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Physical Therapy of the Shoulder FIFTH EDITION • Image Collection • Reference lists linked to Medline • Video clips Physical Therapy of the Shoulder FIFTH EDITION Edited by Robert A. Donatelli, PhD, PT, OCS National Director of Sports Rehabilitation Physiotherapy Associates Las Vegas, Nevada 3251 Riverport Lane St. Louis, Missouri 63043 PHYSICAL THERAPY OF THE SHOULDER, FIFTH EDITION ISBN: 978-1-4377-0740-3 Copyright # 2012, 2004, 1997, 1991, 1987 by Churchill Livingstone, an imprint of Elsevier Inc. All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopy, recording, or any information storage and retrieval system, without permission in writing from the publisher. Details on how to seek permission, further information about the Publisher’s permissions policies and our arrangements with organizations such as the Copyright Clearance Center and the Copyright Licensing Agency, can be found at our website: www.elsevier.com/permissions. This book and the individual contributions contained in it are protected under copyright by the Publisher (other than as may be noted herein). Notices Knowledge and best practice in this field are constantly changing. As new research and experience broaden our understanding, changes in research methods, professional practices, or medical treatment may become necessary. Practitioners and researchers must always rely on their own experience and knowledge in evaluating and using any information, methods, compounds, or experiments described herein. In using such information or methods they should be mindful of their own safety and the safety of others, including parties for whom they have a professional responsibility. With respect to any drug or pharmaceutical products identified, readers are advised to check the most current information provided (i) on procedures featured or (ii) by the manufacturer of each product to be administered, to verify the recommended dose or formula, the method and duration of administration, and contraindications. It is the responsibility of practitioners, relying on their own experience and knowledge of their patients, to make diagnoses, to determine dosages and the best treatment for each individual patient, and to take all appropriate safety precautions. To the fullest extent of the law, neither the Publisher nor the authors, contributors, or editors, assume any liability for any injury and/or damage to persons or property as a matter of products liability, negligence or otherwise, or from any use or operation of any methods, products, instructions, or ideas contained in the material herein. Library of Congress Cataloging-in-Publication Data Physical therapy of the shoulder / edited by Robert A. Donatelli. – 5th ed. p. ; cm. Includes bibliographical references and index. ISBN 978-1-4377-0740-3 (hard copy) 1. Shoulder–Wounds and injuries. 2. Shoulder–Wounds and injuries–Treatment. 3. Shoulder–Wounds and injuries–Physical therapy. I. Donatelli, Robert. II. Title. [DNLM: 1. Shoulder–injuries. 2. Shoulder Joint–injuries. 3. Physical Therapy Modalities. WE 810] RD557.5.P48 2011 617.5’72044–dc22 2011001297 Executive Editor: Kathy Falk Developmental Editor: Megan Fennell US/Chennai Publishing Services Managers: Julie Eddy and Rajendrababu Hemamalini US/Chennai Project Managers: Celeste Clingan and Srikumar Narayanan Designer: Jessica Williams Printed in 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 son, Robby, and my daughters, Briana and Rachel. They have added a new meaning of love, joy and happiness to my life. This page left intentionally blank Contributors RANDA A. BASCHARON, DO, AT XAVIER A. DURALDE, MD Owner, President, Orthopedic and Sports Medicine Peachtree Orthopedics Clinic, Assistant Clinical Professor Institute Of Las Vegas, Sports Performance Institute of of Orthopedic Surgery, Clinical Instructor, Emory University Las Vegas, Las Vegas, Nevada School of Medicine, Atlanta, Georgia MOLLIE BEYERS, DPT RICHARD A. EKSTROM, PT, DSC, MS Physical Therapist, Biomax Rehabilitation, Effingham, Professor, Department of Physical Therapy, University of Illinois South Dakota, Vermillion, South Dakota PETER BONUTTI, MD, FACS, FAAOS, FAANA TODD S. ELLENBECKER, DPT, MS, SCS, OCS, CSCS Founder and Director, Bonutti