What is “…the shoulder?” Definition...throwing athlete in association with internal impingement and SLAP (superior labral anterior posterior) lesions.2,3 • These tears tend

1132019

1

Rotator Cuff Tendonitis Case Study Series

Steven G Yeomans DC FACO 404 Eureka Street Ripon WI 64971-0263 920-748-3644 (Ph) 920-748-3642 (Fax) sgyeomanscharternet wwwyeomansdccom

httpschiroupcom

SGY Disclaimer

Some of todayrsquos slides

were part of the above

presentation

Great work Brandon

What is ldquohellipthe shoulderrdquo

4 ldquoJointsrdquo

Definition bull The rotator cuff is a group of 4 tendons that blend together to help stabilize and

move the shoulder

bull Each of the four tendons connects a muscle originating on the scapula to part of

the proximal humerus

bull The names of these muscle-tendon components of the rotator cuff are

Supraspinatus Runs over the top of the humeral head (ERABD)

Subscapularis Runs across the front of the humeral head (IRADD)

Infraspinatus Runs across the back of the humeral head (ERADD)

Teres minor Runs across the back of the humeral head (ERADD)

Next Slide

1132019

2

ANT

ANT

1132019

3

1132019

4

Risk factors

The following factors may increase your risk of having a

rotator cuff injury

Age As you get older your risk of a rotator cuff injury

increases Rotator cuff tears are most common in people

older than 40

Certain sports Athletes who regularly use repetitive arm

motions such as baseball pitchers archers and tennis

players have a greater risk of having a rotator cuff injury

Construction jobs Occupations such as carpentry or house

painting require repetitive arm motions often overhead that

can damage the rotator cuff over time

Family history There may be a genetic component involved

with rotator cuff injuries as they appear to occur more

commonly in certain families

Rotator Cuff Injuries

1132019

5

httpswwwresearchgatenetpublication326099194_Degenerative_Changes_in_Asymptomatic_Subjects_A_Descriptive_Study_E

xamining_the_Supraspinatus_Using_Musculoskeletal_Sonography_in_a_Young_Population

CASE STUDIES (2019)

1132019

6

httpswwwncbinlmnihgovpmcarticlesPMC3438862

Handout 2


HIGHLIGHTS

bull Rotator cuff injuries are commonly attributed to repetitive overuse in the overhead

throwing athlete in association with internal impingement and SLAP (superior labral

anterior posterior) lesions23

bull These tears tend to be articular sided and are partial tears6

bull Acute traumatic injuries are much less common in this population11 and often result in

contusions of the rotator cuff as opposed to discrete tears7

bull However when full-thickness tears do present in the young population they are

typically the result of acute trauma instead of overuse11

bull Despite the rarity this injury should not be overlooked and must remain in the

differential of shoulder injuries in the young athlete including such entities as SLAP

tears ldquostingersrdquoldquoburnersrdquo cuff contusions and deltoid contusions

bull Contact athletes may initially present with something similar to a ldquodead arm syndromerdquo

with transient loss of use of the involved upper extremity12 If dismissed as a brachial

plexus neuropraxia (stinger or burner) the rotator cuff tear may progress

bull Dead arm syndrome is often attributed to internal impingement ampSLAP tears as well56

bull Cuff contusions are also common in contact athletes and present with acute short-term

loss of rotator cuff function7

bull It has been our experience that traumatic rotator cuff tears progress more rapidly to

the point of irreparability than do degenerative lesions in older patient populations

bull Timely diagnosis is therefore crucial


Case Report

bull 16-year-old RT-hand-dominant high school quarterback

bull LT shoulder injury - outstretched overhead holding the ball as he dove into

the end zone

bull Tackled from behind as he landed with direct contact to the posterior aspect

of the left shoulder

bull Sx immediate severe pain Lt shoulder discontinued play

bull Evaluated next day dt continued pain amp inability to elevate the upper

extremity

bull Radiographs = posterior humeral subluxation but no fracture

bull An magnetic resonance imaging (MRI) scan amp referral made

Case Report

bull Initial Exam (4d post-trauma)

Guarded posture diffuse tenderness throughout the shoulder

Passive ROM was unrestricted (but wsignificant discomfort)

Limited active ROM

Rotator cuff strength testing 25 strength on shoulder abduction

(supraspinatus) and external rotation (infraspinatus) with a positive liftoff test

(subscapularis)

httpswwwslidesharenetAartiSareentests-for-shoulder-joint

Or YouTube

httpswwwyoutubecomwatchv=Q3gIjMkg91k


Case Report


Instability evaluation was limited dt pain amp guarding however no

discrete anterior instability was found w load and shift or with abduction and

external rotation

The humeral head was resting posterior but in a reduced position (sublux)

Increased translation and pain were present with a posterior load and shift

but the shoulder was not able to be dislocated

The patient was neurovascular intact

Sulcus sign was negative

Or YouTube

httpswwwyoutubecomwatchv=vV7u2

JtdYWI


Case Report

Initial Exam (4d post-trauma)

bull The MRI revealed marked posterior subluxation of the humeral

head with a large accumulation of edema and hemorrhage in the

glenohumeral joint

bull The MRI also revealed complete full-thickness tears of the

supraspinatus and infraspinatus tendons from their insertions a

complete full-thickness tear of the subscapularis with medial

subluxation of the long head of the biceps tendon and a probable

full-thickness tear of the teres minor tendon (Figure 1)

1132019

7

Figure 1

Preoperative MRI A gradient echo T2-

weighted axial image (S = subscapularis

muscle) The humeral head is severely

subluxed posteriorly The subscapularis

tendon is completely torn and retracted

(large black arrowhead) The long head of

the biceps tendon (black arrow) is

dislocated medially out of the bicipital

groove (small white arrowhead)

Extensive amorphous low-signal tissue in

the anterior joint is compatible with

hemorrhage

B fat-saturated T2 oblique coronal image

(IS = infraspinatus muscle) The

infraspinatus tendon is completely torn

and retracted (small white arrowhead)

There is also complete rupture of the teres

minor with extensive fluid and

hemorrhage in its expected position (large

white arrowheads)

ANT

POST

httpswwwncbinlmnihgovpmcarticlesPMC3438862 Case Report


Surgery 7 days postinjury

Given the 4-tendon involvement an open-cuff repair was planned however arthroscopy was

recommended to first assess the labrum and biceps tendon

Arthroscopy = marked hemorrhage amp edema in the glenohumeral joint (Figure 2)

A The extensive injury to the rotator cuff was confirmed as was instability of the biceps tendon

B Remarkably the glenoid labrum was intact throughout its perimeter with no posterior labral disruption

A debridement of the tendon edges and hemorrhage was completed the biceps released and the

arthroscope removed in preparation for the open approach The arthroscopic portion of the case

was kept brief to prevent excessive swelling from hampering the open repair



A combined anterior and posterior approach was selected owing to concern that a single extended approach

may not allow complete access to the extremes of the rotator cuff for repair

The posterior approach was first performed A longitudinal incision was created overlying the deltoid and

centered on the posterior glenohumeral joint The posterior arthroscopic portal was incorporated into the incision

The deltoid fascia was incised and upon splitting the deltoid fibers the posterior humeral articular surface was in

direct visualization confirming a complete avulsion of the infraspinatus tendon and disruption of the posterior

capsule (Figure 3)

Involvement of the teres minor was also documented

Two bioabsorbable anchors with a total of 4 suture sets passed in horizontal mattress configuration were used to

accomplish a repair of the infraspinatus and upper teres minor tendons

Posterior approach

Upon reflecting the

deltoid the articular

surface of the

humeral head and

torn infraspinatus

tendon are

visualized



The anterior (deltopectoral) approach was then performed

Upon development of the interval it was readily evident that the subscapularis tendon had completely avulsed

off of its insertion onto the lesser tuberosity and the biceps tendon had subluxed medially out of the bicipital

groove

During superior retraction access to the supraspinatus was achieved and the full-thickness tear was easily

identified

A total of 3 additional double-loaded bioabsorbable anchors were placed to repair the supraspinatus and

subscapularis

With each anchor both sets of sutures were passed in horizontal mattress configuration In all 5 anchors and 10

suture sets were used to complete the rotator cuff repair

The excellent tendon quality and mobility and strong repair resulted in confidence with a single-row repair A

second row was not deemed to be necessary

A biceps tenodesis was also performed through the anterior approach with the use of a bioabsorbable tenodesis

screw

All wounds were thoroughly irrigated and closed The patient was placed into an external rotation sling with

the arm in neutral


bull 2 weeks to 3 months post-surgical

At 2-week follow-up sutures were removed and the patient was continued in the external rotation sling

Elbow range of motion and pendulum exercises were initiated

At 4-week follow-up radiographs revealed a concentric reduction of the glenohumeral joint

Physical therapy was initiated for passive range of motion

At 8-week follow-up the patient continued to show improvement but reported involvement in a motor vehicle

accident 2 weeks beforehand (6 weeks following surgery) with transient increase in shoulder pain

Range of motion revealed forward flexion to 120deg and external rotation to 20deg

Due to the recent trauma a repeat MRI was ordered

The MRI eventually performed nearly 3 months postsurgery revealed a concentrically reduced glenohumeral

joint with no evidence of persistent or recurrent rotator cuff tear (Figure 4)


Postoperative MRI (3-mo) A T1-weighted oblique coronal image Artifact

from an anchor is present within the greater tuberosity (arrowhead) Note the

intact supraspinatus tendon (arrow)

B gradient echo T2-weighted axial image The subscapularis (black arrow) and

infraspinatus (arrowhead) tendons are intact after repair (white arrow = artifact

from anchor)

1132019

8


bull 3 to 12 months post-surgical

Clinical follow-up at 3-months demonstrated continued improvements in motion with

active forward flexion to 140deg and external rotation comparable to the contralateral side

at 60deg

No instability was evident on clinical exam and the patient was without apprehension

At the last clinical follow-up 5 months following surgery the patient demonstrated

170deg of active forward flexion and abduction external and internal rotation comparable

to the contralateral side and an intact rotator cuff throughout to strength testing

At 6 months the patient had returned to baseball with no recurrent symptoms and 1

year following injury he has returned to football without complaint


Case Report

bull DISCUSSION (1 of 6)

Few reports of traumatic rotator cuff tears in adolescent and young adult patients exist

in the literature

One case report of an intercollegiate football player with a high-grade partial

thickness supraspinatus tear was reported after an axial load to the involved shoulder

with impaction of the humeral head into the undersurface of the acromion8

The patient was treated with arthroscopic evaluation followed by open rotator cuff

repair and acromioplasty

The athlete returned to full activity following a structured 4-month 7-phase

rehabilitation program


Case Report

bull DISCUSSION (continued 2 of 6)

In 1996 Blevins et al reported on 10 contact athletes with traumatic rotator cuff injuries4

All were the result of a direct blow to the shoulder while participating in football

Patients were aged 24 to 36 years old

There were 3 full-thickness tears 5 partial-thickness tears and 2 cuff contusions

All underwent operative intervention and 9 of 10 returned to football

The authors reported that internal injury within the rotator cuff and bleeding within the

subacromial space (a cuff contusion) can lead to scar formation that results in an acute

impingement process

They concluded that arthroscopic evaluation should be considered in contact athletes with

shoulder pain and weakness after a direct blow to the shoulder if there is lack of improvement with

a cuff rehabilitation program


Case Report


Another study reported the incidence of rotator cuff tears in adolescents as 08 (3 of 379

tears)10

Of the 3 patients only 1 had a full-thickness (ldquopinhole sizerdquo) tear in the supraspinatus

The remaining 2 were articular-sided partial-thickness tears

All 3 patients developed the cuff lesion as a result of traumatic injury

The authors concluded that rotator cuff tears in the young patient are associated with extrinsic

factors such as traumatic stress applications as opposed to rotator cuff degeneration

These studies highlight the concept that rotator cuff

tears can occur in the young athletic population and

must be considered in the evaluation to not be

overlooked on initial presentation


Case Report


Hulstyn and Fadale reported on the multifactorial nature of rotator cuff tears in an

athletic population9

Three mechanisms were proposed including intrinsic tendon disease associated with

repetitive overuse and microtrauma extrinsic tendon (outlet) impingement as described

by Neer13 and intra-articular impingement (internal impingement)

Each of these proposed mechanisms may contribute to rotator cuff pathology in the

athletic population


Case Report


Traumatic cuff tears may be more prevalent in the setting of high-energy

glenohumeral dislocations as was likely the case in the patient presented above

Although not specifically reported by the patient and although the labrum was intact

dislocation was likely given the marked posterior subluxation of the humeral head on

radiographs and MRI

Disruption of the posterior capsule was evident on MRI and the posterior approach

although it was not specifically addressed

While rotator cuff tear in association with dislocation is most common in adults gt40

years of age the association must not be dismissed in the young patient as well

Even fewer reports of cuff tears exist in association with posterior dislocations

making the diagnosis even more elusive15

1132019

9


Case Report

bull DISCUSSION Conclusions (continued 6 of 6)

Traumatic cuff tears are rare in the young athletic population

Contusions and partial thickness tears of the rotator cuff are more commonly documented in the

literature1714

Despite this full-thickness tears must be considered in the evaluation of a young patient with a

traumatic shoulder injury

Early identification and expedient management are crucial

These injuries may initially be dismissed as brachial plexus neuropraxias or cuff contusions

particularly in the football population

If overlooked the rotator cuff tear is likely to progress and may become irreparable by the time

of diagnosis

Rotator cuff repairs have been shown to produce excellent results in patients younger than 40

years of age and to return patients to preinjury level of function11

We believe that this case report highlights the possibility of massive cuff tear in the young

athletic population to help prevent misdiagnosis and mismanagement of this potentially devastating

injury

When this injury is recognized and treated appropriately good outcomes and return to sport can

be achieved as demonstrated in this patient

SIDEBAR

Are most kids that return to their sport after an injury safe

to do so

httpswwwncbinlmnihgovpubmed30668134

J Athl Train 2019 Feb54(2)170-176 doi 1040851062-6050-553-15 Epub 2019 Jan 22

Changes in Patient-Reported Outcome Measures From the Time of Injury to Return to Play in Adolescent

Athletes at Secondary Schools With an Athletic Trainer

Simon JE1 Valier ARS2 Kerr ZY3 Djoko A4 Marshall SW3 Dompier TP5

Author information 1School of Applied Health Sciences and Wellness Ohio University Athens2Department of Interdisciplinary Health Sciences-Research

Support Arizona School of Health Sciences AT Still University Mesa3University of North Carolina at Chapel Hill4The Datalys

Center for Sports Injury Research and Prevention Inc Indianapolis IN5Lebanon Valley College Annville PA

Abstract

CONTEXT

Typically athletic trainers rely on clinician-centered measures to evaluate athletes return-to-play status However

clinician-centered measures do not provide information regarding patients perceptions

OBJECTIVE

To determine whether clinically important changes in patient-reported outcomes were observed from the time of

lower extremity injury to the time of return to play in adolescent athletes

DESIGN

Cross-sectional study

SETTING

The National Athletic Treatment Injury and Outcomes Network (NATION) program has captured injury and

treatment data in 31 sports from 147 secondary schools across 26 states A subsample of 24 schools participated in

the outcomes study arm during the 2012-2013 and 2013-2014 academic years






PATIENTS OR OTHER PARTICIPANTS

To be included in this report student-athletes must have sustained a knee lower leg ankle or foot injury that

restricted participation from sport for at least 3 days A total of 76 initial assessments were started by athletes for 69

of those return-to-play surveys were completed and analyzed

MAIN OUTCOME MEASURE(S)

All student-athletes completed generic patient-reported outcome measures (Patient-Reported Outcomes

Measurement Information System [PROMIS] survey Global Rating of Change scale and Numeric Pain Rating

Scale) and depending on body region completed an additional region-specific measure (Knee Injury and

Osteoarthritis Outcome Score or Foot and Ankle Ability Measure) All applicable surveys were completed at both the

initial and return-to-play time points Means and standard deviations for the total scores of each patient-reported

outcome measure at each time point were calculated Change scores that reflected the difference from the initial to

the return-to-play time points were calculated for each participant and compared with established benchmarks for

change

RESULTS

The greatest improvement in patient-reported outcomes was in the region-specific forms with scores ranging from

992 to 3773 on the different region-specific subscales (Knee Injury and Osteoarthritis Outcome Score or Foot and

Ankle Ability Measure scores range from 0-100) The region-specific subscales on average still showed a 218- to

375-point deficit in reported health at return to play The PROMIS Lower Extremity score increased on average by

13 points all other PROMIS scales were within normative values after injury

CONCLUSIONS

Adolescent athletes who were injured at a high school with an athletic trainer may have shown improvement in

patient-reported outcomes over time but when they returned to play their outcome scores remained lower than

norms from comparable athlete groups

JCCA DC case study

J Can Chiropr Assoc 2000 Sep 44(3) 169ndash176

PMCID PMC2485523

Adhesive capsulitis a case report

Mohsen Kazemi (RN DC FCCSS(C) (CMCC instructor)

Copyright and License information Disclaimer

httpswwwncbinlmnihgovpmcarticlesP

MC2485523

Handout 3

JCCA DC case study

bull J Can Chiropr Assoc 2000 Sep 44(3) 169ndash176 bull PMCID PMC2485523 bull Adhesive capsulitis a case report bull Mohsen Kazemi (RN DC FCCSS(C) (CMCC instructor) bull Copyright and License information Disclaimer

Abstract bull Adhesive capsulitis or frozen shoulder is an uncommon entity in athletes However it is a common

cause of shoulder pain and disability in the general population bull Although it is a self limiting ailment its rather long restrictive and painful course forces the

affected person to seek treatment bull Conservative management remains the mainstay treatment of adhesive capsulitis This includes

chiropractic manipulation of the shoulder therapeutic modalities mobilization exercise soft tissue therapy nonsteroidal anti-inflammatory drugs and steroid injections

bull Manipulation under anesthesia is advocated when the conservative treatment fails bull A case of secondary adhesive capsulitis in a forty-seven-year-old female recreational squash player

is presented to illustrate clinical presentation diagnosis radiographic assessment and conservative chiropractic management

bull The patientrsquos shoulder range of motion was full and pain free with four months of conservative chiropractic care


1132019

10

JCCA DC case study

Case report bull 40yo F recreational squash player w of LT shoulder pain bull Pain started insidiously in the cervical spine 1yr before and later progressed to the

left shoulder bull PCP gave her anti-inflammatory Rx injected cortisone into her left shoulder Rx PT bull PT Acupuncture mobilization of the left shoulder and neck exercises (using small

weights rubber tube and pulleys) and interferential current therapy for 7 months bull Plus massage and trigger point therapy for 5 months bull Dt continued pain ROM loss ortho consult = LT shoulder cortisone inj amp light

exercises bull Presents to DC (author) w LT shoulder pain after playing squash 1-mo prior bull Symptoms Dull achy pain LT shoulder with sharp pain to the LT posterior arm with

progressing loss of ROM w difficulty dressing amp bathing all ROMs painful bull She complained of not being able to move her left arm and having a hard time

dressing and washing herself The pain was aggravated by any movement lying on the left arm and she was awakened at night when she rolled onto the affected arm The pain was slightly relieved by taking hot showers


JCCA DC case study

Examination

bull UE DTRrsquos = 2+ bilaterally light touch sensation = WNL bull C-spine RT lateral flexion RT rotation and flexion = pulling sensation into the

trapezius levator scapulae and scaleni muscles bull Static and motion palpation Aberrant motions w tenderness LT C2-3 C7-T1 amp T3-

4 facet joints upon bull LT shoulder pain could not be reproduced by the neck examinations (ie range of

motion soft tissue palpation Spurlings Jacksons and maximal compression tests) bull LT shldr joint AROMs IR 15ᵒ ER 10ᵒ FFl 20ᵒ extension 30ᵒ abduction 10ᵒ bull Muscle tests LT glenohumeral joint flexion abduction internal and external rotations

= graded 35 bull LT GHJ PROM was 5ᵒ more in each direction bull Posterior and posteroinferior joint play of the LT GHJ = restricted and painful bull Palpation LT scaleni upper trapezius infraspinatus supraspinatus amp teres muscles =

hypertonic and tender w severe point tenderness over the LT deltoid tubercle bull C-spine amp LT shoulder XR = ldquoUnremarkablerdquo


