Update on shoulder and knee assessment, exercises and progressions - Chris Whybrow and Neil Cheek - Pinehill Hospital

Update on shoulder and knee
assessment, exercises and
progressions
Chris Whybrow and Neil Cheek

ramsayhealth.com

Pinehill Physiotherapy Department
    All MSK problems
    Women’s Health
    ESWT
    Sport Rehab
    OA management
    Chronic pain
    Hand therapy
    Falls management
    General exercise
    Strength and Conditioning

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Learning Outcomes

•   Discuss current methods for shoulder and knee assessment.

•   Develop a basic understanding of fundamental movement patterns
    of the upper and lower limbs.

•   Develop a basic understanding of exercise options for shoulder and
    knee pain.

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Shoulder Assessment

Shoulder assessment
1. Listen to the patient.

2. Think about the language/terms you use (Zadro et al, 2021).

3. Clear cervical spine

4. Avoid special shoulder testing (Hegedus et al, 2008, Lewis et al, 2015).
         "It is not possible to make a definitive diagnosis with the clinical tests currently in use“ (Lewis et al
         2007)
5. Check range of movement.

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Sub acromial impingement?
In some quarters SAI is seen an outdated biomedical model to try and explain non traumatic shoulder pain.

Radiological findings are commonly the same on symptomatic and asymptomatic shoulders. Therefore this
does not correlate well in terms of a diagnosis. (Van Parys et al. 2021 -
https://biblio.ugent.be/publication/8690814 )

The language used to describe shoulder pain has a big bearing on a patients expectation of its management
(Zadro et al, 2021).

Sub acromial pain/Rotator cuff related pain are better terms to use than an impingement.

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Clinical evidence of bilateral radiological changes
on imaging
1. Patients Older Than 40 Years With Unilateral Occupational Claims for
   New Shoulder and Knee Symptoms Have Bilateral MRI Changes (2017)
   https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5599397/

2. Prevalence of abnormalities on shoulder MRI in symptomatic and
   asymptomatic older adult (2014)
   https://onlinelibrary.wiley.com/doi/full/10.1111/1756-185X.12476

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Exercise needs to be MEANINGFUL!

Exercising into pain is okay! (Smith et al, 2017)

Don’t stop – modify!

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Shoulder movement patterns for exercise planning
1. Horizontal Push

2. Horizontal Pull

3. Vertical Push

4. Vertical Pull

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Exercise prescription?

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Knee Assessment

Knee assessment.
1. Listen to the patient

2. Observation

3. Possible need for special tests depending on the nature of the symptoms, palpation if indicated.

4. ROM and ability to complete fundamental movement patterns.

5. Sport specific assessment?

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Exercise needs to be MEANINGFUL!

Exercising into pain is okay!

Don’t stop – modify!

Lower Limb Movement Patterns
1. Squat Pattern

2. Lunge Pattern

3. Hip Hinge

4. Single Leg movement patterns

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Variations of squat

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Summary of key points
1. Listen to patient

2. Avoid unnecessary labels – keep it simple succinct and non- threatening

3. Make exercises meaningful and not generic

4. Don’t stop exercising – modify! Sometimes you have to go backwards to go forwards.

5. Don’t be afraid of pain!

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References
1. Hegedus EJ, Goode A, Campbell S, Morin A, Tamaddoni M, Moorman CT, Cook C. Physical examination tests of
   the shoulder: a systematic review with meta-analysis of individual tests. British journal of sports medicine. 2008 Feb
   1;42(2):80-92.
2. Lewis J, McCreesh K, Roy JS, Ginn K. Rotator cuff tendinopathy: navigating the diagnosis-management
   conundrum. Journal of orthopaedic & sports physical therapy. 2015 Nov;45(11):923-37.
3. Lewis JS, Tennent TD. How Effective are our Diagnostic Tests for Rotator Cuff Pathology. Evidence Based Sports
   Medicine. 2nd Edition. BMJ Books. Blackwell Publishing. 2007
4. Smith B, Hendrick P, Smith T, Bateman M, Moffatt F, Rathleff M, Selfe J & Logan P (2017) Should exercises be
   painful in the management of chronic musculoskeletal pain? A systematic review and meta-analysis. British journal
   of sports medicine, 51(23), 1679–1687.
5. Van Parys M, Alkiar O, Naidoo N, Van Tongel, A and De Wilde L, (2021) Three-dimensional evaluation of the
   scapular morphology in primary glenohumeral arthritis, rotator cuff arthropathy and asymptomatic shoulders.
   Journal of Shoulder and Elbow Surgery. In Press 8 pages
6. Zadro J, O’Keeffe M, Ferreira G, Haas R, Harris I, Buchbinder R & Maher C (2021) Diagnostic Labels for Rotator
   Cuff Disease Can Increase People’s Perceived Need for Shoulder Surgery: An Online Randomized Controlled
   Experiment. Journal Of Orthopaedic & Sports Physical Therapy, 1-45.

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