 3 was rewritten by Jeff Cooper with all the new information on the throwing injuries to
the shoulder. Jeff has included new research data that he has collected over the past several
years on professional baseball pitchers. His approach to evaluation and treatment is state of the
art. Chapter 4 finishes the first section with updates on all the new-evidenced-based special tests
for the shoulder. The special tests on the shoulder greatly assist the clinician in the development
of a differential soft tissue diagnosis. The research-based tests are very reliable and accurate in
determining different pathologies of the glenohumeral articulation.
Section 2, Neurologic Considerations, has been updated with new information and references.
John C. Gray, Ola Grimsby, Peter I. Edgelow, and Susan Ryerson completely revised their
chapters.
Section 3, Special Considerations, was highlighted by a new chapter on the Frozen Shoulder
(Chapter 11) written by Mollie Beyers and Peter Bonutti. This chapter features five tables that
provide an excellent summary of the evidence-based research on treatment of frozen shoulder
pathology. In addition, a new shoulder device for treatment of adhesive capsulitis, through static
progressive stretch and stress relaxation, is also featured in this chapter. John C. Gray’s chapter
on Visceral Referred Pain to the Shoulder (Chapter 13), was rewritten, along with important
updates from Todd S. Ellenbecker, Lori Thein Brody, and Bruce H. Greenfield.
In the Treatment Approaches Section, a new chapter was added by Richard A. Ekstrom and
Roy W. Osborn on Muscle Length Testing and Electromyographic Data for Manual Strength Testing
and Exercises for the Shoulder (Chapter 15). Chapter 14, entitled Manual Therapy Techniques,
was updated with additional illustrations of new manual procedures for the shoulder, with a
section on evidence-based manual therapy treatment approaches.
The Surgical Considerations Section was honored with addition of the chapter by Xavier A.
Duralde, a prominent orthopedic surgeon who specializes in shoulder pathology and has devel-
oped his own components for shoulder replacements. In addition, I was also honored by the addi-
tion of a new chapter on Shoulder Instability (Chapter 17). The lead authors—Michael S. Zazzali
and Vijay B. Vad—are affiliated with the Hospital of Special Surgery in New York, NY. The chapter
xi
xii
PREFACE
includes state-of-the-art concepts in evaluation and treatment of the Bankart lesion, S.L.A.P
lesions, rotator cuff interval concepts, and thermal assisted capsular shifts. Finally, Jacob P.
Irwin updated Chapter 19 on Shoulder Girdle Fractures.
We are pleased to include a CD-ROM with the fourth edition of Physical Therapy of the Shoul-
der. The CD-ROM compliments the text and enhances the clinical application with excerpts of
an evaluation of a patient using manual therapy treatment techniques of the shoulder. Fresh
cadaver slides and also a link to an electronic image collection that features most of the illus-
trations contained in the book are included on the CD-ROM. This provides instructors with a
useful teaching tool because the images can be downloaded into PowerPoint for presentation in
class. The CD-ROM also features animated movement of the musculoskeletal system for the gleno-
humeral joint and scapula.
Any rehabilitation professional entrusted with the care and treatment of mechanical and patho-
logic shoulder dysfunction will benefit from this book. We trust that the fourth edition will meet
the reader’s expectation of comprehensive, clinically relevant presentations that are well docu-
mented, contemporary, and personally challenging to the student and the experienced specialist
alike.
Robert A. Donatelli, PhD, PT, OCS
Color Plates
Long head of biceps tendon
Head of the humerus
Plate 2-1
Glenoid surface with Glenoid
the labrum.
Labrum
Clavicle
Subscapularis
Plate 2-2 bursa opening
Glenohumeral joint capsule
and surrounding structures.
Anterior inferior Subscapularis tendon
glenohumeral capsule
Vertebral border Lower trapezius
of the scapula
Spine of the
scapula
Infraspinatus
Teres minor
Serratus anterior
Plate 2-3
Scapula and surrounding muscles.
Coracoacromial
Acromion process
ligament
Supraspinatus tendon
Head of the humerus
Coracoid process
Plate 2-4
Inferiorly subluxed humeral head demonstrating coracoacromial vault.
Inferior angle of Infraspinatus
the scapula
Posterior deltoid
Serratus anterior
Teres minor
Latissimus Teres major
Plate 2-5
Scapula and related muscles.