JCCA DC case study

DIAGNOSIS

bull Clinical diagnosis LT adhesive capsulitis w C- and upper TH facet joint dysfunction


JCCA DC case study

Treatment

bull IFC bull CMT A-P amp long axis distraction mobilization pendular home exercises soft

tissue therapy (STT) and the spinal manipulation therapy (SMT) of the C- amp T- spine

bull Frequency 3xwk x 2 weeks bull By 6

th visit GHJ AROM (initial range in brackets) ABD FFL amp ER = 35deg (vs 10)

60deg (vs 20) and 15deg (vs 10) degrees respectively bull PROM ABD amp ER = 70deg 80deg and 20deg respectively bull Strengthening exercises w rubber tubing ER FFL amp ABD bull LT GHJ long axis distraction anteroposterior and posteroinferior manual high

speed low amplitude manipulation (Figures 1 2 and 3) bull Tender point therapy and ART of trapezius levator scapulae lateral deltoid

supraspinatus amp infraspinatus muscles (digital compressive pressure to tolerance amp dissipation of pain)


JCCA DC case study

Treatment (continued)

bull ART (Active Release Tech) Deep digital pressure into the muscle fibers starting at the shortest muscle length position of the muscle the patient actively moves toward the longest position of the muscle while the tension is sustained by the clinician

bull 2xwk for 8 wks bull Post-treatment L GHJ AROMs Abduction 100ᵒ w full FFL amp ER bull LT GHJ PROMs Full bull Muscle strength = 45 (0-55 scale) bull Exercises Isotonic strengthening exercises (free weights) in ABD FFL Ext IR

ER 3xwk bull IFC was changed to microcurrent therapy (to promote healing) bull The patient was seen 1xwk for 6-weeks there after bull Post-treatment (16 wks) AROMs = pain free amp full

SEE TABLE 1


JCCA DC case study Treatment (continued)

SEE TABLE 1


1132019

11

JCCA DC case study Discussion bull Lundberg classified patients suffering from frozen shoulder syndrome into primary

and secondary bull Primary adhesive capsulitis Pts w no significant findings in the history clinical

examination or radiographic evaluation to explain their motion loss and pain bull Secondary adhesive capsulitis Specific Hx of trauma or surgery to the affected UE bull Pt in case study = secondary adhesive capsulitis (dt initial neck involvement and

squash trauma later bull Reeves identified 3 phases in the natural history of the frozen shoulder syndrome

ndash (1) an early painful phase lasting 10- 36 weeks ndash (2) an intermediate stiff or frozen phase characterized mainly by limited range of motion lasting 4-

12 months ndash (3) a recovery or thawing phase lasting 5-24 months or more Our patient was in phase one at her

initial visit to our office However she might had been in the recovery phase prior to her squash injury










JCCA DC case study Discussion bull The history usually indicates a gradual onset of stiffness and pain bull The pain is quite intense amp often referred to the insertion of the

deltoid the deltoid muscle region and the bicipital tendon bull Pain is aggravated by the shoulder ROMs (esp ER) and sleeping on

the involved side bull Pain is relieved by limiting the use of the extremity bull There is often soreness in the proximal upper back and neck which

may be as a result of compensatory overuse of the accessory musculature (trapezius scalene levator scapulae rhomboid muscles)

bull Symptoms Pain putting on a coat reaching into the hip pocket for a wallet combing his or her hair amp inability to fasten garments behind the back (These symptoms closely resemble the patient in this case)


JCCA DC case study Discussion bull Some authors state that observation reveals guarded

shoulder movements bull At rest the patient holds the involved arm in adduction

and internal rotation bull The arm swing in gait is usually limited or absent bull Rounded shoulders stooped posture with the involved

shoulder elevated in a protective manner = common bull Because of this altered posture pain and trigger points

often develop over the posterior aspect of the shoulder along the upper trapezius amp posterior cervical muscles


SIDEBAR

Do MRI findings correlate with shoulder symptoms


httpswwwsciencedirectcomsciencearticleabspiiS1058274619302344

1132019

12



Background

Magnetic resonance imaging (MRI) is commonly used to diagnose structural abnormalities in the

shoulder However subsequent findings may not be the source of symptoms The aim of this

study was to determine comparative MRI findings across both shoulders of individuals with

unilateral shoulder symptoms

Materials and methods

bull We prospectively evaluated 123 individuals from the community who had self-reported

unilateral shoulder pain with no signs of adhesive capsulitis no substantial range-of-motion

deficit no history of upper-limb fractures no repeated shoulder dislocations and no neck-related

pain

bull Images in the coronal sagittal and axial planes with T1 T2 and proton density sequences were

generated and independently and randomly interpreted by 2 examiners a board-certified

fellowship-trained orthopedic shoulder surgeon and a musculoskeletal radiologist

bull Absolute and relative frequencies for each MRI finding were calculated and compared between

symptomatic and asymptomatic shoulders Agreement between the shoulder surgeon and the

radiologist was also determined

Bilateral magnetic resonance imaging findings in individuals with unilateral shoulder pain

Journal of Shoulder and Elbow Surgery

Volume 28 Issue 9 September 2019 Pages 1699-1706

ABSTRACT



Results

bull Abnormal MRI findings were highly prevalent in both shoulders Only the frequencies of full-

thickness tears in the supraspinatus tendon and glenohumeral osteoarthritis were higher

(approximately 10) in the symptomatic shoulder according to the surgeons findings

bull Agreement between the musculoskeletal radiologist and shoulder surgeon ranged from slight to

moderate (000-051)

Conclusion

Most abnormal MRI findings were not different in frequency between symptomatic and

asymptomatic shoulders Clinicians should be aware of the common anatomic findings on

MRI when considering diagnostic and treatment planning

ABSTRACT (continued)





Handout 4 Abstract

Background This paper describes the clinical management of four cases of shoulder impingement

syndrome using a conservative multimodal treatment approach

Clinical Features Four patients presented to a chiropractic clinic with chronic shoulder pain

tenderness in the shoulder region and a limited range of motion with pain and catching After

physical and orthopaedic examination a clinical diagnosis of shoulder impingement syndrome

was reached The four patients were admitted to a multi-modal treatment protocol including

Soft tissue therapy (ischaemic pressure and cross-friction massage)

7 minutes of phonophoresis (driving of medication into tissue with ultrasound) with 1

cortisone cream

Diversified spinal and peripheral joint manipulation and rotator cuff and shoulder girdle

muscle exercises

The outcome measures for the study were subjectiveobjective visual analogue pain scales (VAS)

range of motion (goniometer) and return to normal daily work and sporting activities All four

subjects at the end of the treatment protocol were symptom free with all outcome measures being

normal At 1 month follow up all patients continued to be symptom free with full range of

motion and complete return to normal daily activities

Conclusion This case series demonstrates the potential benefit of a multimodal chiropractic

protocol in resolving symptoms associated with a suspected clinical diagnosis of shoulder

impingement syndrome

So what did they do httpswwwncbinlmnihgovpmcarticlesPMC1253520

Background

bull Practitioners of manual therapy commonly encounter patients presenting with shoulder pain and

symptoms associated with rotator cuff pathology

bull Shoulder pain is the most common extraspinal complaint encountered in primary care clinics and

in clinical frequency is exceeded only by low back and neck pain [1]

bull Many shoulder conditions are associated with dysfunction of the rotator cuff [2-4]

bull Rotator cuff disorders represent a complex clinical entity requiring a thorough understanding and

knowledge of shoulder anatomy biomechanics and the functional relationship of the shoulder to

nearby spinal structures including the cervical and thoracic spines

bull Rotator cuff disorders commonly occur secondary to repetitive overuse (occupational or overhead

throwing sports) which contributes to micro traumatic changes within rotator cuff tissue [5]

bull In addition a single macro traumatic episode (fall on outstretched hand) can cause injury to rotator

cuff tissue [5]

bull The normal aging process will also negatively influence the rotator cuff mechanism [2]

bull The most common source of shoulder pain originates from the rotator cuff tendons with the

most prevalent clinical diagnosis being impingement syndrome of the supraspinatus tendon [2-46]


Background

bull Before discussing our case series it is important to review some important elements of taking a

history and performing a shoulder physical examination

bull Certain clinical features may alert the practitioner to potentially serious causes (red flags) of

shoulder pain which constitute possible contra-indication to manual therapy [78]

(Table (Table1)1)


7 Review Regional musculoskeletal conditions shoulder painBrox JI Best Pract Res Clin Rheumatol 2003 Feb 17(1)33-56

[PubMed] [Ref list]

8 Australian Cochrane Collaboration Evidence Based Management of Acute Musculoskeletal Pain Australasian Acute Pain Guidelines Group

Australian Academic Press Brisbane 2003 Acute Shoulder Pain pp 119ndash155 [Google Scholar] [Ref list]

1132019

13

Background

bull Other (yellow flag) features of the clinical history may affect the outcome of manual therapy and

therefore recovery [78] (Table (Table2)2)


9 Souza TA Differential Diagnosis for the Chiropractor Gaithersberg Aspen 1997 Shoulder girdle

complaints pp 141ndash172 [Google Scholar] [Ref list]

Background

bull A differential diagnosis list for shoulder pain [9] is seen in Table 3




Background

bull Table Table44[9] shows sources of shoulder pain mostly derived from local structures within the

shoulder whether due to trauma overuse arthritides or disease




Background

bull This paper will discuss a common cause of shoulder pain and its largely unreported multi-modal

conservative management in a chiropractic setting

bull This management will include pertinent aspects of the patient history physical examination

differential diagnosis for shoulder pain as well as its management in 4 cases


Case Presentations

Four presentations

CASE 1

bull A case of shoulder pain in a fit 42-year-old Caucasian male is presented

bull The pain was located diffusely in the postero-lateral aspect of the right shoulder and started

gradually 4ndash6 weeks prior to presentation

bull No causative event was reported although workplace activities required the patient to repetitively

lift files above the shoulder level onto a shelf

bull Of note was the mention of a particularly busy period (increased intensity and duration) at work

prior to the onset of pain


Case Presentations

Four presentations

CASE 1 (continued)

bull The patient described the pain as being of a constant nagging and aching sensation with an

intensity of 310 on the visual analogue scale (VAS)

bull He also reported an intermittent sharp and catching sensation in the same location on shoulder

abduction with an intensity of 610 (VAS scale)

bull No referred pain or other neurological symptoms were reported although he did report subjective

weakness of the shoulder during elevation above shoulder level and inability to use the right arm

comfortably

bull Holding his arm on top of the steering wheel aggravated the pain when driving as did sleeping on

his right side and also combing his hair

bull He described that heat packs provided short-term relief of pain

bull The patient reported no prior shoulder problems no use of medication and his medical family

and social history were otherwise unremarkable


1132019

14

Case Presentations

Four presentations

CASE 1 (continued)

bull Physical examination of the right arm produced pain and restriction of movement at 50 degrees of

right external rotation in the neutral position with restriction and pain at 90 degrees of abduction

Both movements were guarded

bull An impingement sign was present as confirmed by a positive Hawkins test

Hawkins test involves positioning the arm at 90 degrees of flexion with subsequent internal

rotation

bull Neers impingement test gave slight discomfort

Neers impingement test is performed with the patient sitting as the practitioner stands

behind the patient with one hand supporting the scapula to prevent scapula rotation and the

other hand holding the forearm The shoulder is brought into maximum flexion with a small

degree of internal rotation

The test is considered positive if there is pain in the last 10ndash15 degrees of flexion

Pain is produced because the greater tuberosity is compressed against the anterior acromion

or coracoacromial ligament hence this test may aggravate an inflamed bursa (subacromial)

the supraspinatus tendon or the anterior structures of the coracoacromial arch [10]


Case Presentations

Four presentations

CASE 1 (continued)

bull Muscle testing revealed slight weakness of the right infraspinatus muscle (Grade lV of V) and also

right latissimus dorsi

bull Other routine shoulder tests revealed no abnormal findings (including instability testing glenoid

labrum testing lateral slide test and muscle tests)

bull On palpation muscle spasm was noted in the right infraspinatus muscle and to a lesser extent the

right rhomboid supraspinatus and upper trapezius when compared to the other side

Significant focal tenderness was palpated over the rotator cuff insertion on the greater

tuberosity of the humerus

bull Specific joint motion palpation revealed likely lateral flexion restriction of the right C56 lower

cervical facet joint and left T23 thoracic facet joint with immobility of the right acromio-clavicular

joint in an inferior direction


Case Presentations

Four presentations

CASE 1 (continued)

bull The patient presented with X-rays revealing no abnormalities

bull A likely working diagnosis of a Primary Grade 2 Posterolateral Rotator Cuff Impingement (Neer

classification-Table classification-Table55[11]) was determined


11 Impingement lesionsNeer CS 2nd Clin Orthop Relat Res 1983 Mar (173)70-7 [PubMed] [Ref list]

Case Presentations

Four presentations

CASE 2

bull A second patient presenting was a slightly overweight 32 years old caucasian female with right-

sided shoulder pain located superior and in the postero-lateral aspect of the shoulder

bull The pain started 2 weeks prior to presentation after practicing certain manual therapy maneuvers

of the lumbar spine at university

bull The patient was practicing lumbar spine and sacro-iliac pisiform contact posterior-anterior

manipulation

bull During this the shoulder is placed repetitively in a combined position of adduction flexion and

internal rotation

bull The patient described the pain as being a sharp shooting sensation intermittent dependent on

motion with an intensity of 710 (VAS scale)

bull A diffuse aching sensation was also reported in the right upper deltoid region (so-called military

badge)

bull The pain was aggravated by elevation of the arm and sleeping on the right side

bull Relief was obtained by applying ice and taking anti-inflammatoryanalgesic medication

(Ibuprofen)

bull The patient reported no prior shoulder problems no general use of medication her medical family



Case Presentations

Four presentations

CASE 2 (continued)

bull Physical examination of the right shoulder revealed slight postero-lateral pain in the shoulder on

external rotation and abduction

bull External rotation was restricted at 60 degrees and abduction at 90 degrees

bull Impingement was elicited with the Hawkins test and with the Neers test

bull Other routine shoulder tests revealed no abnormal findings

bull On palpation muscle spasm was notionally present in the right rhomboid major upper trapezius

supraspinatus and particularly the infraspinatus

bull Trigger points were noted in the infraspinatus muscle with reproduction of the upper arm pain

upon specific pressure

bull Motion palpation revealed likely right acromio-clavicular and sternoclavicular joint fixation left

T34 and right C56 lateral flexion restriction

bull The patient presented with plain film radiographs which revealed no abnormality


A likely working diagnosis of Grade 2 Primary Impingement of the rotator cuff (Neer

classification-Table classification-Table55[11]) was determined The working diagnosis

also included the presence of an active infraspinatus myofascial pain syndrome


Case Presentations

Four presentations

CASE 3

bull The third patient was a slightly apprehensive 29-year-old Caucasian male with right-sided diffuse

anterior and superior shoulder pain

bull The pain started gradually over an 8ndash10 week period with the intensity being most prevalent

during the 2 weeks prior to presentation

bull The patient was employed as a factory worker a job that required combined repetitive shoulder

movements and periods of administrative keyboard work

bull The pain was described as a constant deep dull and nagging ache with an intensity of 510 (VAS

scale)

bull No neurological symptoms were reported there were no dermatomalsclerotomal pain referral

patterns although a slight diffuse aching sensation was mentioned in the right elbow and more

prominently right military badge area

bull Together with the shoulder pain the patient reported a less intense (410) dull sensation specifically

at the base of the cervical spine on the right and a vague headache like sensation at the base of the

skull

bull The right shoulder felt subjectively weaker with inability to lift the arm above shoulder level

without pain

bull The pain was aggravated by specific arm postures and lying on the right side There was no

pertinent medicalfamilysocial history


1132019

15

Case Presentations

Four presentations

CASE 3 (continued)

bull Examination revealed a painful arc with onset of pain at 70 degrees abduction external rotation

being restricted at 70 degrees with a catching sensation at the end of motion

bull Reproduction of the pain was elicited with a Hawkins test and on supraspinatus muscle testing

(Empty can test) revealing a grade 4 weakness and pain


bull Right cervical rotation restriction (65 degrees) was noted on the right with a right Kemps joint

stress test (combined right cervical rotation lateral flexion and extension) reproducing the low

cervical pain but no shoulder pain

bull Palpation revealed muscle tenderness in the right supraspinatus upper trapezius levator scapulae

and infraspinatus muscle groups

bull A trigger point was palpated in the infraspinatus muscle which upon applying pressure reproduced

the right upper arm diffuse ache Palpating the rotator cuff insertion on the humerus and

coracoacromial ligament caused significant tenderness

bull Motion palpation revealed likely joint restriction at the right C56 cervical facet joint T23 and

acromio-clavicular joint Of interest was the postural presentation of a rounded shoulder and

increased thoracic kyphosis


Case Presentations

Four presentations

CASE 3 (continued)

A likely primary working diagnosis of a Grade ll Primary Rotator Cuff Impingement (Neer

classification-Table classification-Table55[11]) with Supraspinatus tendonosis was determined with

secondary involvement of the cervical and thoracic spines


Case Presentations

Four presentations

CASE 4

bull The fourth patient presenting was a 40-year-old Caucasian female

bull She presented with right-sided anterior shoulder pain which was nagging aching and

accompanied by a catching sensation on specific movements

bull The aching pain was constant with an intensity of 6510 (VAS scale) while the catching pain was

slightly more intense at 810

bull No neurological sensations were reported

bull The patient reported a diffuse aching pain in the posterior aspect of the shoulder over the scapula

bull Nothing relieved the pain while arm elevation driving prolonged sitting behind the computer and

poor posture made the pain worse

bull The pain started 4 days prior to presentation after spending most of the weekend cleaning the walls

at home with a sponge prior to painting

bull The patient had not had this pain before although due to her work (accountant) she often

complains of posterior shoulder tension

bull The patient had been treated previously for an unrelated complaint (right sided sacroiliac area

pain)

bull The medical family and social histories were unremarkable


Case Presentations

Four presentations

CASE 4 (continued)

bull The physical examination revealed restriction in external rotation (60 degrees) and abduction with

paincatching at 90 degrees

bull Internal rotation was also tight and sore especially with the Hawkins test

bull The impingement sign was present with reproduction of the anterior pain with a Hawkins and

Neers test

bull Scapula dysfunction was also noted with a positive right-sided lateral glide test It should be noted

that no major difference was seen with the lateral glide test on the previous 3 patients

bull Of importance was the postural presentation of anteriorly rotated shoulders increased thoracic

kyphosis and forward head carriage

bull A scoliotic curve was also noted with an apex convex to the right in the mid thoracic region

bull Palpation revealed muscle spasm in the right posterior shoulder girdle muscles with increased

muscular tension and sensitivity to palpation in the right supraspinatus and infraspinatus compared

to the left

bull Infraspinatus palpation revealed local muscle spasm with a reproduction of the posterior ache on

specific pressure

bull Increased tenderness was noted whilst palpating the coracoacromial ligament and supraspinatus

insertion on the humerus

bull Specific joint motion palpation revealed likely restriction in the right C56 joint T34 and

acromioclavicular joint


Case Presentations

Four presentations

CASE 4 (continued)





Neers test








to the left


specific pressure






Case Presentations

Four presentations

CASE 4 (continued)

bull A likely working diagnosis of a Grade ll Primary Shoulder Rotator Cuff Impingement (Neer

classification- refer to Table Table55[11]) was determined

bull Of note was the secondary contribution of the scapula to this process

bull The working diagnosis also included the presence an active infraspinatus myofascial pain

syndrome


1132019

16

Case Presentations

Four presentations

THE INTERVENTIONS

bull The 4 patients were admitted to a multimodal treatment protocol which included the following

interventions soft tissue therapy ultrasound phonophoresis manipulation and exercise

bull All of the patients received soft tissue therapy that involved the application of ischaemic pressure

to the supraspinatus and infraspinatus muscles as well as the rhomboids upper trapezius and

levator scapulae

bull The application involved palpating the muscle bellies and applying a sustained pressure into areas

of muscle spasm until a release of the barrier of resistance was felt

bull Release meaning the relaxation of the point of muscle spasm with a decrease in the sensitivity and

muscle tone after re-palpating the area

bull The pressure was applied repetitively using a myofascial T-bar (a plastic T shaped hand held tool

with a rubber tip attached to the end in contact with the skin)

bull Care was taken not to cause increased discomfort to the patient (to the level of pain tolerance)


