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“How I examine the overhead athlete….” A clinical reasoning algorithm Ann M. Cools, PT, PhD Ghent University Dept of Rehabilitation Sciences & Physiotherapy Belgium
Shoulder pathology? Impingement (SA & int) (Anderson Radiol Clin North Am 2010, Lintner Wrightington nov 2012 2008, Ann Cools Clin Sports Med Seroyer Sports Health 2009 , Reeser BJSM 2006, Briner Sports Med 1997)
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) Cools Wrightington nov 2012 Ann
Shoulder pathology? Impingement Rotator cuff dysfunction, including suprascapular nerve entrapment (Anderson Radiol Clin North Am 2010, Lintner Wrightington nov 2012 2008, Ann Cools Clin Sports Med Seroyer Sports Health 2009 , Reeser BJSM 2006, Briner Sports Med 1997)
Shoulder pathology? Impingement Rotator cuff pathology Instability (traumatic & acquired) (Anderson Radiol Clin North Am 2010, Lintner Wrightington nov 2012 2008, Ann Cools Clin Sports Med Seroyer Sports Health 2009 , Reeser BJSM 2006, Briner Sports Med 1997)
Shoulder pathology? Impingement Rotator cuff pathology Instability SLAP lesions (Anderson Radiol Clin North Am 2010, Lintner Wrightington nov 2012 2008, Ann Cools Clin Sports Med Seroyer Sports Health 2009 , Reeser BJSM 2006, Briner Sports Med 1997)
Shoulder pathology? Impingement Rotator cuff pathology Instability SLAP lesions Scapular dyskinesis (Anderson Radiol Clin North Am 2010, Lintner Wrightington nov 2012 2008, Ann Cools Clin Sports Med Seroyer Sports Health 2009 , Reeser BJSM 2006, Briner Sports Med 1997)
Shoulder pathology? Impingement Rotator cuff pathology Instability SLAP lesions Scapular dyskinesis GIRD (Anderson Radiol Clin North Am 2010, Lintner Wrightington nov 2012 2008, Ann Cools Clin Sports Med Seroyer Sports Health 2009 , Reeser BJSM 2006, Briner Sports Med 1997)
Impingement symptoms External Internal Subacromial (posterior) impingement impingement Primary Secondary Impingement Impingement Rotator cuff Biceps Scapular dyskinesis instability G.I.R.D. pathology SLAP Ann Cools Wrightington nov 2012 (Cools et al. BJSM 2008)
Impingement tests: Jobe, Hawkins, Neer Ann Cools Wrightington nov 2012 (Hegedus 2008)
Impingement symptoms Jobe + Jobe – Neer + ant Neer + post Hawkins + Hawkins – External Internal Subacromial (posterior) impingement impingement Primary Secondary Impingement Impingement Rotator cuff Biceps Scapular dyskinesis instability G.I.R.D. pathology SLAP (Cools et al. BJSM 2008)
Instability tests: Apprehension “Posterior Impingement Sign”– Relocation - Release Ann Cools Wrightington nov 2012 (Meister 2004)
Impingement symptoms Jobe + Jobe – Neer + ant Neer + post Hawkins + Hawkins – Apprehension +(pain) ant Apprehension +(pain) post External Internal Subacromial (posterior) impingement impingement Relocation - Relocation+ Relocation+ Release +(pain) Release +(pain) Primary Secondary Impingement Impingement Rotator cuff Biceps Scapular dyskinesis instability G.I.R.D. pathology SLAP (Cools et al. BJSM 2008)
Rotator cuff tendinopathy?: Full can test (Reinold et al. JOSPT 2009) Ann Cools Wrightington nov 2012
Impingement symptoms Jobe + Jobe – Neer + ant Neer + post Hawkins + Hawkins – Apprehension +(pain) ant Apprehension +(pain) post External Internal Subacromial (posterior) impingement impingement Relocation - Relocation+ Relocation+ Release +(pain) Release +(pain) Primary Secondary Impingement Impingement Full Can + Rotator cuff Biceps Scapular dyskinesis instability G.I.R.D. pathology SLAP (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 Jobe + Jobe – Neer + ant Neer + post Hawkins + Hawkins – Apprehension +(pain) ant Apprehension +(pain) post External Internal Subacromial (posterior) impingement impingement Relocation - Relocation+ Relocation+ Release +(pain) Release +(pain) Primary Secondary Impingement Impingement SAT + Full Can + SRT + Rotator cuff Biceps Scapular dyskinesis instability G.I.R.D. pathology SLAP (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 Jobe + Jobe – Neer + ant Neer + post Hawkins + Hawkins – Apprehension +(pain) ant Apprehension +(pain) post External Internal Subacromial (posterior) impingement impingement Relocation - Relocation+ Relocation+ Release +(pain) Release +(pain) Primary Secondary Impingement Impingement SAT + Laxity tests + Full Can + Appr + (appr) SRT + Relocation + (appr) Rotator cuff Biceps Scapular dyskinesis instability G.I.R.D. pathology SLAP (Cools et al. BJSM 2008)