Clinic, Founder and Clinic Director, Physiotherapy Associates Scottsdale Sports Director, Bonutti Technology, Effingham, Illinois, Assistant Clinic, National Director of Clinical Research, Physiotherapy Clinical Professor, Department of Orthopedic Surgery, Associates, Director of Sports Medicine, ATP World Tour, University of Arkansas, Fayetteville, Arkansas Scottsdale, Arizona KENJI C. CARP, MPT, OCS, ATC ROBERT L. ELVEY, BAPPSC, GRAD. DIP. MANIP. THER. Certified Vestibular Therapist, Director, Owner, Senior Lecturer, Curkin University, Physiotherapy Cooperative Performance and Rehabilitation, Eugene, Consultant, Southcare Physiotherapy, Perth, Australia Oregon KATHLEEN GEIST, PT, DPT, OCS, COMT JEFF COOPER, MS, ATC Assistant Professor, Division of Physical Therapy, Athletic Training Solutions, Wilmington, Delaware, Department of Rehabilitation Medicine, Emory University Consultant, Player Development, Philadelphia Phillies, School of Medicine, Atlanta, Georgia Philadelphia, Pennsylvania JOHN C. GRAY, DPT, OCS, FAAOMPT DONN DIMOND, PT, OCS Lead Clinical Specialist, Department of Physical Director of Clinical Operations, Owner, The KOR Physical Therapy, Sharp Rees-Stealy, Clinical Instructor, Ola Therapy, Portland, Oregon Grimsby Institute, Credentialed Clinical Instructor, American Physical Therapy Association, Associate Editor, JAN DOMMERHOLT Journal of Manual and Manipulative Therapy, San Diego, President and Physical Therapist, Bethesda Physiocare, California Inc/Myopain Seminars, LLC, Bethesda, Maryland BRUCE H. GREENFIELD, PT, PHD, OCS PHILLIP B. DONLEY, PT ATC MS Assistant Professor, Department of Rehabilitation, Center Optimum Physical Therapy, West Chester, Pennsylvania for Ethics, Emory University, Atlanta, Georgia viii Contributors OLA GRIMSBY, PT DOUGLAS M. MURRAY, MD Chairman of the Board, Ola Grimsby Institute, San Diego, Surgeon, Peachtree Orthopedic Clinic, Consulting California Physician, Shepherd Center, Atlanta, Georgia TOBY M. HALL, PHD, MSC, POST GRAD DIP MANIP THER, ROY W. OSBORN, PT, MS, OCS ASSOC IN PHYSIOTHERAPY Associate Professor, Physical Therapist, Physical Therapy Director Manual Concepts, Perth, Australia, Adjunct Department, Avera McKennan Hospital and University Senior Teaching Fellow, School of Physiotherapy, Curtin Health System, Sioux Falls, South Dakota Innovation Health Research Institute, Curtin University of Technology, Bentley, Australia, Senior Teaching Fellow, The University of Western Australia, Perth, Australia, Director JAIME C. PAZ, PT, DPT, MS Manual Concepts, Perth, Australia Clinical Associate Professor, Division of Physical Therapy, Walsh University, North Canton, Ohio { SCOT IRWIN, DPT, CCS Formerly, Associate Professor, Department of Physical SCOTT D. PENNINGTON, MD Therapy, North Georgia College and State University, Surgeon, Peachtree Orthopedic Clinic, Atlanta, Georgia Dahlonega, Georgia ROBERT C. MANSKE, PT, DPT, SCS, MED, ATC, CSCSC VIJAY B. VAD, MD Associate Professor, Department of Physical Therapy, Assistant Professor of Rehabilitation Medicine, Hospital Wichita State University, Wichita, Kansas for Special Surgery, New York, New York JOHNSON MCEVOY, PT, BSC, MSC, DPT, MISCP, MCSP JOSEPH S. WILKES, MD Chartered Physiotherapist in Private Practice, United Clinical Associate Professor, Orthopedics, Emory Physiotherapy Clinic, Limerick, Ireland, Head University, Active Staff Member, Piedmont Hospital, Physiotherapist, Irish Boxing High Performance Team, Specialty Consulting, Crawford Long Hospital, Atlanta, Dublin, Ireland, External Lecturer, Sports Science, University Georgia, Active Staff Member, Fayette Community Hospital, of Limerick, Limerick, Ireland Fayetteville, Georgia CRAIG D. MORGAN, MD Clinical Professor, University of Pennsylvania, Department MICHAEL S. ZAZZALI, DSC, PT, OCS of Orthopaedics, Philadelphia, Pennsylvania, Morgan Kalman Co-Director and Partner, Physical Therapy Associates of Clinic, Wilmington, Delaware New York, New York, New York { Deceased. Preface The first edition of Physical Therapy of the Shoulder was pub- Part 2, Neurologic Considerations, has been updated with lished in 1987, and now we are publishing the fifth edition new information and references. John C. Gray and Ola Grimsby’s nearly 25 years later. I would like to thank my readers for