Case Presentations

Four presentations

THE INTERVENTIONS (continued)

bull Longitudinal and transverse friction massage was applied to the posterior tenomuscular junction

of the infraspinatus muscle the coracoacromial ligament (postero-inferior aspect) and the insertion

of the supraspinatus on the greater tuberosity of the humerus

bull The friction massage application was achieved by palpating the capsular or tendinous adhesions

and frictioning over its surface with the practitioners index finger This was maintained until

friction anaesthesia was achieved and the patient could not feel any discomfort A new point was

then chosen and the process repeated Once again care was taken to not cause excessive discomfort

to the patient

bull At the end of the treatment sessions ice application was advised at a frequency of three

applications of 15 minutes with two 20-minute breaks


Case Presentations

Four presentations


bull Ultrasound phonophoresis was applied to the areas that previously underwent friction massage

with a topical corticosteroid [1 sigmacort]

bull Ultrasound was applied with a continuous wave form for 7 minutes at a setting of 22 Wcm2 to the

rotator cuff insertion on the anterior-inferior aspect of the humerus and posterior inferior aspect of

the acromioclavicular joint

bull Peripheral thrust manual manipulation was applied to the glenohumeral joints in external rotation

(progressive) and inferiorly to the acromioclavicular joint and anterior to posterior to the

sternoclavicular joint in all of the patients where a likely motion restriction was detected


Case Presentations

Four presentations


bull Mechanically assisted manipulations were also used with the Activator 2 apparatus in humeral

external rotation or inferior through the AC joint This particular technique was chosen for one of the female patients (fourth patient as an alternative) who

expressed concern with peripheral manual manipulation after the first treatment session as an alternative

technique

bull Diversified spinal manipulations were used to manipulate the thoracic and cervical spines at the

level of T34 and C56

bull All patients were given a basic exercise program with initial emphasis on isometric strengthening

of the supraspinatus and infraspinatus muscles This was implemented once a reduction in pain and

improved range of motion was noted at a frequency of 4 sets of 10 repetitions 2ndash3 times per day

bull Theraband (extendable elastic) exercises were also implemented at the same frequency after the

initial isometric strengthening period

bull This also included shoulder shrugs wall push-ups and scapula retraction exercises


Case Presentations

Four presentations


bull Patient 1 was treated for a total of 5 visits

bull Patient 2 was treated 4 times



bull At the end of the last treatment session (5 and 4 treatments respectively) a repeat physical

examination revealed a full and painless range of motion with no subjective symptoms and

negative orthopaedic testing (Hawkins and Neers)

bull Patient 1 was seen 4 weeks later for a new and unrelated complaint who after questioning reported

no shoulder complaints (pain) Full range of motion was maintained

bull Patient 2 was contacted via the phone and upon questioning also reported no subjective pain and

full return to normal activities at 1 month post treatment

bull Patient 3 was followed at 4 and 8 weeks after the last treatment revealing no subjective and

objective symptoms

bull Patient 4 was seen at 4 and 8 weeks with no symptoms of impingement reported and no objective

findings


Case Presentations

Four presentations

DISCUSSION amp CONCLUSIONS

bull Rotator cuff impingement and or tendonosis is a common disorder encountered in a primary health

care setting [12-15]

bull Perhaps less in chiropractic practices as opposed to medical and physiotherapy

bull To date (2010) there are no data investigating the prevalence of shoulder pain in the chiropractic

setting

bull This may be due to the lack of general public awareness about the scope and capabilities of

chiropractors to be involved in management of non-spinal disorders or simply the public making

another choice

bull This condition presents a challenge to the chiropractor due to its prevalence and its possible close

interrelationship with the spine

bull A major reason for documenting this treatment protocol is to encourage the development of future

clinical guidelines for chiropractors and to encourage the expansion of their treatment range to

include peripheral disorders


1132019

17

Case Presentations

Four presentations

DISCUSSION amp CONCLUSIONS (continued)

bull Another goal of this report is to highlight that multimodal management is often required to

address the painful shoulder and not to determine or show which treatment approach or particular

therapy was more effective

bull The four patients in this paper were managed with a treatment protocol that included a number of

therapies

bull The literature [16-22] suggests that the multimodal approach is an appropriate method for the

successful conservative management of shoulder problems

bull The cervical and thoracic spines should be reviewed as a possible factor associated with rotator-

cuff dysfunction

bull As an example consider the slumping posture in a competitive swimmer Others and we

hypothesize that the rounded shoulders and increased thoracic kyphosis places increased demands

on the rotator cuff and contributes to the impingement process [23] A possible mechanism for this hypothesis is as follows the posture may alter the mechanical function

(orientation) of the scapula and humerus leading to muscular imbalances abnormal movement patterns

during glenohumeral elevation with associated weakness of the posterior cuff muscles

Therefore this may lead to a loss of force couple at the glenohumeral joint with resultant repetitive

humeral head impingement [23-25]


Case Presentations

Four presentations


bull The outcome measures for the study included improvement of pain return to pre-treatment

activities and restoration of full active and passive movements

bull The outcome measures were mainly subjective in nature and dependent on the response of the

patients and the practitioners skill in conducting the orthopaedic reassessment therefore allowing

an element of examination bias

bull This particular shortcoming may be improved by using more sensitive scoring systems that can be

accurately reproduced by different observers such as the subjective shoulder rating system [26]

UCLA scoring system [27] or the highly sensitive ConstantMurley functional assessment of the

shoulder [28] [SGY OATs]

bull Although frequently advocated for outcomes based assessment goniometric measurement for the

shoulder remains questionable Williams et al [29] studied 22 observers who used three different types of goniometers to assess the range

of abduction and visual estimation The results demonstrated visual estimation to be the most reliable

method

Moderate inter-observer reliability was also demonstrated in a study by Bostrom et al [30] where range of

motion was measured using a goniometer


Case Presentations

Four presentations


bull This report presents an approach that combines aspects of traditional forms of chiropractic

physiotherapy and medicine in the conservative management of certain shoulder pain

bull The individual therapies that were used in this multimodal treatment protocol have been shown

to be useful in the management of shoulder pain both singularly and in combination [181931-36]

bull Of the electro-modalities the apparatus used was ultrasound Some authors routinely advocate the

usage of ultrasound in conjunction with other modalities and report positive outcomes [31635]

bull The physiologic benefits of ultrasound have been attributed to its thermal actions these involve

an increase in peripheral blood flow increased tissue metabolism and greater tissue extensibility

[37]


Case Presentations

Four presentations


bull The use of ultrasound for shoulder pain and its effect on soft tissue structures of the shoulder has

been studied extensively in the literature

bull A recent study by Nykanen [36] investigating pulsed ultrasound treatment of the painful shoulder

in a randomised double blind and placebo controlled study showed no differences in outcome

between the treatment and placebo groups at the end of the trial period

However when the ultrasound was used to complement treatment the patients reported a

significant subjective improvement in symptoms

bull A further study by Downing [35] and Perron et al [38] also showed no apparent benefit from

ultrasound therapy

bull None of these studies demonstrated statistically significant results supporting ultrasound therapy

bull A recent review of the literature conducted by Van der Windt [39] also concluded that there is little

evidence that ultrasound therapy is effective for soft tissue disorders of the shoulder

bull By contrast to the above studies the subjects in this paper were treated with a 3MHz setting plus

phonophoresis that may have influenced the outcome measures

bull Nevertheless the efficacy and effectiveness of ultrasound for shoulder pain remains in doubt


Case Presentations

Four presentations


bull In this study the subjects were also treated with an ultrasound technique known as phonophoresis

bull Phonophoresis involves the movement of a medication through intact skin into the underlying

soft tissue by ultrasonic pertubation [37]

bull By using ultrasound a topical corticosteroid cream can be successfully delivered across the skin

with a view to reducing the inflammation and pain associated with the more superficial soft tissue

injuries and disorders [40]

bull Davick [40] showed in his study corticosteroid medication penetration through to the epidermal

layer of skin and further into the stratum corneum The medication used to treat the subjects was a

topical corticosteroid ndash Sigmacort 1 This approach combined with the therapeutic effects of

ultrasound appeared subjectively to have a beneficial effect as a treatment adjunct

bull There is some evidence reporting the positive effects of phonophoresis Griffin et al [41]

conducted a double blind study comparing the effects of phonophoresis and ultrasound in 102

patients with various shoulder complaints Of the subjects receiving phonophoresis 68 showed

significant improvement in range of motion and pain as opposed to 28 in the ultrasound group

bull In 1999 one paper by chiropractors investigated the benefits of phonophoresis Gimblet et al [16]

reported treating two subjects with calcific tendonitis by using soft tissue therapy phonophoresis

and manipulation Both subjects at the end of the treatment protocol experienced complete

resolution of symptoms


SGY We canrsquot do this in WI Case Presentations

Four presentations


bull Transverse friction massage has been advocated by a number of authors in the management of

shoulder disorders [1934]

bull Hammer describes friction massage as a technique where an involved muscle tendon or ligament

is massaged by applying pressure with a reinforced finger [1934] The transverse motion across the

involved tissue and the resultant hyperaemia are said to be the chief healing factors of friction

massage [1934] The transverse action is said to prevent the formation of scar tissue while

longitudinal friction effects the transportation of blood and lymph [19]

bull The traumatic hyperaemia is postulated to release histamine and bradykinins resulting in

vasodilation and reduction of oedema [34]

bull Friction massage is said to stimulate the proliferation of fibroblasts and collagen fiber realignment

with cross linkages [39]

bull It is reported that up to two weeks are required for mature cross-links to form [24]

bull In the acute stage a light friction is suggested while in the chronic condition a stronger pressure

may be required [34]

bull Hammer [19] also describes the successful management of a chronic bursitis by the use of soft

tissue friction massage


1132019

18

Case Presentations

Four presentations


bull The management of the subjects in this paper also included orthopaedic motion assessment and

treatment of spinal structures including the cervical and thoracic spines

bull Diversified spinal adjustments were directed at the identified hypo mobile motion segments of the

cervical and thoracic spines

bull This included assessment and adjustment of the glenohumeral joint in restricted planes of motion

bull It is postulated that abnormal thoracic and cervical spine postural alignment (with any associated

spinal joint fixation) may alter the resting position of the scapula contributing to problems of the

rotator cuff musculature [23]

bull In our cases changes in the lateral spinal curves were particularly noted in the third and fourth

patients [23]

bull Abnormal spinal curves can result from chronic poor posture which may result in shoulder girdle

muscle imbalance altered muscle length tension relationships joint incongruity ligamentous laxity

changes in arthrokinematics and gross shoulder motion [23]


23 Greenfield B Catlin P Coats P Green E McDonald J North C Posture in patients with shoulder overuse

injuries and healthy individuals J Orthop Sports Phys Ther 1995 21(5)287-295

Case Presentations

Four presentations


bull As noted by many clinicians a commonly related postural condition is that associated with

anterior head carriage associated with rounded shoulders [1923]

bull This type of postural deviation often causes a compensatory extension at the atlanto-occipital

articulation reversal or flattening of the cervical lordosis thoracic kyphosis protraction of the

scapulae with the inferior angle of the scapula moving medially whilst the glenoid fossa moves

anterior and inferior and finally internal rotation of the humerus

bull As a result muscle imbalances of the shoulder girdle may occur

bull These potentially include parascapular muscle weakness winging of the scapula altered scapula

position and scapula dysrhythmia [1023]

bull Also weakness of the posterior rotator cuff muscles may influence the force couple mechanism at

the glenohumeral joint causing a resultant upward shear of the humeral head during elevation of the

arm


19 Hammer WI The use of transverse friction massage in the management of chronic bursitis of the hip or

shoulder J Manipulative Physiol Ther 1993 16107-111



Case Presentations

Four presentations


bull During shoulder elevation the dominant force vector is provided by the deltoid muscle and in a superior

direction

bull Under normal circumstances the cuff muscles will counter this superior shear in the opposite direction creating

a stabilizing and compressive action of the humeral head with respect to the glenoid during elevation

bull A diagrammatic representation of the gleno-humeral force couple [42] is seen in Figure Figure11

bull With cuff weakness (even slight) the force couple may be altered enabling an abnormal upward displacement

of the humeral head and the impingement of the subacromial structures and the humeral head against the under

surface of the acromion [1023]


Figure 1

The glenohumeral force couple The resultant force

(action) of the rotator cuff muscles results in

compression and inferior glide of the humeral head

during elevation (RA = resultant action Deltoid SS

= Supraspinatus SSc = Subscapularis IS =

Infraspinatus and TM = Teres Minor) [42]

42 Donatelli RA Impingement syndrome and

impingement related instability In Physical therapy of the

shoulder 3rd edition Churchill Livingstone 1997229-256

Case Presentations

Four presentations


bull Repetition of this process may cause irritation of pain producing structures creating shoulder pain syndromes

bull In order to address the abnormal force couple and its potentially causative mechanism specific exercises were

introduced to help restore strength and muscular functioning of the glenohumeral joint and scapula articulations

(That is once motion was normalised)

bull It is acknowledged that a significant weakness in this case series is the lack of imaging using diagnostic

ultrasound to confirm the diagnosis of impingement or indeed some other cause for the pain

bull We encourage a further study of the treatment protocol described above

bull This study should be a randomised controlled trial and include diagnostic ultrasound confirmed impingement

bull Successful management of rotator cuff impingement and related shoulder pain syndromes should include the

consideration of potential sources of shoulder pain

bull Also the function of the implicated structures in global shoulder function should be reviewed This should

include the associated structures of the scapulohumeral scapulothoracic articulations the cervical and the thoracic

spine

bull This paper highlights a successful outcome for 4 subjects with clinically diagnosed shoulder

impingement syndrome after receiving a multimodal treatment approach in a chiropractic

setting


Are there any chiropractic managed case studies that

precede 2010

1132019

19

So how prevalent is shoulder pain

cases in chiropractic


J Manipulative Physiol Ther 2009 Feb32(2)107-17 doi 101016jjmpt200812005

An epidemiologic survey of shoulder pain in chiropractic practice in australia

Pribicevic M1 Pollard H Bonello R Author information

1Private practice of chiropractic Harbord NSW Australia

Abstract

OBJECTIVE

This survey investigated the demographic characteristics of the responding

practitioners the prevalence of shoulder pain symptoms seen in weekly chiropractic

practice the sources of shoulder pain the chiropractor-diagnosed prevalence of

shoulder clinical syndromes and the management strategies for Australian

chiropractors

METHODS

A survey was created by the authors consisting of questions seeking demographic

information from the respondents shoulder syndrome and shoulder management

information The survey was mailed to every chiropractic practitioner based in the

Australian state of New South Wales (general population 68 million in 2005) Contact

details were derived from Yellow Pages online listings




Pribicevic M1 Pollard H Bonello R

Author information


Abstract

(CONTINUED)

RESULTS

One thousand thirty-seven surveys were mailed to New South Wales-based chiropractors with

192 (21) returning a completed survey The prevalence of shoulder pain symptoms as reported

by the practitioners was 12 of the total weekly patients with the major cause of symptoms

related to overuse (32) The most prevalent working diagnosis of shoulder pain was shoulder

impingement syndrome (13) followed by impingement syndrome with rotator cuff tendinosis

(17) impingement syndrome without rotator cuff tendinosis (14) and chiropractic shoulder

subluxation (12) Shoulder pain is managed with a combination of manipulation mainly

diversified technique (81) peripheral joint manipulation (82) and various soft tissue

strategies used by 92 of practitioners Rehabilitation strategies were also used by 89 of

practitioners with a main emphasis placed on rotator cuff strengthening

CONCLUSION

The results suggest a moderate prevalence of shoulder pain in clinical practice with the most

prevalent structure involved being the rotator cuff tendon Most practitioners use a multimodal

therapeutic treatment approach in managing disorders of the shoulder

2017 update on nondrug nonsurg systematic review of shoulder conditions


1132019

20


Abstract

OBJECTIVE

The purpose of this review was to evaluate the effectiveness of conservative nondrug nonsurgical

interventions either alone or in combination for conditions of the shoulder

METHODS

The review was conducted from March 2016 to November 2016 in accordance with the Preferred

Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and was registered with

PROSPERO Eligibility criteria included randomized controlled trials (RCTs) systematic reviews

or meta-analyses studying adult patients with a shoulder diagnosis Interventions qualified if they

did not involve prescription medication or surgical procedures although these could be used in the

comparison group or groups At least 2 independent reviewers assessed the quality of each study

using the Scottish Intercollegiate Guidelines Network checklists Shoulder conditions addressed

were shoulder impingement syndrome (SIS) rotator cuff-associated disorders (RCs) adhesive

capsulitis (AC) and nonspecific shoulder pain


Abstract

RESULTS

Twenty-five systematic reviews and 44 RCTs met inclusion criteria Low- to moderate-quality

evidence supported the use of manual therapies for all 4 shoulder conditions Exercise

particularly combined with physical therapy protocols was beneficial for SIS and AC For SIS

moderate evidence supported several passive modalities For RC physical therapy protocols were

found beneficial but not superior to surgery in the long term Moderate evidence supported

extracorporeal shockwave therapy for calcific tendinitis RC Low-level laser was the only

modality for which there was moderate evidence supporting its use for all 4 conditions

CONCLUSION

The findings of this literature review may help inform practitioners who use conservative methods

(eg doctors of chiropractic physical therapists and other manual therapists) regarding the levels of

evidence for modalities used for common shoulder conditions

Shoulder impingement syndrome (SIS) rotator cuff-associated disorders (RCs) adhesive

capsulitis (AC)

So what about surgery for shoulder impingement

httpswwwncbinlmnihgovpubmed30846616 httpswwwncbinlmnihgovpubmed30846616

Abstract

BACKGROUND

Shoulder impingement is one of the most common nontraumatic upper limb causes of disability in

adults Our aim was to evaluate the efficacy of surgical intervention in comparison with

nonoperative or sham treatments in patients with shoulder impingement in terms of both pain

and functional outcomes

METHODS

We conducted a systematic review and meta-analysis of randomized controlled trials Two

reviewers independently screened MEDLINE Embase PubMed and Cochrane databases for

randomized controlled trials published from 1946 to July 19 2018 A risk-of-bias assessment was

conducted for all included studies and outcomes were pooled using a random effects model The

primary outcome was improvement in pain up to 2 years Secondary outcomes were

functional outcome scores reported in the short term (le 1 yr) and long term (ge 2 yr)

Heterogeneity was assessed using the I 2 statistic Functional outcome scores were presented along

with minimal clinically important differences to provide clinical context for findings


Abstract

RESULTS

Thirteen randomized controlled trials (n = 1062 patients) were included in this review Eligible

patients had a mean age of 48 (standard deviation plusmn 4) years and 45 were men The pooled

treatment effect of surgical intervention for shoulder impingement did not demonstrate

any benefit to surgery with respect to pain relief (mean difference -007 95 CI -

040 to 026) or short-term functional outcomes (standardized mean difference -009

95 confidence interval [CI] -027 to 008) Surgical intervention did result in a small statistically

significant but clinically unimportant improvement in long-term functional outcomes (standardized

mean difference 023 95 CI 006 to 041)

INTERPRETATION

Evidence suggests surgical intervention has little if any benefit for

impingement pathology in the middle-aged patient Further research is required to

identify those patients who will reliably benefit from surgical intervention as well as optimal

conservative treatment strategies


Bone Joint J 2014 Jan96-B(1)75-81 doi 1013020301-620X96B132168

Treatment of non-traumatic rotator cuff tears A randomised controlled trial with one-year clinical results

Kukkonen J1 Joukainen A Lehtinen J Mattila KT Tuominen EK Kauko T Aaumlrimaa V Author information

1Department of Orthopaedics and Traumatology Turku University Hospital PO Box 28 FIN-20701 Turku Finland