Biceps pathology or SLAP? O’ Brien, Speed’s, Biceps Load II Ann Cools Wrightington nov 2012 (Hegedus et al. BJSM 2008, Oh et al. AJSM 2008)
Impingement symptoms Jobe + Jobe – Neer + ant Neer + post Hawkins + Hawkins – Apprehension +(pain) ant Apprehension +(pain) post External Internal Subacromial (posterior) impingement impingement Relocation - Relocation+ Relocation+ Release +(pain) Release +(pain) Primary Secondary Impingement Impingement O’Brien+ SAT + Laxity tests + Speeds+ Full Can + Appr + (appr) Biceps load II+ SRT + Relocation + (appr) Rotator cuff Biceps Scapular dyskinesis instability G.I.R.D. pathology SLAP (Cools et al. BJSM 2008)
GIRD? Internal Rotation ROM in 90° abduction Ann Cools Wrightington nov 2012 (Trakis et al. AJSM 2008, Cools BJSM 2010, Borstad JOSPT 2011)
Impingement symptoms Jobe + Jobe – Neer + ant Neer + post Hawkins + Hawkins – Apprehension +(pain) ant Apprehension +(pain) post External Internal Subacromial (posterior) impingement impingement Relocation - Relocation+ Relocation+ Release +(pain) Release +(pain) Primary Secondary Impingement Impingement O’Brien+ SAT + Laxity tests + Speeds+ IR Full Can + Appr + (appr) Biceps load II+ ROM↓ SRT + Relocation + (appr) Rotator cuff Biceps Scapular dyskinesis instability G.I.R.D. pathology SLAP (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) www.standaarduitgeverij.be Ann.cools@ugent.be Ann Cools Wrightington nov 2012
29
Future congress: 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
(Gent- Belgium) Thank you!! Ann Cools Wrightington nov 2012

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Ann cools 1 clinical exam [compatibiliteitsmodus]

  • 1. “How I examine the overhead athlete….” A clinical reasoning algorithm Ann M. Cools, PT, PhD Ghent University Dept of Rehabilitation Sciences & Physiotherapy Belgium
  • 2. Shoulder pathology? Impingement (SA & int) (Anderson Radiol Clin North Am 2010, Lintner Wrightington nov 2012 2008, Ann Cools Clin Sports Med Seroyer Sports Health 2009 , Reeser BJSM 2006, Briner Sports Med 1997)
  • 3. Shoulder impingement Impingement of soft tissue (tendon) between bony components External (Subacromial) Impingement (Neer 1972) Ann Cools Wrightington nov 2012
  • 4. Shoulder impingement Impingement of soft tissue (tendon) between bony components Internal (postero superior glenoid) Impingement (Walch 1990, Drakos JBJS 2009) Cools Wrightington nov 2012 Ann
  • 5. Shoulder pathology? Impingement Rotator cuff dysfunction, including suprascapular nerve entrapment (Anderson Radiol Clin North Am 2010, Lintner Wrightington nov 2012 2008, Ann Cools Clin Sports Med Seroyer Sports Health 2009 , Reeser BJSM 2006, Briner Sports Med 1997)
  • 6. Shoulder pathology? Impingement Rotator cuff pathology Instability (traumatic & acquired) (Anderson Radiol Clin North Am 2010, Lintner Wrightington nov 2012 2008, Ann Cools Clin Sports Med Seroyer Sports Health 2009 , Reeser BJSM 2006, Briner Sports Med 1997)
  • 7. Shoulder pathology? Impingement Rotator cuff pathology Instability SLAP lesions (Anderson Radiol Clin North Am 2010, Lintner Wrightington nov 2012 2008, Ann Cools Clin Sports Med Seroyer Sports Health 2009 , Reeser BJSM 2006, Briner Sports Med 1997)
  • 8. Shoulder pathology? Impingement Rotator cuff pathology Instability SLAP lesions Scapular dyskinesis (Anderson Radiol Clin North Am 2010, Lintner Wrightington nov 2012 2008, Ann Cools Clin Sports Med Seroyer Sports Health 2009 , Reeser BJSM 2006, Briner Sports Med 1997)
  • 9. Shoulder pathology? Impingement Rotator cuff pathology Instability SLAP lesions Scapular dyskinesis GIRD (Anderson Radiol Clin North Am 2010, Lintner Wrightington nov 2012 2008, Ann Cools Clin Sports Med Seroyer Sports Health 2009 , Reeser BJSM 2006, Briner Sports Med 1997)
  • 10. Impingement symptoms External Internal Subacromial (posterior) impingement impingement Primary Secondary Impingement Impingement Rotator cuff Biceps Scapular dyskinesis instability G.I.R.D. pathology SLAP Ann Cools Wrightington nov 2012 (Cools et al. BJSM 2008)
  • 11. Impingement tests: Jobe, Hawkins, Neer Ann Cools Wrightington nov 2012 (Hegedus 2008)