chapter, Interrelationship of the Spine, Rib Cage, and Shoulder, their support throughout the years that has made this book along with Neural Tension Testing by Tobby Hall and Bob successful. The fifth edition has kept up with the tradition Elvy have been revised, and Bruce H. Greenfield and Kathleen of Physical Therapy evidence-based practice. It is amazing Geist did a great job updating the chapter on Evaluation and how the literature now has developed our profession from Treatment of Brachial Plexus Lesions. A new chapter, Sensory and art to a science. Each chapter is a excellent example of Integration and Neuromuscular Control of the Shoulder by how the science of Physical Therapy continues to grow. Kenji Carp has been added to the neurological section. I think The shoulder joint is a complicated structure consisting of you will find that Kenji did an excellent job on defining three synovial joints, the scapula thoracic articulation, and 17 neuromuscular control in the upper limb. The chapter is an muscles. The shoulder complex hangs off the rib cage and is excellent representation of state of the art information that is connected to the cervical and thoracic spine. The complexity of critical to the rehabilitation of shoulder patients. the shoulder makes many rehabilitation students and clinicians Part 3, Special Considerations, was highlighted by the uncertain in assessing shoulder pathomechanics and in establish- separation of Chapter 10 into two chapters, Impingement ing treatment approaches for different shoulder pathologies. Syndrome and Shoulder Instabilities. Bruce Greenfield did In keeping up to date with new and innovative treatment an excellent job on describing the mechanisms of impinge- techniques, surgical procedures, and evaluation methods for ment and the new chapter, on shoulder instabilities, by the shoulder, this fifth edition of Physical Therapy of the Shoulder Michael Zazzali, focused on the conservative approach to the has been updated appropriately. There are 7 new chapters and evaluation and treatment of shoulder instabilities. The Frozen 8 new authors. The fifth edition is once again divided into five Shoulder chapter was update by Mollie Beyers and Peter parts; Mechanics of Movement and Evaluation, Neurologic Bonutti. This chapter provides an excellent summary of the Considerations, Special Considerations, Treatment Approaches, evidence-based research on treatment of frozen shoulder and Surgical Considerations. pathology. John C. Gray’s chapter on Visceral Referred Pain In honor of the memory of the late Scot Irwin, Jaime Paz to the Shoulder, was rewritten, along with important updates helped to revise the Guide to Physical Therapist Practice. from Todd S. Ellenbecker on rotator cuff pathology. The chapter is an overview of the Guide. Chapter 2 was In the Treatment Approaches Section, Richard A. Ekstrom updated with new anatomic and biomechanical information and Roy W. Osborn did an excellent job on adding addition on how the shoulder moves. Chapter 3 was rewritten by Jeff research on Muscle Length Testing and Electromyographic Cooper with all the new information on the throwing injuries Evidence for Manual Strength Testing and Exercises for the to the shoulder. Jeff has included new research data that he Shoulder. The Manual Therapy Techniques was updated with has collected over the past several years on professional baseball additional illustrations of new manual procedures for the pitchers. His approach to evaluation and treatment is state shoulder, with a section on evidence-based manual therapy of the art. Chapter 4 is a new chapter by Donn Dimond treatment approaches. The treatment section was highlighted that finishes the first section with updates on all the new- by one of two new chapters by Donn Dimond on strength evidenced-based special tests for the shoulder. The special tests training in the shoulder. As previously noted the shoulder on the shoulder greatly assist the clinician in the development has 17 muscle that allow it to move in multiple planes. of a differential soft tissue diagnosis. In addition, manual Therefore this chapter is long awaited as the strength of muscle testing to isolate the shoulder muscles is illustrated. the shoulder muscles is critical to the overall function. Finally,