Abstract

bull We have compared three different methods of treating symptomatic non-traumatic tears of the supraspinatus tendon

in patients above 55 years of age

bull A total of 180 shoulders (173 patients) with supraspinatus tendon tears were randomly allocated into one of three

groups (each of 60 shoulders) physiotherapy (group 1) acromioplasty and physiotherapy (group 2) and rotator cuff

repair acromioplasty and physiotherapy (group 3)

bull The Constant score was assessed and followed up by an independent observer pre-operatively and at three six and

twelve months after the intervention

bull Of these 167 shoulders were available for assessment at one year (follow-up rate of 928)

bull There were 55 shoulders in group 1 (24 in males and 31 in females mean age 65 years (55 to 79)) 57 in group 2 (29

male and 28 female mean age 65 years (55 to 79)) and 55 shoulders in group 3 (26 male and 29 female mean age 65

years (55 to 81))

bull There were no between-group differences in the Constant score at final follow-up 741 (sd 142) 772 (sd 130)

and 779 (sd 121) in groups 1 2 and 3 respectively (p = 034)

bull The mean change in the Constant score was 170 175 and 198 respectively (p = 034)

bull These results suggest that at one-year follow-up operative treatment is no better than

conservative treatment with regard to non-traumatic supraspinatus tears and that conservative treatment

should be considered as the primary method of treatment for this condition

KEYWORDS

Acromioplasty Constant score Non-traumatic rotator cuff tear Physiotherapy Rotator cuff Rotator cuff repair

SGY Herersquos another one

1132019

21


Handout 5 THIS STUDY INCLUDES MANY CHIROPRACTIC TREATMENT OPTIONS

RESULTS

1) Specific exercises were superior to generic exercises

2) SGY Anti-inflammatory nutrients vs Nonsteroidal anti-inflammatory drugs (NSAIDS) had a small to

moderate SMD of -029 (95 CI -053 to -005) compared with placebo

3) Manual therapy was superior to placebo (SMD -035 95thinspCI -069 to -001)

4) When combined with exercise manual therapy was superior to exercise alone but only at the shortest follow-

up (SMD -032 95 CI -062 to -001)

4) Laser was superior to sham laser (SMD -088 95thinspCI -148 to -027)

5) Extracorporeal shockwave therapy (ECSWT) was superior to sham (-039 95thinspCI -078 to -001) and

5) Tape was superior to sham (-064 95thinspCI -116 to -012) with small to moderate SMDs

CONCLUSION

Although there was only very low quality evidence exercise should be considered for

patients with shoulder impingement symptoms and tape ECSWT laser or manual

therapy might be added NSAIDS and corticosteroids are superior to placebo but it is

unclear how these treatments compare to exercise


Table 3 (next slide)


Table 4 (next 6 slides)



1132019

22




1132019

23


BMC Musculoskelet Disord 2017 Apr 1718(1)158 doi

101186s12891-017-1518-0

Specific or general exercise strategy for subacromial

impingement syndrome-does it matter A systematic literature

review and meta analysis

Shire AR1 Staelighr TAB2 Overby JB2 Bastholm Dahl M2 Sandell

Jacobsen J2 Hoslashyrup Christiansen D3

Author information 1Department of Physiotherapy VIA University College Hedeager 2 Aarhus N Denmark

ashirelivecomau2Department of Physiotherapy VIA University College Hedeager 2 Aarhus

N Denmark3Danish Ramazzini Centre Department of Occupational Medicine University

Research Clinic Regional Hospital West Jutland Herning Denmark

Abstract

BACKGROUND

Exercise is frequently suggested as a treatment option for patients presenting with symptoms of subacromial

impingement syndrome Some would argue implementing a specific exercise strategy with special focus on correction

of kinematic deficits would be superior to general exercise strategy There is however a lack of evidence comparing

such exercise strategies to determine which is the most effective in the treatment of subacromial impingement

syndrome The aim of this review is to evaluate whether implementing specific exercise strategies involving

resistive exercises are more effective than a general exercise strategy for the treatment of patients with

subacromial impingement syndrome

METHODS

Randomized controlled trials were identified through an electronic search on PubMedMEDLINE EMBASE

Cochrane Central Register of Controlled Trials Web of Science and PEDro In addition article reference lists and

Clinicaltrialsgov were searched Studies were considered eligible if they included interventions with resistive specific

exercises as compared to general resistance exercise Four reviewers assessed risk of bias and methodological quality

guided by Cochrane recommendations Results were synthesised qualitatively or quantitatively where appropriate

RESULTS

Six randomized controlled trials were included with 231 participants who experienced symptoms of subacromial

impingement syndrome Four studies evaluated the effectiveness of specific scapular exercise strategy and two

studies evaluated the effectiveness of specific proprioceptive strategy Five studies were of moderate quality and

one study was of low quality No consistent statistical significant differences in outcomes between treatment groups

were reported in the studies Standardized mean difference (SMD) for pain was SMD -019 (95 CI -061 022) and

SMD 030 (95 CI -016 076) for function

CONCLUSIONS

There is insufficient evidence to support or refute the effectiveness of specific resistive exercise strategies in the

rehabilitation of subacromial impingement syndrome More high quality research is needed to accurately

assess this This review provides suggestions on how to improve the methodological design of future studies in

this area


Herersquos a new approach

httpswwwncbinlmnihgovpmcarticlesPMC6709267 httpswwwncbinlmnihgovpmcarticlesPMC6709267

Abstract

Amniotic membrane (AM) and umbilical cord (UC) are well known to have anti-

inflammatory properties and have been shown to promote healing in various orthopedic

indications This study investigated whether intra-articular injection of AMUC

particulate matrix promotes healing of partial rotator cuff tears (RCTs)

A case series was performed on 10 patients that received injection of 50 mg AMUC for

partial RCTs that were refractory to conservative treatment Outcomes included Penn

Shoulder Score (PSS) questionnaire range of motion examination and magnetic

resonance imaging (MRI) analysis before and at 6 months Final MRI analysis was

performed by a musculoskeletal radiologist in a blinded fashion


Abstract

Average PSS score (out of 100) increased from 468 plusmn 237 at baseline to 820 plusmn 191 at 6

months The average PSS sub-scores of pain satisfaction and function increased 784

371 and 823 from baseline respectively The subjects range of motion was 779

at baseline and increased to 999 at 6-months Follow-up MRI scans did not

demonstrate any significant change in RCT size No adverse events were noted

This small case series provides preliminary data for use of cryopreserved AMUC

particulate matrix in patients with refractory partial RCTs


Introduction

bull The prevalence of rotator cuff tears (RCTs) is widespread however its incidence is known to

increase with age with up to 30 of the population older than 60 years having some form of an

RCT[2ndash5]

bull Once a RCT has occurred its prognosis is hard to predict but is more likely to increase in size due

to the continuous mechanical tension and lack of regenerative capability of the tendon[6ndash9]

bull As the first standard of care for partial RCTs nonsurgical management consisting of rest

activity modification physical therapy NSAIDs andor steroid injections is usually performed for 3

months to relieve pain and improve function before surgery is considered[10ndash12]

bull However it is recognized that prolonged nonsurgical management in symptomatic patients can

have negative consequences including increase in RCT size tear retraction increased difficulty of

repair and increased risk of muscular atrophy and fatty infiltration[613]

bull This is also further complicated by the patients continued pain limitation in activities of daily

living and overall dissatisfaction with the non-operative management therefore the choice of

surgery largely remains up to the patient taking into account their symptoms activity level

life goals and medical co-morbidities[14]

1132019

24


Introduction

bull Despite these outcomes in RCTs surgical management is controversial and presents inherent risks

of infection permanent stiffness of the joint and a lengthy recovery time that ranges anywhere from

3 to 6 months post-operatively[1823]

bull Due to the aforementioned limitations of conventional therapy alternative treatment methods are

sought to improve the condition of patients suffering from partial RCTs without introducing the

possibility of negative side effects

bull One well studied alternative is platelet-rich plasma (PRP) however review of level I and II studies

have found minimal clinical difference with its application[24ndash27]


Introduction

bull Alternatively amniotic membrane (AM) and umbilical cord (UC) tissue have emerged as potential

solutions

bull The unique anti-inflammatory and anti-scarring properties of this birth tissue have encouraged

many to use it for multiple clinical applications in ophthalmology[28] non-healing skin ulcers and

burns and many surgical reconstructive procedures[29ndash31]

bull AMUC has also shown to promote healing in orthopedic indications[3233] including when used as

a tendon wrap to prevent inflammation and formation of adhesions[29313435]

bull Within the matrix of cryopreserved AM and UC tissues there exists a unique glycoprotein

complex termed the HC-HAPTX3 complex that has been found to be responsible for many of the

anti-inflammatory and anti-scarring actions of these tissues[36]


Introduction

bull We thus speculated that AMUC might aid in the healing of partial RCTs through such healing

action

bull Unfortunately there has been a limited number of human trials for this particular application

despite the numerous laboratory and pre-clinical animal studies

bull Hence in this pilot study we evaluated the effects of intra-articular injections of cryopreserved

human AMUC particulate matrix in patients suffering from partial RCTs refractory to conventional

medical treatments as a non-surgical therapy to promote healing improve patients quality of life

and prevent the need for surgical intervention


Materials and Methods

After approval by the Institutional Review Board (Cleveland Clinic IRB16ndash125) patients were

identified by retrospectively reviewing medical records at a local community hospital Eligible

patients had to have

(1) A magnetic resonance imaging (MRI)-documented partial rotator cuff tear according to the

treating physician and original MRI report

(2) Remained symptomatic despite non-surgical treatments including rest physical therapy

NSAIDs andor steroid injection and

(3) Went on to receive intra-articular injection of cryopreserved AMUC product (CLARIX FLO

Amniox Medical Inc Atlanta GA) from 1 of the general orthopedic surgeonsauthors

A total of 35 patients were then contacted by mail and telephone to see if they were interested in

the study A total of 11 patients were reached a written informed consent was obtained and the

rights of subjects were protected Of the 11 patients 10 of them returned to the clinic for a 6

month follow up visit after AMUC injection for evaluation


Results

bull Pre-injection MRI results confirmed partial RCTs as evidenced by damage to the supraspinatus

bull However based on the blinded MRI interpretation 1 patient had tendinosis of the supraspinatus while another

patients tendon appeared normal

bull Of those patients with confirmed RCTs by the treating physician and radiologist in our study the average AP

and ML tear dimensions were 100 plusmn 77 and 123 plusmn 67 mm respectively

bull Five patients presented with partial tears gt50 (3 articular 2 bursal) and 3 patients presented with partial tears

le50 (2 articular 1 bursal)

bull In addition many of the patients presented with infraspinatus tendinosis (75) subscapularis tendinosis

(50) moderate effusion (125) synovitis (125) and capsulitis (25) of the joint



Results

bull The MRI results showed an insignificant change (P gt05) in rotator cuff size of 104 plusmn 74 mm (AP) and

134 plusmn 80 mm (ML)

bull There was also no change in the depth of the rotator cuff tears however 2 of the 4 cases with fluid intensity at

baseline decreased to PDT2 at 6 months (Fig (Fig1)1)

bull In addition the 1 subject with moderate effusion at baseline decreased to small effusion and all cases showed

absence of capsulitis at 6 months

bull There was no change in presence of synovitis nor subscapularis diagnosis however 1 additional case of

infraspinatus tendinosis was diagnosed at 6 months


1132019

25


Results









Figure 1

Representative MRI images of

rotator cuff pre- and post-

injection Improved signal

intensities in the supraspinatus

and to a lesser extent the

infraspinatus MRI = magnetic

resonance imaging


Discussion

bull Rotator cuff tears are the leading causes of shoulder pain accounting for more than 45 million physician

visits annually[43]

bull Corticosteroid injections remain 1 of the most commonly used treatments for chronic tendon

disorders[12] however there are some controversies including

(1) A lack of clinical studies evaluating their use for partial RCTs

(2) There is not a defined dosage regimen

(3) They have been shown to promote full thickness tears within 12 weeks and

(4) Are usually short-lasting[4445]



Discussion (continued)

bull More recently platelet-rich plasma and mesenchymal stem cells (MSC) have been investigated for their use in

RCTs

bull Most studies have evaluated the use of PRP in conjunction with arthroscopic RCT repair but results are

contrasting[2246ndash48]

bull One study has evaluated MSCs in full rotator cuff tear repair however it was also through surgical intervention

in 14 patients[49]

bull In regards to non-surgical treatment PRP has been shown to have better effects than steroids at 12 weeks

although statistically significant results were not achieved at any time thereafter [50ndash52]

bull Herein we surmise that non-surgical treatment with corticosteroid and PRP injections for partial RCTs and

tendinosis have limited clinical benefit after 12 weeks from procedure

bull By indirect comparison we note that intra-articular injection of AMUC particulate matrix was effective in

reducing pain and improving function in the shoulders of patients suffering partial RCTs that were refractory to

conservative non-surgical treatments through the duration of the study at 6 months

bull This was demonstrated by a notable 752 increase in the average Penn Shoulder Score and a 281 increase

in the average ROM




bull Despite the symptomatic relief experienced by these refractory patients follow-up MRI scans did not

demonstrate any significant change in the RCT size as anticipated

bull This potentially could be due to the short follow up period of 6 months limited sample size or difficulty in

MRI interpretation[5354]

Also while we do not fully understand why 1 person had increased tendonosis we hypothesize this may be

attributed to the previously mentioned limitations of the MRI as their particular PSS and function improved

bull This present study showed an absence of any MRI evidence of tear progression whereas numerous other

studies have shown partial RCTs often likely to increase in size and progress to full-thickness tears[76ndash9]

bull This coupled with the symptomatic relief suggests an overall clinical benefit

SGY

bull The discussion continues emphasizing the strong anti-inflammatoryanti-scarring benefits of

AMUC and how that benefits the stages of healing especially in the proliferativeremodeling

stage (next slide)

bull They also compared costs of this non-surg method vs surgery extrapolating a societal cost

savings of $344 billion per year They outline methods for a larger scaled randomized

clinical trial could be designed to better validate the findings from this pilot study


Soft Tissue Injury and Healing bull Phases of healing

ndash Inflammatory ndash 72 hours bull Swelling

ndash ProliferativeRepair phase ndash 6-8 weeks bull Being of scar tissue formation

ndash Remodeling Phase ndash 3-14 weeks up to 1-2 years in severe injury bull Maturing of scar tissue

ndash Contraction phase ndash Lifetime bull Natural shortening of scar tissue

(SGY From Rehab Class)


Conclusion

bull This small case series provides preliminary data for use of cryopreserved AMUC


bull This data is based on a limited sample size and further prospective studies using a large sample

size and a control group is warranted to confirm this therapeutic benefit


1132019

26


Yet MORE evidence for promoting Vit D3


Abstract Introduction

Rotator cuff tears are one of the most common injuries worldwide yet it is difficult to predict

which patients will have poor outcomes after arthroscopic rotator cuff repair (RCR) The

purpose of this study was to identify an association between preoperative vitamin D (25D)

levels and postoperative complications in arthroscopic RCR

Methods

From a national claims database patients undergoing arthroscopic RCR with preoperative 25D

levels were reviewed Patients were stratified into 25D-sufficient (ge20 ngdL) or 25D-deficient

(lt20 ngdL) categories and examined for development of postoperative complications

Multivariate logistic regression was performed using age sex and Charlson Comorbidity Index

(CCI) as covariates From this risk-adjusted odds ratios (ORs) were calculated comparing

complications between the two groups

Results

1881 patients with measured preoperative 25D levels were identified 229 patients were 25D

deficient (122) After adjusting for age sex and Charlson Comorbidity Index 25D-deficient

patients had increased odds of revision RCR (OR 154 95 confidence interval 121 to

197 P lt 0001) and stiffness requiring manipulation under anesthesia (OR 116 95

confidence interval 103 to 203 P = 0035)

Conclusions

Vitamin D deficiency is associated with a greater risk of postoperative surgical

complications after arthroscopic RCR and may be a modifiable risk factor Further

investigation on preoperative vitamin D repletion is warranted


Abstract

Background

Rotator cuff disease has a high prevalence and is associated with shoulder pain and disability Dyslipidemia might

be an intrinsic factor related to the development of the disease as it might increase tendon stiffness and result in

tendon problems The purposes of the present study were (1) to systematically review the association between

lipid disorders and the risk of rotator cuff disease and (2) to provide physicians with guidance to prevent

rotator cuff disease

Methods

Six databases were searched through July 6 2016 MEDLINE Embase CINAHL Web of Science

SPORTDiscus and the Cochrane Central Register of Controlled Trials Eligible studies were assessed for risk of

bias and strength of evidence Meta-analysis was performed for the effect of dyslipidemia on the presence of

rotator cuff disease with the effect being expressed as an odds ratio The overall effect was estimated and

heterogeneity across studies was expressed with the I2 statistic We used standard and contour-enhanced funnel

plots as well as the Begg and Egger tests to check for publication bias


Abstract

Results

Three cross-sectional studies 1 cohort study and 3 case-control studies involving 505852 participants were

selected with 6 of these studies being eligible for meta-analysis The main-effect meta-analysis yielded a pooled

odds ratio of 217 (95 confidence interval 146 to 323 p lt 0001 I2 = 824) indicating a higher rate of

rotator cuff disease in patients with dyslipidemia The sensitivity analysis was not different from the main-effect

analysis Contour-enhanced funnel plots revealed the possibility of publication bias or other small-study effects

Conclusions

We found that dyslipidemia was associated with high occurrence of rotator cuff disease We recommend

that physicians examine tendon conditions if their patients have severe dyslipidemia

Level of Evidence

Prognostic Level IV See Instructions for Authors for a complete description of levels of evidence

SGY Discuss Red Yeast Rice

httpsnccihnihgovhealthredyeastrice

Red Yeast Rice

bullKey Facts

bullAbout Red Yeast Rice

bullSafety

bullWhat the Science Says

bullLegal Status of Red Yeast Rice

bullIf You Are Considering Red Yeast Rice

bullFor More Information

bullKey References

bullAcknowledgments

1132019

27


Red Yeast Rice

bullKey Facts


bullSafety





bullKey References

bullAcknowledgments

Red yeast rice is a traditional Chinese culinary and medicinal product In the United States dietary supplements

containing red yeast rice have been marketed to help lower blood levels of cholesterol and related lipids Red yeast

rice products may not be safe some may have the same side effects as certain cholesterol-lowering drugs and some

may contain a potentially harmful contaminant This fact sheet provides basic information about red yeast rice

summarizes scientific research on effectiveness and safety discusses the legal status of red yeast rice and suggests

sources for additional information

Key Facts

bull Some red yeast rice products contain substantial amounts of monacolin K which is chemically identical to the

active ingredient in the cholesterol-lowering drug lovastatin These products may lower blood cholesterol levels and

can cause the same types of side effects and drug interactions as lovastatin

bull Other red yeast rice products contain little or no monacolin K It is not known whether these products have any

effect on blood cholesterol levels

bull Consumers have no way of knowing how much monacolin K is present in most red yeast rice products The labels

on these products usually state only the amount of red yeast rice that they contain not the amount of monacolin K

bull The US Food and Drug Administration (FDA) has determined that red yeast rice products that contain more than

trace amounts of monacolin K are unapproved new drugs and cannot be sold legally as dietary supplements

bull Some red yeast rice products contain a contaminant called citrinin which can cause kidney failure

bull Tell all your health care providers about any complementary health approaches you use Give them a full picture of

what you do to manage your health This will help ensure coordinated and safe care httpswwwwebmdcomcholesterol-managementred-yeast-rice1

Is Red Yeast Rice Extract a Drug or a Supplement

Confusingly the answer is both One of the most important ingredients in RYRE is monacolin

K Its also known as lovastatin the active ingredient in the prescription drug Mevacor

So on one hand the extract is a traditional remedy that helps lower cholesterol On the other

the pharmaceutical manufacturer of Mevacor argues that it owns the rights to the ingredient

lovastatin

This confusion extends to how the supplement is sold in the US Because red yeast rice extract

contains a substance classified as a prescription drug the FDA has requested that several RYRE

products be withdrawn from the market because they contained lovastatin The FDA cited a

risk of severe muscle problems that could lead to kidney disease

Despite the FDAs attempts many people in the US still manage to get similar red yeast rice

extracts from other countries or on the Internet

How Well Does Red Yeast Rice Lower Cholesterol

Studies have shown that certain red yeast rice products that contain statin can significantly

lower levels of total cholesterol and specifically LDL or bad cholesterol One showed that

taking 24 grams per day reduced LDL levels by 22 and total cholesterol by 16 in 12 weeks