  • 12. Impingement symptoms Jobe + Jobe – Neer + ant Neer + post Hawkins + Hawkins – External Internal Subacromial (posterior) impingement impingement Primary Secondary Impingement Impingement Rotator cuff Biceps Scapular dyskinesis instability G.I.R.D. pathology SLAP (Cools et al. BJSM 2008)
  • 13. Instability tests: Apprehension “Posterior Impingement Sign”– Relocation - Release Ann Cools Wrightington nov 2012 (Meister 2004)
  • 14. Impingement symptoms Jobe + Jobe – Neer + ant Neer + post Hawkins + Hawkins – Apprehension +(pain) ant Apprehension +(pain) post External Internal Subacromial (posterior) impingement impingement Relocation - Relocation+ Relocation+ Release +(pain) Release +(pain) Primary Secondary Impingement Impingement Rotator cuff Biceps Scapular dyskinesis instability G.I.R.D. pathology SLAP (Cools et al. BJSM 2008)
  • 15. Rotator cuff tendinopathy?: Full can test (Reinold et al. JOSPT 2009) Ann Cools Wrightington nov 2012
  • 16. Impingement symptoms Jobe + Jobe – Neer + ant Neer + post Hawkins + Hawkins – Apprehension +(pain) ant Apprehension +(pain) post External Internal Subacromial (posterior) impingement impingement Relocation - Relocation+ Relocation+ Release +(pain) Release +(pain) Primary Secondary Impingement Impingement Full Can + Rotator cuff Biceps Scapular dyskinesis instability G.I.R.D. pathology SLAP (Cools et al. BJSM 2008)
  • 17. 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
  • 18. Impingement symptoms Jobe + Jobe – Neer + ant Neer + post Hawkins + Hawkins – Apprehension +(pain) ant Apprehension +(pain) post External Internal Subacromial (posterior) impingement impingement Relocation - Relocation+ Relocation+ Release +(pain) Release +(pain) Primary Secondary Impingement Impingement SAT + Full Can + SRT + Rotator cuff Biceps Scapular dyskinesis instability G.I.R.D. pathology SLAP (Cools et al. BJSM 2008)
  • 19. Glenohumeral laxity? Load&shift, Sulcus, posterior subluxation test Ann Cools Wrightington nov 2012
  • 20. Glenohumeral laxity? Load&shift, Sulcus, posterior subluxation test Ann Cools Wrightington nov 2012
  • 21. Impingement symptoms Jobe + Jobe – Neer + ant Neer + post Hawkins + Hawkins – Apprehension +(pain) ant Apprehension +(pain) post External Internal Subacromial (posterior) impingement impingement Relocation - Relocation+ Relocation+ Release +(pain) Release +(pain) Primary Secondary Impingement Impingement SAT + Laxity tests + Full Can + Appr + (appr) SRT + Relocation + (appr) Rotator cuff Biceps Scapular dyskinesis instability G.I.R.D. pathology SLAP (Cools et al. BJSM 2008)
  • 22. Biceps pathology or SLAP? O’ Brien, Speed’s, Biceps Load II Ann Cools Wrightington nov 2012 (Hegedus et al. BJSM 2008, Oh et al. AJSM 2008)
  • 23. Impingement symptoms Jobe + Jobe – Neer + ant Neer + post Hawkins + Hawkins – Apprehension +(pain) ant Apprehension +(pain) post External Internal Subacromial (posterior) impingement impingement Relocation - Relocation+ Relocation+ Release +(pain) Release +(pain) Primary Secondary Impingement Impingement O’Brien+ SAT + Laxity tests + Speeds+ Full Can + Appr + (appr) Biceps load II+ SRT + Relocation + (appr) Rotator cuff Biceps Scapular dyskinesis instability G.I.R.D. pathology SLAP (Cools et al. BJSM 2008)
  • 24. GIRD? Internal Rotation ROM in 90° abduction Ann Cools Wrightington nov 2012 (Trakis et al. AJSM 2008, Cools BJSM 2010, Borstad JOSPT 2011)
  • 25. Impingement symptoms Jobe + Jobe – Neer + ant Neer + post Hawkins + Hawkins – Apprehension +(pain) ant Apprehension +(pain) post External Internal Subacromial (posterior) impingement impingement Relocation - Relocation+ Relocation+ Release +(pain) Release +(pain) Primary Secondary Impingement Impingement O’Brien+ SAT + Laxity tests + Speeds+ IR Full Can + Appr + (appr) Biceps load II+ ROM↓ SRT + Relocation + (appr) Rotator cuff Biceps Scapular dyskinesis instability G.I.R.D. pathology SLAP (Cools et al. BJSM 2008)
  • 26. Measurement of GH ROM Digital inclinometer (Acumar) (Cools et al. Submitted JAT 2012) Ann Cools Wrightington nov 2012
  • 27. 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
  • 28. 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) www.standaarduitgeverij.be Ann.cools@ugent.be Ann Cools Wrightington nov 2012
  • 29. 29
  • 30. Future congress: 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
  • 31. (Gent- Belgium) Thank you!! Ann Cools Wrightington nov 2012