Another study showed that taking 12 grams per day lowered LDL levels by 26 in just eight

weeks

However the results of these studies depend on the amount of statin that is in the extract and it

can vary widely The FDA considers extracts that contain statins to be illegal in the US but

many are still available

SGY

We know that including cervical and thoracic spinal

manipulation helps patients that have shoulder pain

Why is this



Abstract

Rotator cuff tendon tears are prevalent in patients with shoulder pain the 3rd most common

musculoskeletal complaint As shoulders are largely innervated by cervical nerves it seems

possible that rotator cuff pathology could have an association with cervical spine disorders although

few studies have investigated this possibility This study aimed to explore the association between

rotator cuff tendon tears and cervical radiculopathy (at C5 and C6 levels) in the shoulder pain

population

We conducted a retrospective review of a clinical registry of shoulder ultrasound (US) examinations

and cervical spine radiographs recruiting a total of 126 patients with cervical spine radiographs

taken within 1 year of US examinations Foraminal stenosis was grouped into 4 categories C45

intervertebral foramen only C56 intervertebral foramen only both C45 and C56

intervertebral foramina and neither C45 nor C56 intervertebral foramen The groups with

and without rotator cuff tendon tears were compared for various factors using the Mann-

Whitney U test for continuous variables and the χ2 test for categorical variables A multivariate

analysis was conducted using a logistic regression model to investigate the association between

rotator cuff tendon tears and cervical foraminal stenosis


Abstract

Patients with rotator cuff tendon tears tended to be older and had more night-time pain No

significant association was identified between rotator cuff tendon tears and cervical foraminal

stenosis at C5 and C6 levels The only factor significantly predicting rotator cuff tendon tears

was old age (odds ratio 104 95 confidence interval 100ndash109)

In patients with shoulder or neck pain no significant association existed between rotator cuff

tendon tears and cervical foraminal stenosis (at the C5 and C6 levels) When patients

present with undifferentiated shoulder and neck pain physicians should take a

detailed history perform physical examinations and imaging studies of both

the neck and shoulder regions

SGY They STILL rec C-XR in pts

w undifferentiated shoulder pain

1132019

28


Introduction

bull Shoulder pain is the 3rd most common musculoskeletal complaint (after low back and neck

pain) with a prevalence ranging from 69 to 260 in the general population[1]

bull The possible causes of shoulder pain are various and sometimes it is not easily differentiated from

other painful conditions of the neck or trunk

bull Rotator cuff tendon tears are highly prevalent in patients with shoulder pain often leading to

significant disability and decreased quality of life[23]

bull The etiology of rotator cuff tendon tears varies in different age groups Acute trauma is more common in young adults degeneration caused by chronic overuse is prevalent in the

elderly[4]

bull Patients with rotator cuff tendon tears may also develop symptoms similar to those of C5 or C6

radiculopathies (pain radiating to the deltoid muscle region and weakness during shoulder abduction)

bull As the shoulders are largely innervated by nerves arising from cervical roots[5] it seems

possible that rotator cuff pathology could have an association with cervical spine disorders

although few studies have investigated this possibility


Introduction

bull Coexistence of shoulder and neck pain is not rare in patients visiting pain clinics

bull This might be a consequence of the anatomical associations between the 2 regions

bull There are several muscles directly connecting the shoulder girdle to the cervical spine for example

the upper trapezius and levator scapulae muscles

bull A recent systematic review indicated that neckshoulder pain was related to reduced vascularity and

oxygenation at the trapezius muscle while performing upper extremity tasks[6]

bull Instability of the cervical spine could lead to overuse of these muscles thereby interfering with

normal shoulder kinematics[7]

bull Another potential link derives from a faulty posture of the spine

bull A previous study found a higher risk of rotator cuff tendon tears in patients with a kyphotic-lordotic

spine than in those with an ideal alignment[8]

bull Peripheral nerve dysfunction (such as suprascapular or axillary nerve neuropathy) caused by

proximal cervical nerve root entrapment (especially at the C5 and C6 root levels) has also been

considered a possible cause of painful shoulders[9ndash11] In fact ultrasound (US)-guided intervention for the proximal suprascapular nerve has been shown effective

in recalcitrant shoulder pain[12]

bull Taken together these observations suggest that clarification of the relationship between

shoulder and cervical spine pathologies could be helpful in the diagnosis and treatment of

relevant painful syndromes

bull The present study aimed to explore the association between rotator cuff tendon tears and cervical

radiculopathies at the C5 and C6 root levels

SGY Great review of pos EArsquos

for neckshldr connection


Our study had several limitations bull First the diagnosis of cervical radiculopathy at the C5 and C6 levels was based on radiography

which is less sensitive than magnetic resonance imaging

bull However considering the cost and insurance coverage patients undergoing cervical x-ray imaging

significantly outnumbered those receiving magnetic resonance imaging (which also yielded greater

statistical power for a retrospective analysis)

bull Additionally to increase the diagnostic sensitivity we enrolled patients only if they had cervical

radiographs for four view planes

bull Second all the cervical radiographs were not taken on the same dates as the shoulder ultrasound

scans

bull However the longest interval permitted between the 2 imaging sessions was 1 year

bull As cervical foraminal stenosis is mostly derived from degeneration and develops during a duration of

many years this timing allowance remained in accordance with a cross-sectional design

bull Third the study did not include healthy controls because the data were extracted from a medical

registry of shoulder patients

bull Although we speculate that the prevalence of shoulder and cervical pathologies might be lower in

asymptomatic participants a prospective study using a control group would be needed to show this

definitively

SGY

bull We have reviewed studies showing significant benefits with non-surgical chiropractic

care combined with patient-specific exercise certain modalities (LLLT gt US) soft-tissue

therapy

bull MRI findings of the non-injured side have VERY similar pathology as the symptomatic

side

bull Cortisone may promote more tearing and only benefits short-term

bull PRP appears better than cortisone but it too appears to be only short-term effective

bull AMUC looks promising but needs a larger scaled study to gain further evidence support

bull Bottom line Donrsquot be afraid to manage chronic RCT ndash our methods are equal or better

than other non-surgical approaches AND surgery is no guarantee (and in impingement

no better)

bull Acute traumatic RCT especially in younger patients favors surgical repair especially

when significant pathology is found ndash PROMPTLY ORDER AN MRI

Diagnosis

1132019

29

Neerrsquos sign

This test allows demonstration of a pain during passive abduction of the arm with the scapula stabilized the

examiner lifting the arm in the scapular plane with the arm internally rotated (Figure 1) It was described

originally in 1977 and did not as such describe an lsquoarcrsquo of pain However a painful arc through abduction is

often associated with the eponym As a supplementary part to this manoeuvre the effect on the pain following

an injection of local anaesthetic placed into the subacromial space is called Neers test A significant reduction

or abolition of the pain is seen as a positive test

httpsvideosearchyahoocomsearchvideofr=mcafeeampp=neer+test+for+imping

ementid=1ampvid=95276d4d0b1f5bf7ffda5fb9b9986a5bampaction=click Video 142m

See Handout - Article

HawkinsndashKennedy test

Described in 1980 this test is again a passive test with the examiner positioning the patients

arm at 90deg in the scapular plane the elbow bent to 90deg and the arm taken passively into internal

rotation Creation of pain during this maneuver is indicative of a positive test (Figure 2)

A recent pooled data analysis from

Hegedus et al has shown the

sensitivity (a true positive) of each of

the tests varies (79 for Hawkinsndash

Kennedy 72 for Neerrsquos test) but

importantly specificity (the statistical

ability of a test to be negative when a

defined pathological condition is not

present) is lower calculated at 59

and 60 respectively11

httpsvideosearchyahoocomsearchvideofr=mcafeeampp=hawkins+kennedy+test+f

or+impingementid=1ampvid=385e7d8097dae8b74ebf5dca4bd168eaampaction=click Video 135m

1132019

30

1132019

31

Treatment Exercise Sequence bull Acute

ndash Pendulum (Codmanrsquos)

ndash Finger Walks (Sagittal to Oblique to Frontal to Multi-planar)

ndash LIGHT Isometrics (vary the ldquostartrdquo position use wall or door jam)

ndash Long-Axis Traction Chair hold Standing vary height (continue until full ROM)

bull Subacute ndash Isotonics Eccentric gt Concentric

ndash TheraTube ldquoClockrdquo Exercise of 3rsquos (respect ROM limitations)

ndash Stay within ldquoReasonable Pain Boundariesrdquo

bull Chronic ndash TheraTube ldquoClockrdquo Exercise of 3rsquos

ndash Light weights (dumb-bells kettle bells cable systems)

ndash ADL Sport specific

SGY ldquoTestrdquo amp Prognosis w Sitting

Distraction Maneuver (demonstrate)

Occipital Lift


1132019

32


Abstract

Background

Although commonly prescribed the evidence to support exercises therapy (ET) and conservative

management for the treatment of full-thickness rotator cuff tears (FTT) is equivocal

Purpose

The purpose of this systematic review of the literature was to determine the current level of evidence

available for ET in the treatment of FTT and to provide a formal Grading of Recommendations

Assessment Development and Evaluation (GRADE) Working Group of recommendation

Methods

Five databases were systematically searched to evaluate the effectiveness of ET for FTT Inclusion

criteria experimental or observational studies of adults clinically diagnosed with FTT or massive or

inoperable tears that contained a treatment group that received ET for FTT Exclusion criteria included

history of surgical repair concurrent significant trauma neurological impairment and level V studies

Articles were assessed for quality the level of evidence (I ndash V) and GRADE of recommendation (A to

F) was determined Data extraction included demographics specific interventions and outcomes


Abstract

Results

One thousand five-hundred and sixty-nine unique citations were identified 35 studies were included

nine randomized controlled studies six cohort studies 15 case series and five case reports There were

2010 shoulders in 1913 subjects with an average age of 642 years 54 males 73 of tears

werethinspgtthinsp1thinspcm and 37 were classified as massive Based on studies that reported gt58 of tears

werethinspgtthinsp1 year and 73 were atraumatic Of the non-operatively treated cohorts that reported the

respective outcomes 78 improved in pain (910 cohorts that reported statistically significant

differences [stat-sig] plt005) 81 improved in ROM (1414 cohorts that reported met stat-sig)

85 improved in strength (78 cohorts that reported met stat-sig) 84 improved in functional

outcomes (1717 cohorts that reported met stat-sig) Dissatisfied outcomes occurred in 15 of

patients who then transitioned to surgery

Conclusion

The current literature indicates GRADE B recommendation (moderate strength) to support the use of

ET in the management of FTT There is further need for well-designed randomized controlled

trials

Level of Evidence 2a


Abstract

bull Controversy exists as to whether different dynamic muscle actions produce divergent hypertrophic responses

bull The purpose of this paper was to conduct a systematic review and meta-analysis of randomized controlled trials

comparing the hypertrophic effects of concentric vs eccentric training in healthy adults after regimented resistance

training (RT)

bull Studies were deemed eligible for inclusion if they met the following criteria (a) were an experimental trial published

in an English-language refereed journal (b) directly compared concentric and eccentric actions without the use of

external implements (ie blood pressure cuffs) and all other RT variables equivalent (c) measured morphologic

changes using biopsy imaging (magnetic resonance imaging computerized tomography or ultrasound) bioelectrical

impedance andor densitometry (d) had a minimum duration of 6 weeks and (e) used human participants without

musculoskeletal injury or any health condition that could directly or through the medications associated with the

management of said condition be expected to impact the hypertrophic response to resistance exercise

bull A systematic literature search determined that 15 studies met inclusion criteria

bull Results showed that eccentric muscle actions resulted in a greater effect size (ES) compared with concentric actions

but results did not reach statistical significance (ES difference = 025 plusmn 013 95 confidence interval -003 to 052 p

= 0076)

bull The mean percent change in muscle growth across studies favored eccentric compared with concentric actions

(100 vs 68 respectively) The findings indicate the importance of including eccentric and concentric actions in a

hypertrophy-oriented RT program as both have shown to be effective in increasing muscle hypertrophy

STM Soft Tissue Manipulation

Manual

Therapy

1132019

33

Infra-clavicular MCL while PASSIVELY abduct amp extend

with Figure 8 Mobilization

Subclavius Release

Pts will instinctively try to actively ldquohelprdquo ndash DONrsquoT LET THEM

GH Traction

EXERCISES

1132019

34

1132019

35

Other Exercise Options

Cane exercises Do multi-planar ROMs standing prone amp supine

SLOW Concentric 2x SLOWER Eccentric

REST ELBOW ON CHAIRBACK Monitor deltoid for mm

contraction - NOT ALLOWED

1132019

36

MODIFY 1) Isometrics

2) Isotonics

a) Eccentric

b) Concentric

Equipment

1) A wall

2) TheraTube

or Band

3) Dumb bells

Exercise Sequence bull Acute











SGY Donrsquot forget CHAIR PULLS andor WRIST PULLS

(relax shoulder while gripping = takes concentration

DEMONSTRATEWORKSHOP

When able ldquohangrdquo (by your hands) from a barledge door

jamhellip

1132019

37

TheraTube Exercises TheraTube ldquoClockrdquo

1) 6 positions total

2) 3 SLOW Reps

3) Eccentric release emphasis

4) Slide feetmove body (to

capture full ROM)

5) Work up to multiple sets (but

no more than 3 repsset

6) Concentrate while you do

these

7) Increase your ROMs as able

staying ldquowithin reasonable

pain boundariesrdquo

8) BE PATIENT

Cervical Spine Exercises bull Anterior Head Carriage Series

Effects of a Resistance and Stretching Training Program on Forward

Head and Protracted Shoulder Posture in Adolescents

Article (PDF Available) in Journal of manipulative and

physiological therapeutics 40(1) middot November 2016 DOI

101016jjmpt201610005 httpswwwresearchgatenetpublication309956478_Effects_of_a_Resistance_and_Stretching_Training_Program_on_Forward_Head_and_Protracted_Shoulder_Posture_in_Adolescents

ABSTRACT

Objective The purpose of this study was to evaluate the effects of a 16-week resistance and stretching

training program applied in physical education (PE) classes on forward head posture and protracted

shoulder posture in Portuguese adolescents

Methods This prospective randomized controlled study was conducted in 2 secondary schools incl

130 adolescents (aged 15-17 years) with forward head and protracted shoulder posture that were

randomly assigned to a control or experimental group Sagittal head cervical and shoulder angles were

measured with photogrammetry and Postural Assessment Software The American Shoulder and Elbow

Surgeons Shoulder Assessment was used to assess shoulder pain and neck pain during the last month

was self-reported with a single question These variables were assessed before and after a 16-week

intervention period The control group (n= 46) attended the PE classes whereas the exercise group (n=

84) received a posture corrective exercise program in addition to PE classes

Results A significant increase in cervical and shoulder angles was observed in the intervention group

from pretest to posttest (P lt 05) For the shoulder pain scores in both groups there were no significant

changes after the 16 weeks

Conclusions A 16-week resistance and stretching training program decreased forward head and

protracted shoulder postures in adolescents (J Manipulative Physiol Ther 2017401-10)

Key Indexing Terms Neck Exercise Posture Rehabilitation

httpswwwresearchgatenetpublication309956478_Effects_of_a_Resistance_and_Stretching_Training_Program_on_Forward_Head_and_Protracted_Shoulder_Posture_in_Adolescents


Sagittal head angle (ldquoArdquo) The angle formed at the

intersection of a horizontal line through the tragus of the

ear and a line

joining the tragus of the ear and the lateral canthus of the

eye

Cervical angle (ldquoBrdquo) The angle formed at the intersection

of a horizontal line through the spinous process of C7 and

a line to the tragus of the ear If the cervical angle was less

than 50deg the participant was considered to have FHP

Selection of 50deg as a reference angle was guided by the

studies of Diab and Moustafa24 and Yip et al25 with the

latter reporting 5502deg plusmn 286deg as a normal range As is

well

known participants with FHP have a significantly smaller

cervical angle compared with normal participants15

Shoulder angle (ldquoCrdquo) The angle formed at the

intersection of the line between the midpoint of the

humerus and the spinous process of C7 and the horizontal

line through the midpoint of the humerus


1132019

38


Exercise Form ndash

see

Next 3 slides

httpswwwresearchgatenetpublication309956478_Effects_of_a_Resistance_and_Stretching_Training_Program_on_Forward_Head_an

d_Protracted_Shoulder_Posture_in_Adolescents

httpswwwresearchgatenetpublication309956478_Effects_of_a_Resistance_and_Stretching_Training_Program_on_Forward_Head_and_Protracted_Shoulder_Posture_in_Adolescents httpswwwresearchgatenetpublication309956478_Effects_of_a_Resistance_and_Stretching_Training_Program_on_Forward_Head_and_Protracted_Shoulder_Posture_in_Adolescents

Table 1 is printed on back of the

Exercise Form

Scapular Stabilization Scapular Stabilization

1132019

39

1132019

40

1132019

41

VIDEO (325m)

httpsvideosearchyahoocomsearchvideo_ylt=AwrC5plh5r1dw1EAR

yP7w8QF_ylu=X3oDMTBscHIxaTlxBHNlYwNzZWFyY2gEdnRpZAN

CODY0NQ--

_ylc=X0kDRVRGcGpERXdMakhwYy5xaldadkUud0NvTnpFdU9RQU

FBQURra3NNcQRfUwM5Njc4MTMwNwRfcgMyBGFjdG4DY2xrBGN

zcmNwdmlkA0VURnBqREV3TGpIcGMucWpXWnZFLndDb056RXVP

UUFBQUFEa2tzTXEEZnIDbWNhZmVlBGZyMgNwOnMsdjp2LG06c2

IscmduOnRvcARncHJpZANiLkNUR01fNlJEcUNTRk1Tcy5CYlpBBG5

fcnNsdAMwBG5fc3VnZwMwBG9yaWdpbgN2aWRlby5zZWFyY2gue

WFob28uY29tBHBvcwMwBHBxc3RyAwRwcXN0cmwDMARxc3Ryb

AMyNgRxdWVyeQNTY2FwdWxvaHVtZXJhbCUyMHJoeXRobSUyM

FRlc3QEdF9zdG1wAzE1NzI3Mjc5MjAEdnRlc3RpZANCODY0NQ--

p=Scapulohumeral+rhythm+Testampei=UTF-

8ampfr2=p3As2Cv3Av2Cm3Asb2Crgn3Atopampfr=mcafeei

d=1ampvid=cd6272d27cabb76a68f27b990d295758ampaction=view

3 Phases

1) Phase 1 0-30deg Elevation humerus 30deg Abd Clav 0-5deg elev Scapula = minimal medial

2) Phase 2 90deg Elevation humerus 40-90deg Abd 15deg clav elev Scap 20deg lat Rot (amp sl posterior)

3) Phase 3 90-180deg Elevation humerus 60deg Abd 90deg latrot Scap 30-40deg latrot clav 30-50degPR

15deg elev

Phase 2 amp 3

ACJ 20deg

SCJ 40deg

Scapulohumeral Rhythm Test

Watch BOTH Asc amp Descending UE

1132019

42

Abstract

Study Design

Prospective cohort

Introduction

Assessment of scapular dysfunction is considered important in the clinical evaluation and treatment of patients with

symptoms of subacromial impingement However sparse research has been conducted into the reliability and predictive

value of clinical tests with which to identify scapular dyskinesis

Purpose of the Study

To evaluate intrarater and interrater reliability and predictive value of the Scapular Dyskinesis Test (SDT) in patients with


Methods

Forty-five patients with subacromial impingement syndrome were included The presence of scapular dyskinesis was

classified by 2 raters using the SDT Intrarater and interrater reliabilities were examined and compared Patients with and

without scapular dyskinesis were compared in terms of Oxford Shoulder Score and EQ-5D-5L scores at baseline and 3

months as well rating of overall improvement in shoulder condition

Abstract (continued)

Results

SDT could not be performed in 5 patients leaving 40 patients for further analysis Kappa with squared weights was 064

for rater A and 086 for rater B the intrarater agreement was 88 for A and 96 for B For interrater comparison the

Kappa value was 059 and agreement 86 No statically significant differences in Oxford Shoulder Score and EQ-5D-5L

baseline and change scores or overall improvement in shoulder condition at 3 months were observed between patients

with or without scapular dyskinesis [SGY This is better than the original 2009 McClure statistics]

Conclusions

Intrarater and interrater reliability and agreement of the SDT were determined The findings that functional

impairment and outcomes did not differ between patients with or without the presences of scapular dyskinesis may

question the clinical value of the SDT in patients with subacromial impingement syndrome

Level of Evidence

1b

VIDEO

httpsvideosearchyahoocomsearchvideo_ylt=AwrE19Cw5L1dPzsAhRxXNyoA_ylu=X3oDMTEzZnNnMjV0BGNvbG8DYmYxBHBvcwMxB

HZ0aWQDVUlDMV8xBHNlYwNwaXZzp=Scapular+Dyskinesis+Testampfr2=piv-

webampfr=mcafeeid=1ampvid=f02502f0a604f3694f375478fcd4b53bampaction=view

VIDEO (428m)




McClure Method (see 2009 paperhandout)

bull 5 reps w3 DB if lt150 or 5 if gt150 2-3 secrep thumbs up

bull 2 ROMs FFL x5 ABD x5 rate as 1) Normal 2) Subtle 3) Obvious (on ge3 of 5 reps) Dyskinesis

bull Look for 1) Scap winging (post Displacement) or

bull 2) Dysrhythmia (lt60deg or excessive shldr elev or protraction non-smoothstutter ROM) rapid drop

httpsvideosearchyahoocomsearchvideo_ylt=AwrDQ2rt9L1d8RIAyVT7w8QF_ylu=X3oDMTBscHIxaTlxBHNlYwNzZWFyY2gEdnRpZANCODY0NQ--

_ylc=X0kDVU0xNUR6RXdMakhwYy5xaldadkUud0ZuTnpFdU9RQUFBQURDaF9vZwRfUwM5Njc4MTMwNwRfcgMyBGFjdG4DY2xrBGNzcmNwdmlkA1VNMTVEekV3TGpIcGMucWpXWnZFLndGbk56RXVPUUFBQUFEQ2hfb2cEZnIDbWNhZmVlBGZyMgNwOnMsdjp2LG06c2IscmduOnRvcARncHJpZANJT0NvY2sxdlJ0Q18ueHlsTXBRVU9BBG5fcnNsdAMwBG5fc3VnZwMwBG9yaWdpbgN2aWRlby5zZWFyY2gueWFob28uY29tBHBvcwMwBHBxc3RyAwRwcXN0cmwDMARxc3RybAM0MQRxdWVyeQNRdWFkcnVwZWQl

MjBSb2NrJTIwVGVzdCUyMC0lMjBzY2FwdWxhciUyMGR5c2tpbmVzaXMEdF9zdG1wAzE1NzI3MzAyMDYEdnRlc3RpZANCODY0NQ--p=Quadruped+Rock+Test+-+scapular+dyskinesisampei=UTF-

8ampfr2=p3As2Cv3Av2Cm3Asb2Crgn3Atopampfr=mcafeeid=1ampvid=35c83024143b42f507972838b122a532ampaction=view

Video link (135m)

Quadruped or 4-Point Rock

(for Scap Instability)

LT Neutral ldquostartrdquo position MID Partial push-upFW rock (worse) RT tries to spread

scap (still ldquowingsrdquo) Lastly move her side-to-side and LT scap ldquopopsrdquo more (not shown)

ldquoStartrdquo position Hands under shldrs knees under hips

neutral pelvis

Video 043s

Soft Tissue Mobilization (STM) Biceps Brachii

INSTRUCTIONS

bull Place Bar over the biceps w

pronated armhand on mat

palm down

bull Roll bar prox-dist-prox x3

bull Find TP hold bar still while

pronatesupinate UE (palm up

to down) x3

httpswwwyoutubecomwatchv=SCjPvU3cz1k httpswwwyoutubecomwatchv=a691yzF-4C8 Video 044s

Soft Tissue Mobilization (STM) Pect Minor

Abd-Adduction

Backward Extension to FFL reps

Place tennis ball over pect

minor move ball updown

the muscle leaning into the

doorrsquos edge ldquodiggingrdquo out

the tight tender muscle while

extflex and Abdadd the UE

1132019

43

Soft Tissue Mobilization (STM) Upper

TrapsRhomboids


Place tennis ball golf ball or ldquoRogue Lacrosse Ballrdquo (pictured)

over the involved muscle (TP) and ldquodigrdquo it out

httpswwwrogueeuropeeurogue-lacrosse-ball-eu Foam Roller

1132019

44

MANY OTHER EXERCISES ndash See Phases Rehab or Web Exercises

1132019

2

ANT

ANT

1132019

3

1132019

4

Risk factors


rotator cuff injury



older than 40











1132019

5



CASE STUDIES (2019)

1132019

6


Handout 2


HIGHLIGHTS






















Case Report



the end zone





extremity



Case Report




Limited active ROM



(subscapularis)


Or YouTube



Case Report




external rotation






Or YouTube


JtdYWI


Case Report




glenohumeral joint






1132019

7

Figure 1












hemorrhage








white arrowheads)

ANT

POST




















capsule (Figure 3)




Posterior approach

Upon reflecting the


surface of the

humeral head and

torn infraspinatus

tendon are

visualized






groove


identified


subscapularis






screw


the arm in neutral



















from anchor)

1132019

8





at 60deg








Case Report



in the literature









Case Report









impingement process





Case Report



tears)10











Case Report








athletic population


Case Report






radiographs and MRI







1132019

9


Case Report




literature1714







of diagnosis





injury



SIDEBAR


to do so









Abstract

CONTEXT



OBJECTIVE



DESIGN


SETTING





















change

RESULTS






CONCLUSIONS




JCCA DC case study


PMCID PMC2485523





MC2485523

Handout 3

JCCA DC case study










1132019

10

JCCA DC case study








JCCA DC case study

Examination








JCCA DC case study

DIAGNOSIS



JCCA DC case study

Treatment









JCCA DC case study





SEE TABLE 1



SEE TABLE 1


1132019

11





























SIDEBAR




1132019

12



Background









pain










ABSTRACT



Results





moderate (000-051)

Conclusion









Handout 4 Abstract









cortisone cream


muscle exercises










Background












cuff tissue [5]





Background





(Table (Table1)1)



[PubMed] [Ref list]



1132019

13

Background






Background





Background






Background






Case Presentations

Four presentations

CASE 1









Case Presentations

Four presentations

CASE 1 (continued)







comfortably







1132019

14

Case Presentations

Four presentations

CASE 1 (continued)






rotation











Case Presentations

Four presentations

CASE 1 (continued)













Case Presentations

Four presentations

CASE 1 (continued)






Case Presentations

Four presentations

CASE 2






manipulation


internal rotation




badge)



(Ibuprofen)




Case Presentations

Four presentations

CASE 2 (continued)


















Case Presentations

Four presentations

CASE 3








scale)






skull


without pain




1132019

15

Case Presentations

Four presentations

CASE 3 (continued)


















Case Presentations

Four presentations

CASE 3 (continued)





Case Presentations

Four presentations

CASE 4















pain)



Case Presentations

Four presentations

CASE 4 (continued)





Neers test








to the left


specific pressure






Case Presentations

Four presentations

CASE 4 (continued)





Neers test








to the left


specific pressure






Case Presentations

Four presentations

CASE 4 (continued)





syndrome


1132019

16

Case Presentations

Four presentations

THE INTERVENTIONS





levator scapulae









Case Presentations

Four presentations









to the patient




Case Presentations

Four presentations











Case Presentations

Four presentations





technique










Case Presentations

Four presentations














objective symptoms


findings


Case Presentations

Four presentations






setting



another choice







1132019

17

Case Presentations

Four presentations






therapies




cuff dysfunction









Case Presentations

Four presentations














method




Case Presentations

Four presentations










[37]


Case Presentations

Four presentations










ultrasound therapy








Case Presentations

Four presentations






















Four presentations



















1132019

18

Case Presentations

Four presentations











patients [23]







Case Presentations

Four presentations













arm






Case Presentations

Four presentations



direction








Figure 1










Case Presentations

Four presentations














spine



setting



precede 2010

1132019

19








Abstract

OBJECTIVE





chiropractors

METHODS










Author information


Abstract

(CONTINUED)

RESULTS











CONCLUSION






1132019

20


Abstract

OBJECTIVE



METHODS











Abstract

RESULTS








CONCLUSION





capsulitis (AC)



Abstract

BACKGROUND





METHODS










Abstract

RESULTS









INTERPRETATION










Abstract











years (55 to 81))







KEYWORDS



1132019

21



RESULTS






up (SMD -032 95 CI -062 to -001)




CONCLUSION











1132019

22




1132019

23



101186s12891-017-1518-0










Abstract

BACKGROUND








METHODS






RESULTS







CONCLUSIONS




this area




Abstract











Abstract









Introduction



RCT[2ndash5]













1132019

24


Introduction










Introduction


solutions










Introduction


action























Results












Results










1132019

25


Results









Figure 1







resonance imaging


Discussion


visits annually[43]











RCTs




in 14 patients[49]









in the average ROM













SGY



stage (next slide)












Conclusion






1132019

26









Methods







Results






Conclusions





Abstract

Background






Methods








Abstract

Results






Conclusions



Level of Evidence




Red Yeast Rice

bullKey Facts


bullSafety





bullKey References

bullAcknowledgments

1132019

27


Red Yeast Rice

bullKey Facts


bullSafety





bullKey References

bullAcknowledgments







Key Facts


















lovastatin












weeks




SGY



Why is this



Abstract






population











Abstract












1132019

28


Introduction








elderly[4]







Introduction
































scans








definitively

SGY



therapy


side






no better)



Diagnosis

1132019

29

Neerrsquos sign


























1132019

30

1132019

31














Occipital Lift


1132019

32


Abstract

Background



Purpose




Methods








Abstract

Results











Conclusion



trials



Abstract




training (RT)











= 0076)





Manual

Therapy

1132019

33



Subclavius Release


GH Traction

EXERCISES

1132019

34

1132019

35






1132019

36


2) Isotonics

a) Eccentric

b) Concentric

Equipment

1) A wall

2) TheraTube

or Band

3) Dumb bells














DEMONSTRATEWORKSHOP


jamhellip

1132019

37



2) 3 SLOW Reps



capture full ROM)




these




8) BE PATIENT







ABSTRACT






















ear and a line


eye








well








1132019

38


Exercise Form ndash

see

Next 3 slides





Exercise Form


1132019

39

1132019

40

1132019

41

VIDEO (325m)



CODY0NQ--













3 Phases




15deg elev

Phase 2 amp 3

ACJ 20deg

SCJ 40deg



1132019

42

Abstract

Study Design

Prospective cohort

Introduction







Methods






Results






Conclusions




Level of Evidence

1b

VIDEO




VIDEO (428m)













Video link (135m)






neutral pelvis

Video 043s


INSTRUCTIONS



palm down




to down) x3



Abd-Adduction








1132019

43


TrapsRhomboids





1132019

44


1132019

3

1132019

4

Risk factors


rotator cuff injury



older than 40











1132019

5



CASE STUDIES (2019)

1132019

6


Handout 2


HIGHLIGHTS






















Case Report



the end zone





extremity



Case Report




Limited active ROM



(subscapularis)


Or YouTube



Case Report




external rotation






Or YouTube


JtdYWI


Case Report




glenohumeral joint






1132019

7

Figure 1












hemorrhage








white arrowheads)

ANT

POST




















capsule (Figure 3)




Posterior approach

Upon reflecting the


surface of the

humeral head and

torn infraspinatus

tendon are

visualized






groove


identified


subscapularis






screw


the arm in neutral



















from anchor)

1132019

8





at 60deg








Case Report



in the literature









Case Report









impingement process





Case Report



tears)10











Case Report








athletic population


Case Report






radiographs and MRI







1132019

9


Case Report




literature1714







of diagnosis





injury



SIDEBAR


to do so









Abstract

CONTEXT



OBJECTIVE



DESIGN


SETTING





















change

RESULTS






CONCLUSIONS




JCCA DC case study


PMCID PMC2485523





MC2485523

Handout 3

JCCA DC case study










1132019

10

JCCA DC case study








JCCA DC case study

Examination








JCCA DC case study

DIAGNOSIS



JCCA DC case study

Treatment









JCCA DC case study





SEE TABLE 1



SEE TABLE 1


1132019

11





























SIDEBAR




1132019

12



Background









pain










ABSTRACT



Results





moderate (000-051)

Conclusion









Handout 4 Abstract









cortisone cream


muscle exercises










Background












cuff tissue [5]





Background





(Table (Table1)1)



[PubMed] [Ref list]



1132019

13

Background






Background





Background






Background






Case Presentations

Four presentations

CASE 1









Case Presentations

Four presentations

CASE 1 (continued)







comfortably







1132019

14

Case Presentations

Four presentations

CASE 1 (continued)






rotation











Case Presentations

Four presentations

CASE 1 (continued)













Case Presentations

Four presentations

CASE 1 (continued)






Case Presentations

Four presentations

CASE 2






manipulation


internal rotation




badge)



(Ibuprofen)




Case Presentations

Four presentations

CASE 2 (continued)


















Case Presentations

Four presentations

CASE 3








scale)






skull


without pain




1132019

15

Case Presentations

Four presentations

CASE 3 (continued)


















Case Presentations

Four presentations

CASE 3 (continued)





Case Presentations

Four presentations

CASE 4















pain)



Case Presentations

Four presentations

CASE 4 (continued)





Neers test








to the left


specific pressure






Case Presentations

Four presentations

CASE 4 (continued)





Neers test








to the left


specific pressure






Case Presentations

Four presentations

CASE 4 (continued)





syndrome


1132019

16

Case Presentations

Four presentations

THE INTERVENTIONS





levator scapulae









Case Presentations

Four presentations









to the patient




Case Presentations

Four presentations











Case Presentations

Four presentations





technique










Case Presentations

Four presentations














objective symptoms


findings


Case Presentations

Four presentations






setting



another choice







1132019

17

Case Presentations

Four presentations






therapies




cuff dysfunction









Case Presentations

Four presentations














method




Case Presentations

Four presentations










[37]


Case Presentations

Four presentations










ultrasound therapy








Case Presentations

Four presentations






















Four presentations



















1132019

18

Case Presentations

Four presentations











patients [23]







Case Presentations

Four presentations













arm






Case Presentations

Four presentations



direction








Figure 1










Case Presentations

Four presentations














spine



setting



precede 2010

1132019

19








Abstract

OBJECTIVE





chiropractors

METHODS










Author information


Abstract

(CONTINUED)

RESULTS











CONCLUSION






1132019

20


Abstract

OBJECTIVE



METHODS











Abstract

RESULTS








CONCLUSION





capsulitis (AC)



Abstract

BACKGROUND





METHODS










Abstract

RESULTS









INTERPRETATION










Abstract











years (55 to 81))







KEYWORDS



1132019

21



RESULTS






up (SMD -032 95 CI -062 to -001)




CONCLUSION











1132019

22




1132019

23



101186s12891-017-1518-0










Abstract

BACKGROUND








METHODS






RESULTS







CONCLUSIONS




this area




Abstract











Abstract









Introduction



RCT[2ndash5]













1132019

24


Introduction










Introduction


solutions










Introduction


action























Results












Results










1132019

25


Results









Figure 1







resonance imaging


Discussion


visits annually[43]











RCTs




in 14 patients[49]









in the average ROM













SGY



stage (next slide)












Conclusion






1132019

26









Methods







Results






Conclusions





Abstract

Background






Methods








Abstract

Results






Conclusions



Level of Evidence




Red Yeast Rice

bullKey Facts


bullSafety





bullKey References

bullAcknowledgments

1132019

27


Red Yeast Rice

bullKey Facts


bullSafety





bullKey References

bullAcknowledgments







Key Facts


















lovastatin












weeks




SGY



Why is this



Abstract






population











Abstract












1132019

28


Introduction








elderly[4]







Introduction
































scans








definitively

SGY



therapy


side






no better)



Diagnosis

1132019

29

Neerrsquos sign


























1132019

30

1132019

31














Occipital Lift


1132019

32


Abstract

Background



Purpose




Methods








Abstract

Results











Conclusion



trials



Abstract




training (RT)











= 0076)





Manual

Therapy

1132019

33



Subclavius Release


GH Traction

EXERCISES

1132019

34

1132019

35






1132019

36


2) Isotonics

a) Eccentric

b) Concentric

Equipment

1) A wall

2) TheraTube

or Band

3) Dumb bells














DEMONSTRATEWORKSHOP


jamhellip

1132019

37



2) 3 SLOW Reps



capture full ROM)




these




8) BE PATIENT







ABSTRACT






















ear and a line


eye








well








1132019

38


Exercise Form ndash

see

Next 3 slides





Exercise Form


1132019

39

1132019

40

1132019

41

VIDEO (325m)



CODY0NQ--













3 Phases




15deg elev

Phase 2 amp 3

ACJ 20deg

SCJ 40deg



1132019

42

Abstract

Study Design

Prospective cohort

Introduction







Methods






Results






Conclusions




Level of Evidence

1b

VIDEO




VIDEO (428m)













Video link (135m)






neutral pelvis

Video 043s


INSTRUCTIONS



palm down




to down) x3



Abd-Adduction








1132019

43


TrapsRhomboids





1132019

44


1132019

4

Risk factors


rotator cuff injury



older than 40











1132019

5



CASE STUDIES (2019)

1132019

6


Handout 2


HIGHLIGHTS






















Case Report



the end zone





extremity



Case Report




Limited active ROM



(subscapularis)


Or YouTube



Case Report




external rotation






Or YouTube


JtdYWI


Case Report




glenohumeral joint






1132019

7

Figure 1












hemorrhage








white arrowheads)

ANT

POST




















capsule (Figure 3)




Posterior approach

Upon reflecting the


surface of the

humeral head and

torn infraspinatus

tendon are

visualized






groove


identified


subscapularis






screw


the arm in neutral



















from anchor)

1132019

8





at 60deg








Case Report



in the literature









Case Report









impingement process





Case Report



tears)10











Case Report








athletic population


Case Report






radiographs and MRI







1132019

9


Case Report




literature1714







of diagnosis





injury



SIDEBAR


to do so









Abstract

CONTEXT



OBJECTIVE



DESIGN


SETTING





















change

RESULTS






CONCLUSIONS




JCCA DC case study


PMCID PMC2485523





MC2485523

Handout 3

JCCA DC case study










1132019

10

JCCA DC case study








JCCA DC case study

Examination








JCCA DC case study

DIAGNOSIS



JCCA DC case study

Treatment









JCCA DC case study





SEE TABLE 1



SEE TABLE 1


1132019

11





























SIDEBAR




1132019

12



Background









pain










ABSTRACT



Results





moderate (000-051)

Conclusion









Handout 4 Abstract









cortisone cream


muscle exercises










Background












cuff tissue [5]





Background





(Table (Table1)1)



[PubMed] [Ref list]



1132019

13

Background






Background





Background






Background






Case Presentations

Four presentations

CASE 1









Case Presentations

Four presentations

CASE 1 (continued)







comfortably







1132019

14

Case Presentations

Four presentations

CASE 1 (continued)






rotation











Case Presentations

Four presentations

CASE 1 (continued)













Case Presentations

Four presentations

CASE 1 (continued)






Case Presentations

Four presentations

CASE 2






manipulation


internal rotation




badge)



(Ibuprofen)




Case Presentations

Four presentations

CASE 2 (continued)


















Case Presentations

Four presentations

CASE 3








scale)






skull


without pain




1132019

15

Case Presentations

Four presentations

CASE 3 (continued)


















Case Presentations

Four presentations

CASE 3 (continued)





Case Presentations

Four presentations

CASE 4















pain)



Case Presentations

Four presentations

CASE 4 (continued)





Neers test








to the left


specific pressure






Case Presentations

Four presentations

CASE 4 (continued)





Neers test








to the left


specific pressure






Case Presentations

Four presentations

CASE 4 (continued)





syndrome


1132019

16

Case Presentations

Four presentations

THE INTERVENTIONS





levator scapulae









Case Presentations

Four presentations









to the patient




Case Presentations

Four presentations











Case Presentations

Four presentations





technique










Case Presentations

Four presentations














objective symptoms


findings


Case Presentations

Four presentations






setting



another choice







1132019

17

Case Presentations

Four presentations






therapies




cuff dysfunction









Case Presentations

Four presentations














method




Case Presentations

Four presentations










[37]


Case Presentations

Four presentations










ultrasound therapy








Case Presentations

Four presentations






















Four presentations



















1132019

18

Case Presentations

Four presentations











patients [23]







Case Presentations

Four presentations













arm






Case Presentations

Four presentations



direction








Figure 1










Case Presentations

Four presentations














spine



setting



precede 2010

1132019

19








Abstract

OBJECTIVE





chiropractors

METHODS










Author information


Abstract

(CONTINUED)

RESULTS











CONCLUSION






1132019

20


Abstract

OBJECTIVE



METHODS











Abstract

RESULTS








CONCLUSION





capsulitis (AC)



Abstract

BACKGROUND





METHODS










Abstract

RESULTS









INTERPRETATION










Abstract











years (55 to 81))







KEYWORDS



1132019

21



RESULTS






up (SMD -032 95 CI -062 to -001)




CONCLUSION











1132019

22




1132019

23



101186s12891-017-1518-0










Abstract

BACKGROUND








METHODS






RESULTS







CONCLUSIONS




this area




Abstract











Abstract









Introduction



RCT[2ndash5]













1132019

24


Introduction










Introduction


solutions










Introduction


action























Results












Results










1132019

25


Results









Figure 1







resonance imaging


Discussion


visits annually[43]











RCTs




in 14 patients[49]









in the average ROM













SGY



stage (next slide)












Conclusion






1132019

26









Methods







Results






Conclusions





Abstract

Background






Methods








Abstract

Results






Conclusions



Level of Evidence




Red Yeast Rice

bullKey Facts


bullSafety





bullKey References

bullAcknowledgments

1132019

27


Red Yeast Rice

bullKey Facts


bullSafety





bullKey References

bullAcknowledgments







Key Facts


















lovastatin












weeks




SGY



Why is this



Abstract






population











Abstract












1132019

28


Introduction








elderly[4]







Introduction
































scans








definitively

SGY



therapy


side






no better)



Diagnosis

1132019

29

Neerrsquos sign


























1132019

30

1132019

31














Occipital Lift


1132019

32


Abstract

Background



Purpose




Methods








Abstract

Results











Conclusion



trials



Abstract




training (RT)











= 0076)





Manual

Therapy

1132019

33



Subclavius Release


GH Traction

EXERCISES

1132019

34

1132019

35






1132019

36


2) Isotonics

a) Eccentric

b) Concentric

Equipment

1) A wall

2) TheraTube

or Band

3) Dumb bells














DEMONSTRATEWORKSHOP


jamhellip

1132019

37



2) 3 SLOW Reps



capture full ROM)




these




8) BE PATIENT







ABSTRACT






















ear and a line


eye








well








1132019

38


Exercise Form ndash

see

Next 3 slides





Exercise Form


1132019

39

1132019

40

1132019

41

VIDEO (325m)



CODY0NQ--













3 Phases




15deg elev

Phase 2 amp 3

ACJ 20deg

SCJ 40deg



1132019

42

Abstract

Study Design

Prospective cohort

Introduction







Methods






Results






Conclusions




Level of Evidence

1b

VIDEO




VIDEO (428m)













Video link (135m)






neutral pelvis

Video 043s


INSTRUCTIONS



palm down




to down) x3



Abd-Adduction








1132019

43


TrapsRhomboids





1132019

44


1132019

5



CASE STUDIES (2019)

1132019

6


Handout 2


HIGHLIGHTS






















Case Report



the end zone





extremity



Case Report




Limited active ROM



(subscapularis)


Or YouTube



Case Report




external rotation






Or YouTube


JtdYWI


Case Report




glenohumeral joint






1132019

7

Figure 1












hemorrhage








white arrowheads)

ANT

POST




















capsule (Figure 3)




Posterior approach

Upon reflecting the


surface of the

humeral head and

torn infraspinatus

tendon are

visualized






groove


identified


subscapularis






screw


the arm in neutral



















from anchor)

1132019

8





at 60deg








Case Report



in the literature









Case Report









impingement process





Case Report



tears)10











Case Report








athletic population


Case Report






radiographs and MRI







1132019

9


Case Report




literature1714







of diagnosis





injury



SIDEBAR


to do so









Abstract

CONTEXT



OBJECTIVE



DESIGN


SETTING





















change

RESULTS






CONCLUSIONS




JCCA DC case study


PMCID PMC2485523





MC2485523

Handout 3

JCCA DC case study










1132019

10

JCCA DC case study








JCCA DC case study

Examination








JCCA DC case study

DIAGNOSIS



JCCA DC case study

Treatment









JCCA DC case study





SEE TABLE 1



SEE TABLE 1


1132019

11





























SIDEBAR




1132019

12



Background









pain










ABSTRACT



Results





moderate (000-051)

Conclusion









Handout 4 Abstract









cortisone cream


muscle exercises










Background












cuff tissue [5]





Background





(Table (Table1)1)



[PubMed] [Ref list]



1132019

13

Background






Background





Background






Background






Case Presentations

Four presentations

CASE 1









Case Presentations

Four presentations

CASE 1 (continued)







comfortably







1132019

14

Case Presentations

Four presentations

CASE 1 (continued)






rotation











Case Presentations

Four presentations

CASE 1 (continued)













Case Presentations

Four presentations

CASE 1 (continued)






Case Presentations

Four presentations

CASE 2






manipulation


internal rotation




badge)



(Ibuprofen)




Case Presentations

Four presentations

CASE 2 (continued)


















Case Presentations

Four presentations

CASE 3








scale)






skull


without pain




1132019

15

Case Presentations

Four presentations

CASE 3 (continued)


















Case Presentations

Four presentations

CASE 3 (continued)





Case Presentations

Four presentations

CASE 4















pain)



Case Presentations

Four presentations

CASE 4 (continued)





Neers test








to the left


specific pressure






Case Presentations

Four presentations

CASE 4 (continued)





Neers test








to the left


specific pressure






Case Presentations

Four presentations

CASE 4 (continued)





syndrome


1132019

16

Case Presentations

Four presentations

THE INTERVENTIONS





levator scapulae









Case Presentations

Four presentations









to the patient




Case Presentations

Four presentations











Case Presentations

Four presentations





technique










Case Presentations

Four presentations














objective symptoms


findings


Case Presentations

Four presentations






setting



another choice







1132019

17

Case Presentations

Four presentations






therapies




cuff dysfunction









Case Presentations

Four presentations














method




Case Presentations

Four presentations










[37]


Case Presentations

Four presentations










ultrasound therapy








Case Presentations

Four presentations






















Four presentations



















1132019

18

Case Presentations

Four presentations











patients [23]







Case Presentations

Four presentations













arm






Case Presentations

Four presentations



direction








Figure 1










Case Presentations

Four presentations














spine



setting



precede 2010

1132019

19








Abstract

OBJECTIVE





chiropractors

METHODS










Author information


Abstract

(CONTINUED)

RESULTS











CONCLUSION






1132019

20


Abstract

OBJECTIVE



METHODS











Abstract

RESULTS








CONCLUSION





capsulitis (AC)



Abstract

BACKGROUND





METHODS










Abstract

RESULTS









INTERPRETATION










Abstract











years (55 to 81))







KEYWORDS



1132019

21



RESULTS






up (SMD -032 95 CI -062 to -001)




CONCLUSION











1132019

22




1132019

23



101186s12891-017-1518-0










Abstract

BACKGROUND








METHODS






RESULTS







CONCLUSIONS




this area




Abstract











Abstract









Introduction



RCT[2ndash5]













1132019

24


Introduction










Introduction


solutions










Introduction


action























Results












Results










1132019

25


Results









Figure 1







resonance imaging


Discussion


visits annually[43]











RCTs




in 14 patients[49]









in the average ROM













SGY



stage (next slide)












Conclusion






1132019

26









Methods







Results






Conclusions





Abstract

Background






Methods








Abstract

Results






Conclusions



Level of Evidence




Red Yeast Rice

bullKey Facts


bullSafety





bullKey References

bullAcknowledgments

1132019

27


Red Yeast Rice

bullKey Facts


bullSafety





bullKey References

bullAcknowledgments







Key Facts


















lovastatin












weeks




SGY



Why is this



Abstract






population











Abstract












1132019

28


Introduction








elderly[4]







Introduction
































scans








definitively

SGY



therapy


side






no better)



Diagnosis

1132019

29

Neerrsquos sign


























1132019

30

1132019

31














Occipital Lift


1132019

32


Abstract

Background



Purpose




Methods








Abstract

Results











Conclusion



trials



Abstract




training (RT)











= 0076)





Manual

Therapy

1132019

33



Subclavius Release


GH Traction

EXERCISES

1132019

34

1132019

35






1132019

36


2) Isotonics

a) Eccentric

b) Concentric

Equipment

1) A wall

2) TheraTube

or Band

3) Dumb bells














DEMONSTRATEWORKSHOP


jamhellip

1132019

37



2) 3 SLOW Reps



capture full ROM)




these




8) BE PATIENT







ABSTRACT






















ear and a line


eye








well








1132019

38


Exercise Form ndash

see

Next 3 slides





Exercise Form


1132019

39

1132019

40

1132019

41

VIDEO (325m)



CODY0NQ--













3 Phases




15deg elev

Phase 2 amp 3

ACJ 20deg

SCJ 40deg



1132019

42

Abstract

Study Design

Prospective cohort

Introduction







Methods






Results






Conclusions




Level of Evidence

1b

VIDEO




VIDEO (428m)













Video link (135m)






neutral pelvis

Video 043s


INSTRUCTIONS



palm down




to down) x3



Abd-Adduction








1132019

43


TrapsRhomboids





1132019

44


1132019

6


Handout 2


HIGHLIGHTS






















Case Report



the end zone





extremity



Case Report




Limited active ROM



(subscapularis)


Or YouTube



Case Report




external rotation






Or YouTube


JtdYWI


Case Report




glenohumeral joint






1132019

7

Figure 1












hemorrhage








white arrowheads)

ANT

POST




















capsule (Figure 3)




Posterior approach

Upon reflecting the


surface of the

humeral head and

torn infraspinatus

tendon are

visualized






groove


identified


subscapularis






screw


the arm in neutral



















from anchor)

1132019

8





at 60deg








Case Report



in the literature









Case Report









impingement process





Case Report



tears)10











Case Report








athletic population


Case Report






radiographs and MRI







1132019

9


Case Report




literature1714







of diagnosis





injury



SIDEBAR


to do so









Abstract

CONTEXT



OBJECTIVE



DESIGN


SETTING





















change

RESULTS






CONCLUSIONS




JCCA DC case study


PMCID PMC2485523





MC2485523

Handout 3

JCCA DC case study










1132019

10

JCCA DC case study








JCCA DC case study

Examination








JCCA DC case study

DIAGNOSIS



JCCA DC case study

Treatment









JCCA DC case study





SEE TABLE 1



SEE TABLE 1


1132019

11





























SIDEBAR




1132019

12



Background









pain










ABSTRACT



Results





moderate (000-051)

Conclusion









Handout 4 Abstract









cortisone cream


muscle exercises










Background












cuff tissue [5]





Background





(Table (Table1)1)



[PubMed] [Ref list]



1132019

13

Background






Background





Background






Background






Case Presentations

Four presentations

CASE 1









Case Presentations

Four presentations

CASE 1 (continued)







comfortably







1132019

14

Case Presentations

Four presentations

CASE 1 (continued)






rotation











Case Presentations

Four presentations

CASE 1 (continued)













Case Presentations

Four presentations

CASE 1 (continued)






Case Presentations

Four presentations

CASE 2






manipulation


internal rotation




badge)



(Ibuprofen)




Case Presentations

Four presentations

CASE 2 (continued)


















Case Presentations

Four presentations

CASE 3








scale)






skull


without pain




1132019

15

Case Presentations

Four presentations

CASE 3 (continued)


















Case Presentations

Four presentations

CASE 3 (continued)





Case Presentations

Four presentations

CASE 4















pain)



Case Presentations

Four presentations

CASE 4 (continued)





Neers test








to the left


specific pressure






Case Presentations

Four presentations

CASE 4 (continued)





Neers test








to the left


specific pressure






Case Presentations

Four presentations

CASE 4 (continued)





syndrome


1132019

16

Case Presentations

Four presentations

THE INTERVENTIONS





levator scapulae









Case Presentations

Four presentations









to the patient




Case Presentations

Four presentations











Case Presentations

Four presentations





technique










Case Presentations

Four presentations














objective symptoms


findings


Case Presentations

Four presentations






setting



another choice







1132019

17

Case Presentations

Four presentations






therapies




cuff dysfunction









Case Presentations

Four presentations














method




Case Presentations

Four presentations










[37]


Case Presentations

Four presentations










ultrasound therapy








Case Presentations

Four presentations






















Four presentations



















1132019

18

Case Presentations

Four presentations











patients [23]







Case Presentations

Four presentations













arm






Case Presentations

Four presentations



direction








Figure 1










Case Presentations

Four presentations














spine



setting



precede 2010

1132019

19








Abstract

OBJECTIVE





chiropractors

METHODS










Author information


Abstract

(CONTINUED)

RESULTS











CONCLUSION






1132019

20


Abstract

OBJECTIVE



METHODS











Abstract

RESULTS








CONCLUSION





capsulitis (AC)



Abstract

BACKGROUND





METHODS










Abstract

RESULTS









INTERPRETATION










Abstract











years (55 to 81))







KEYWORDS



1132019

21



RESULTS






up (SMD -032 95 CI -062 to -001)




CONCLUSION











1132019

22




1132019

23



101186s12891-017-1518-0










Abstract

BACKGROUND








METHODS






RESULTS







CONCLUSIONS




this area




Abstract











Abstract









Introduction



RCT[2ndash5]













1132019

24


Introduction










Introduction


solutions










Introduction


action























Results












Results










1132019

25


Results









Figure 1







resonance imaging


Discussion


visits annually[43]











RCTs




in 14 patients[49]









in the average ROM













SGY



stage (next slide)












Conclusion






1132019

26









Methods







Results






Conclusions





Abstract

Background






Methods








Abstract

Results






Conclusions



Level of Evidence




Red Yeast Rice

bullKey Facts


bullSafety





bullKey References

bullAcknowledgments

1132019

27


Red Yeast Rice

bullKey Facts


bullSafety





bullKey References

bullAcknowledgments







Key Facts


















lovastatin












weeks




SGY



Why is this



Abstract






population











Abstract












1132019

28


Introduction








elderly[4]







Introduction
































scans








definitively

SGY



therapy


side






no better)



Diagnosis

1132019

29

Neerrsquos sign


























1132019

30

1132019

31














Occipital Lift


1132019

32


Abstract

Background



Purpose




Methods








Abstract

Results











Conclusion



trials



Abstract




training (RT)











= 0076)





Manual

Therapy

1132019

33



Subclavius Release


GH Traction

EXERCISES

1132019

34

1132019

35






1132019

36


2) Isotonics

a) Eccentric

b) Concentric

Equipment

1) A wall

2) TheraTube

or Band

3) Dumb bells














DEMONSTRATEWORKSHOP


jamhellip

1132019

37



2) 3 SLOW Reps



capture full ROM)




these




8) BE PATIENT







ABSTRACT






















ear and a line


eye








well








1132019

38


Exercise Form ndash

see

Next 3 slides





Exercise Form


1132019

39

1132019

40

1132019

41

VIDEO (325m)



CODY0NQ--













3 Phases




15deg elev

Phase 2 amp 3

ACJ 20deg

SCJ 40deg



1132019

42

Abstract

Study Design

Prospective cohort

Introduction







Methods






Results






Conclusions




Level of Evidence

1b

VIDEO




VIDEO (428m)













Video link (135m)






neutral pelvis

Video 043s


INSTRUCTIONS



palm down




to down) x3



Abd-Adduction








1132019

43


TrapsRhomboids





1132019

44


1132019

7

Figure 1












hemorrhage








white arrowheads)

ANT

POST




















capsule (Figure 3)




Posterior approach

Upon reflecting the


surface of the

humeral head and

torn infraspinatus

tendon are

visualized






groove


identified


subscapularis






screw


the arm in neutral



















from anchor)

1132019

8





at 60deg








Case Report



in the literature









Case Report









impingement process





Case Report



tears)10











Case Report








athletic population


Case Report






radiographs and MRI







1132019

9


Case Report




literature1714







of diagnosis





injury



SIDEBAR


to do so









Abstract

CONTEXT



OBJECTIVE



DESIGN


SETTING





















change

RESULTS






CONCLUSIONS




JCCA DC case study


PMCID PMC2485523





MC2485523

Handout 3

JCCA DC case study










1132019

10

JCCA DC case study








JCCA DC case study

Examination








JCCA DC case study

DIAGNOSIS



JCCA DC case study

Treatment









JCCA DC case study





SEE TABLE 1



SEE TABLE 1


1132019

11





























SIDEBAR




1132019

12



Background









pain










ABSTRACT



Results





moderate (000-051)

Conclusion









Handout 4 Abstract









cortisone cream


muscle exercises










Background












cuff tissue [5]





Background





(Table (Table1)1)



[PubMed] [Ref list]



1132019

13

Background






Background





Background






Background






Case Presentations

Four presentations

CASE 1









Case Presentations

Four presentations

CASE 1 (continued)







comfortably







1132019

14

Case Presentations

Four presentations

CASE 1 (continued)






rotation











Case Presentations

Four presentations

CASE 1 (continued)













Case Presentations

Four presentations

CASE 1 (continued)






Case Presentations

Four presentations

CASE 2






manipulation


internal rotation




badge)



(Ibuprofen)




Case Presentations

Four presentations

CASE 2 (continued)


















Case Presentations

Four presentations

CASE 3








scale)






skull


without pain




1132019

15

Case Presentations

Four presentations

CASE 3 (continued)


















Case Presentations

Four presentations

CASE 3 (continued)





Case Presentations

Four presentations

CASE 4















pain)



Case Presentations

Four presentations

CASE 4 (continued)





Neers test








to the left


specific pressure






Case Presentations

Four presentations

CASE 4 (continued)





Neers test








to the left


specific pressure






Case Presentations

Four presentations

CASE 4 (continued)





syndrome


1132019

16

Case Presentations

Four presentations

THE INTERVENTIONS





levator scapulae









Case Presentations

Four presentations









to the patient




Case Presentations

Four presentations











Case Presentations

Four presentations





technique










Case Presentations

Four presentations














objective symptoms


findings


Case Presentations

Four presentations






setting



another choice







1132019

17

Case Presentations

Four presentations






therapies




cuff dysfunction









Case Presentations

Four presentations














method




Case Presentations

Four presentations










[37]


Case Presentations

Four presentations










ultrasound therapy








Case Presentations

Four presentations






















Four presentations



















1132019

18

Case Presentations

Four presentations











patients [23]







Case Presentations

Four presentations













arm






Case Presentations

Four presentations



direction








Figure 1










Case Presentations

Four presentations














spine



setting



precede 2010

1132019

19








Abstract

OBJECTIVE





chiropractors

METHODS










Author information


Abstract

(CONTINUED)

RESULTS











CONCLUSION






1132019

20


Abstract

OBJECTIVE



METHODS











Abstract

RESULTS








CONCLUSION





capsulitis (AC)



Abstract

BACKGROUND





METHODS










Abstract

RESULTS









INTERPRETATION










Abstract











years (55 to 81))







KEYWORDS



1132019

21



RESULTS






up (SMD -032 95 CI -062 to -001)




CONCLUSION











1132019

22




1132019

23



101186s12891-017-1518-0










Abstract

BACKGROUND








METHODS






RESULTS







CONCLUSIONS




this area




Abstract











Abstract









Introduction



RCT[2ndash5]













1132019

24


Introduction










Introduction


solutions










Introduction


action























Results












Results










1132019

25


Results









Figure 1







resonance imaging


Discussion


visits annually[43]











RCTs




in 14 patients[49]









in the average ROM













SGY



stage (next slide)












Conclusion






1132019

26









Methods







Results






Conclusions





Abstract

Background






Methods








Abstract

Results






Conclusions



Level of Evidence




Red Yeast Rice

bullKey Facts


bullSafety





bullKey References

bullAcknowledgments

1132019

27


Red Yeast Rice

bullKey Facts


bullSafety





bullKey References

bullAcknowledgments







Key Facts


















lovastatin












weeks




SGY



Why is this



Abstract






population











Abstract












1132019

28


Introduction








elderly[4]







Introduction
































scans








definitively

SGY



therapy


side






no better)



Diagnosis

1132019

29

Neerrsquos sign


























1132019

30

1132019

31














Occipital Lift


1132019

32


Abstract

Background



Purpose




Methods








Abstract

Results











Conclusion



trials



Abstract




training (RT)











= 0076)





Manual

Therapy

1132019

33



Subclavius Release


GH Traction

EXERCISES

1132019

34

1132019

35






1132019

36


2) Isotonics

a) Eccentric

b) Concentric

Equipment

1) A wall

2) TheraTube

or Band

3) Dumb bells














DEMONSTRATEWORKSHOP


jamhellip

1132019

37



2) 3 SLOW Reps



capture full ROM)




these




8) BE PATIENT







ABSTRACT






















ear and a line


eye








well








1132019

38


Exercise Form ndash

see

Next 3 slides





Exercise Form


1132019

39

1132019

40

1132019

41

VIDEO (325m)



CODY0NQ--













3 Phases




15deg elev

Phase 2 amp 3

ACJ 20deg

SCJ 40deg



1132019

42

Abstract

Study Design

Prospective cohort

Introduction







Methods






Results






Conclusions




Level of Evidence

1b

VIDEO




VIDEO (428m)













Video link (135m)






neutral pelvis

Video 043s


INSTRUCTIONS



palm down




to down) x3



Abd-Adduction








1132019

43


TrapsRhomboids





1132019

44


1132019

8





at 60deg








Case Report



in the literature









Case Report









impingement process





Case Report



tears)10











Case Report








athletic population


Case Report






radiographs and MRI







1132019

9


Case Report




literature1714







of diagnosis





injury



SIDEBAR


to do so









Abstract

CONTEXT



OBJECTIVE



DESIGN


SETTING





















change

RESULTS






CONCLUSIONS




JCCA DC case study


PMCID PMC2485523





MC2485523

Handout 3

JCCA DC case study










1132019

10

JCCA DC case study








JCCA DC case study

Examination








JCCA DC case study

DIAGNOSIS



JCCA DC case study

Treatment









JCCA DC case study





SEE TABLE 1



SEE TABLE 1


1132019

11





























SIDEBAR




1132019

12



Background









pain










ABSTRACT



Results





moderate (000-051)

Conclusion









Handout 4 Abstract









cortisone cream


muscle exercises










Background












cuff tissue [5]





Background





(Table (Table1)1)



[PubMed] [Ref list]



1132019

13

Background






Background





Background






Background






Case Presentations

Four presentations

CASE 1









Case Presentations

Four presentations

CASE 1 (continued)







comfortably







1132019

14

Case Presentations

Four presentations

CASE 1 (continued)






rotation











Case Presentations

Four presentations

CASE 1 (continued)













Case Presentations

Four presentations

CASE 1 (continued)






Case Presentations

Four presentations

CASE 2






manipulation


internal rotation




badge)



(Ibuprofen)




Case Presentations

Four presentations

CASE 2 (continued)


















Case Presentations

Four presentations

CASE 3








scale)






skull


without pain




1132019

15

Case Presentations

Four presentations

CASE 3 (continued)


















Case Presentations

Four presentations

CASE 3 (continued)





Case Presentations

Four presentations

CASE 4















pain)



Case Presentations

Four presentations

CASE 4 (continued)





Neers test








to the left


specific pressure






Case Presentations

Four presentations

CASE 4 (continued)





Neers test








to the left


specific pressure






Case Presentations

Four presentations

CASE 4 (continued)





syndrome


1132019

16

Case Presentations

Four presentations

THE INTERVENTIONS





levator scapulae









Case Presentations

Four presentations









to the patient




Case Presentations

Four presentations











Case Presentations

Four presentations





technique










Case Presentations

Four presentations














objective symptoms


findings


Case Presentations

Four presentations






setting



another choice







1132019

17

Case Presentations

Four presentations






therapies




cuff dysfunction









Case Presentations

Four presentations














method




Case Presentations

Four presentations










[37]


Case Presentations

Four presentations










ultrasound therapy








Case Presentations

Four presentations






















Four presentations



















1132019

18

Case Presentations

Four presentations











patients [23]







Case Presentations

Four presentations













arm






Case Presentations

Four presentations



direction








Figure 1










Case Presentations

Four presentations














spine



setting



precede 2010

1132019

19








Abstract

OBJECTIVE





chiropractors

METHODS










Author information


Abstract

(CONTINUED)

RESULTS











CONCLUSION






1132019

20


Abstract

OBJECTIVE



METHODS











Abstract

RESULTS








CONCLUSION





capsulitis (AC)



Abstract

BACKGROUND





METHODS










Abstract

RESULTS









INTERPRETATION










Abstract











years (55 to 81))







KEYWORDS



1132019

21



RESULTS






up (SMD -032 95 CI -062 to -001)




CONCLUSION











1132019

22




1132019

23



101186s12891-017-1518-0










Abstract

BACKGROUND








METHODS






RESULTS







CONCLUSIONS




this area




Abstract











Abstract









Introduction



RCT[2ndash5]













1132019

24


Introduction










Introduction


solutions










Introduction


action























Results












Results










1132019

25


Results









Figure 1







resonance imaging


Discussion


visits annually[43]











RCTs




in 14 patients[49]









in the average ROM













SGY



stage (next slide)












Conclusion






1132019

26









Methods







Results






Conclusions





Abstract

Background






Methods








Abstract

Results






Conclusions



Level of Evidence




Red Yeast Rice

bullKey Facts


bullSafety





bullKey References

bullAcknowledgments

1132019

27


Red Yeast Rice

bullKey Facts


bullSafety





bullKey References

bullAcknowledgments







Key Facts


















lovastatin












weeks




SGY



Why is this



Abstract






population











Abstract












1132019

28


Introduction








elderly[4]







Introduction
































scans








definitively

SGY



therapy


side






no better)



Diagnosis

1132019

29

Neerrsquos sign


























1132019

30

1132019

31














Occipital Lift


1132019

32


Abstract

Background



Purpose




Methods








Abstract

Results











Conclusion



trials



Abstract




training (RT)











= 0076)





Manual

Therapy

1132019

33



Subclavius Release


GH Traction

EXERCISES

1132019

34

1132019

35






1132019

36


2) Isotonics

a) Eccentric

b) Concentric

Equipment

1) A wall

2) TheraTube

or Band

3) Dumb bells














DEMONSTRATEWORKSHOP


jamhellip

1132019

37



2) 3 SLOW Reps



capture full ROM)




these




8) BE PATIENT







ABSTRACT






















ear and a line


eye








well








1132019

38


Exercise Form ndash

see

Next 3 slides





Exercise Form


1132019

39

1132019

40

1132019

41

VIDEO (325m)



CODY0NQ--













3 Phases




15deg elev

Phase 2 amp 3

ACJ 20deg

SCJ 40deg



1132019

42

Abstract

Study Design

Prospective cohort

Introduction







Methods






Results






Conclusions




Level of Evidence

1b

VIDEO




VIDEO (428m)













Video link (135m)






neutral pelvis

Video 043s


INSTRUCTIONS



palm down




to down) x3



Abd-Adduction








1132019

43


TrapsRhomboids





1132019

44


1132019

9


Case Report




literature1714







of diagnosis





injury



SIDEBAR


to do so









Abstract

CONTEXT



OBJECTIVE



DESIGN


SETTING





















change

RESULTS






CONCLUSIONS




JCCA DC case study


PMCID PMC2485523





MC2485523

Handout 3

JCCA DC case study










1132019

10

JCCA DC case study








JCCA DC case study

Examination








JCCA DC case study

DIAGNOSIS



JCCA DC case study

Treatment









JCCA DC case study





SEE TABLE 1



SEE TABLE 1


1132019

11





























SIDEBAR




1132019

12



Background









pain










ABSTRACT



Results





moderate (000-051)

Conclusion









Handout 4 Abstract









cortisone cream


muscle exercises










Background












cuff tissue [5]





Background





(Table (Table1)1)



[PubMed] [Ref list]



1132019

13

Background






Background





Background






Background






Case Presentations

Four presentations

CASE 1









Case Presentations

Four presentations

CASE 1 (continued)







comfortably







1132019

14

Case Presentations

Four presentations

CASE 1 (continued)






rotation











Case Presentations

Four presentations

CASE 1 (continued)













Case Presentations

Four presentations

CASE 1 (continued)






Case Presentations

Four presentations

CASE 2






manipulation


internal rotation




badge)



(Ibuprofen)




Case Presentations

Four presentations

CASE 2 (continued)


















Case Presentations

Four presentations

CASE 3








scale)






skull


without pain




1132019

15

Case Presentations

Four presentations

CASE 3 (continued)


















Case Presentations

Four presentations

CASE 3 (continued)





Case Presentations

Four presentations

CASE 4















pain)



Case Presentations

Four presentations

CASE 4 (continued)





Neers test








to the left


specific pressure






Case Presentations

Four presentations

CASE 4 (continued)





Neers test








to the left


specific pressure






Case Presentations

Four presentations

CASE 4 (continued)





syndrome


1132019

16

Case Presentations

Four presentations

THE INTERVENTIONS





levator scapulae









Case Presentations

Four presentations









to the patient




Case Presentations

Four presentations











Case Presentations

Four presentations





technique










Case Presentations

Four presentations














objective symptoms


findings


Case Presentations

Four presentations






setting



another choice







1132019

17

Case Presentations

Four presentations






therapies




cuff dysfunction









Case Presentations

Four presentations














method




Case Presentations

Four presentations










[37]


Case Presentations

Four presentations










ultrasound therapy








Case Presentations

Four presentations






















Four presentations



















1132019

18

Case Presentations

Four presentations











patients [23]







Case Presentations

Four presentations













arm






Case Presentations

Four presentations



direction








Figure 1










Case Presentations

Four presentations














spine



setting



precede 2010

1132019

19








Abstract

OBJECTIVE





chiropractors

METHODS










Author information


Abstract

(CONTINUED)

RESULTS











CONCLUSION






1132019

20


Abstract

OBJECTIVE



METHODS











Abstract

RESULTS








CONCLUSION





capsulitis (AC)



Abstract

BACKGROUND





METHODS










Abstract

RESULTS









INTERPRETATION










Abstract











years (55 to 81))







KEYWORDS



1132019

21



RESULTS






up (SMD -032 95 CI -062 to -001)




CONCLUSION











1132019

22




1132019

23



101186s12891-017-1518-0










Abstract

BACKGROUND








METHODS






RESULTS







CONCLUSIONS




this area




Abstract











Abstract









Introduction



RCT[2ndash5]













1132019

24


Introduction










Introduction


solutions










Introduction


action























Results












Results










1132019

25


Results









Figure 1







resonance imaging


Discussion


visits annually[43]











RCTs




in 14 patients[49]









in the average ROM













SGY



stage (next slide)












Conclusion






1132019

26









Methods







Results






Conclusions





Abstract

Background






Methods








Abstract

Results






Conclusions



Level of Evidence




Red Yeast Rice

bullKey Facts


bullSafety





bullKey References

bullAcknowledgments

1132019

27


Red Yeast Rice

bullKey Facts


bullSafety





bullKey References

bullAcknowledgments







Key Facts


















lovastatin












weeks




SGY



Why is this



Abstract






population











Abstract












1132019

28


Introduction








elderly[4]







Introduction
































scans








definitively

SGY



therapy


side






no better)



Diagnosis

1132019

29

Neerrsquos sign


























1132019

30

1132019

31














Occipital Lift


1132019

32


Abstract

Background



Purpose




Methods








Abstract

Results











Conclusion



trials



Abstract




training (RT)











= 0076)





Manual

Therapy

1132019

33



Subclavius Release


GH Traction

EXERCISES

1132019

34

1132019

35






1132019

36


2) Isotonics

a) Eccentric

b) Concentric

Equipment

1) A wall

2) TheraTube

or Band

3) Dumb bells














DEMONSTRATEWORKSHOP


jamhellip

1132019

37



2) 3 SLOW Reps



capture full ROM)




these




8) BE PATIENT







ABSTRACT






















ear and a line


eye








well








1132019

38


Exercise Form ndash

see

Next 3 slides





Exercise Form


1132019

39

1132019

40

1132019

41

VIDEO (325m)



CODY0NQ--













3 Phases




15deg elev

Phase 2 amp 3

ACJ 20deg

SCJ 40deg



1132019

42

Abstract

Study Design

Prospective cohort

Introduction







Methods






Results






Conclusions




Level of Evidence

1b

VIDEO




VIDEO (428m)













Video link (135m)






neutral pelvis

Video 043s


INSTRUCTIONS



palm down




to down) x3



Abd-Adduction








1132019

43


TrapsRhomboids





1132019

44


1132019

10

JCCA DC case study








JCCA DC case study

Examination








JCCA DC case study

DIAGNOSIS



JCCA DC case study

Treatment









JCCA DC case study





SEE TABLE 1



SEE TABLE 1


1132019

11





























SIDEBAR




1132019

12



Background









pain










ABSTRACT



Results





moderate (000-051)

Conclusion









Handout 4 Abstract









cortisone cream


muscle exercises










Background












cuff tissue [5]





Background





(Table (Table1)1)



[PubMed] [Ref list]



1132019

13

Background






Background





Background






Background






Case Presentations

Four presentations

CASE 1









Case Presentations

Four presentations

CASE 1 (continued)







comfortably







1132019

14

Case Presentations

Four presentations

CASE 1 (continued)






rotation











Case Presentations

Four presentations

CASE 1 (continued)













Case Presentations

Four presentations

CASE 1 (continued)






Case Presentations

Four presentations

CASE 2






manipulation


internal rotation




badge)



(Ibuprofen)




Case Presentations

Four presentations

CASE 2 (continued)


















Case Presentations

Four presentations

CASE 3








scale)






skull


without pain




1132019

15

Case Presentations

Four presentations

CASE 3 (continued)


















Case Presentations

Four presentations

CASE 3 (continued)





Case Presentations

Four presentations

CASE 4















pain)



Case Presentations

Four presentations

CASE 4 (continued)





Neers test








to the left


specific pressure






Case Presentations

Four presentations

CASE 4 (continued)





Neers test








to the left


specific pressure






Case Presentations

Four presentations

CASE 4 (continued)





syndrome


1132019

16

Case Presentations

Four presentations

THE INTERVENTIONS





levator scapulae









Case Presentations

Four presentations









to the patient




Case Presentations

Four presentations











Case Presentations

Four presentations





technique










Case Presentations

Four presentations














objective symptoms


findings


Case Presentations

Four presentations






setting



another choice







1132019

17

Case Presentations

Four presentations






therapies




cuff dysfunction









Case Presentations

Four presentations














method




Case Presentations

Four presentations










[37]


Case Presentations

Four presentations










ultrasound therapy








Case Presentations

Four presentations






















Four presentations



















1132019

18

Case Presentations

Four presentations











patients [23]







Case Presentations

Four presentations













arm






Case Presentations

Four presentations



direction








Figure 1










Case Presentations

Four presentations














spine



setting



precede 2010

1132019

19








Abstract

OBJECTIVE





chiropractors

METHODS










Author information


Abstract

(CONTINUED)

RESULTS











CONCLUSION






1132019

20


Abstract

OBJECTIVE



METHODS











Abstract

RESULTS








CONCLUSION





capsulitis (AC)



Abstract

BACKGROUND





METHODS










Abstract

RESULTS









INTERPRETATION










Abstract











years (55 to 81))







KEYWORDS



1132019

21



RESULTS






up (SMD -032 95 CI -062 to -001)




CONCLUSION











1132019

22




1132019

23



101186s12891-017-1518-0










Abstract

BACKGROUND








METHODS






RESULTS







CONCLUSIONS




this area




Abstract











Abstract









Introduction



RCT[2ndash5]













1132019

24


Introduction










Introduction


solutions










Introduction


action























Results












Results










1132019

25


Results









Figure 1







resonance imaging


Discussion


visits annually[43]











RCTs




in 14 patients[49]









in the average ROM













SGY



stage (next slide)












Conclusion






1132019

26









Methods







Results






Conclusions





Abstract

Background






Methods








Abstract

Results






Conclusions



Level of Evidence




Red Yeast Rice

bullKey Facts


bullSafety





bullKey References

bullAcknowledgments

1132019

27


Red Yeast Rice

bullKey Facts


bullSafety





bullKey References

bullAcknowledgments







Key Facts


















lovastatin












weeks




SGY



Why is this



Abstract






population











Abstract












1132019

28


Introduction








elderly[4]







Introduction
































scans








definitively

SGY



therapy


side






no better)



Diagnosis

1132019

29

Neerrsquos sign


























1132019

30

1132019

31














Occipital Lift


1132019

32


Abstract

Background



Purpose




Methods








Abstract

Results











Conclusion



trials



Abstract




training (RT)











= 0076)





Manual

Therapy

1132019

33



Subclavius Release


GH Traction

EXERCISES

1132019

34

1132019

35






1132019

36


2) Isotonics

a) Eccentric

b) Concentric

Equipment

1) A wall

2) TheraTube

or Band

3) Dumb bells














DEMONSTRATEWORKSHOP


jamhellip

1132019

37



2) 3 SLOW Reps



capture full ROM)




these




8) BE PATIENT







ABSTRACT






















ear and a line


eye








well








1132019

38


Exercise Form ndash

see

Next 3 slides





Exercise Form


1132019

39

1132019

40

1132019

41

VIDEO (325m)



CODY0NQ--













3 Phases




15deg elev

Phase 2 amp 3

ACJ 20deg

SCJ 40deg



1132019

42

Abstract

Study Design

Prospective cohort

Introduction







Methods






Results






Conclusions




Level of Evidence

1b

VIDEO




VIDEO (428m)













Video link (135m)






neutral pelvis

Video 043s


INSTRUCTIONS



palm down




to down) x3



Abd-Adduction








1132019

43


TrapsRhomboids





1132019

44


1132019

11





























SIDEBAR




1132019

12



Background









pain










ABSTRACT



Results





moderate (000-051)

Conclusion









Handout 4 Abstract









cortisone cream


muscle exercises










Background












cuff tissue [5]





Background





(Table (Table1)1)



[PubMed] [Ref list]



1132019

13

Background






Background





Background






Background






Case Presentations

Four presentations

CASE 1









Case Presentations

Four presentations

CASE 1 (continued)







comfortably







1132019

14

Case Presentations

Four presentations

CASE 1 (continued)






rotation











Case Presentations

Four presentations

CASE 1 (continued)













Case Presentations

Four presentations

CASE 1 (continued)






Case Presentations

Four presentations

CASE 2






manipulation


internal rotation




badge)



(Ibuprofen)




Case Presentations

Four presentations

CASE 2 (continued)


















Case Presentations

Four presentations

CASE 3








scale)






skull


without pain




1132019

15

Case Presentations

Four presentations

CASE 3 (continued)


















Case Presentations

Four presentations

CASE 3 (continued)





Case Presentations

Four presentations

CASE 4















pain)



Case Presentations

Four presentations

CASE 4 (continued)





Neers test








to the left


specific pressure






Case Presentations

Four presentations

CASE 4 (continued)





Neers test








to the left


specific pressure






Case Presentations

Four presentations

CASE 4 (continued)





syndrome


1132019

16

Case Presentations

Four presentations

THE INTERVENTIONS





levator scapulae









Case Presentations

Four presentations









to the patient




Case Presentations

Four presentations











Case Presentations

Four presentations





technique










Case Presentations

Four presentations














objective symptoms


findings


Case Presentations

Four presentations






setting



another choice







1132019

17

Case Presentations

Four presentations






therapies




cuff dysfunction









Case Presentations

Four presentations














method




Case Presentations

Four presentations










[37]


Case Presentations

Four presentations










ultrasound therapy








Case Presentations

Four presentations






















Four presentations



















1132019

18

Case Presentations

Four presentations











patients [23]







Case Presentations

Four presentations













arm






Case Presentations

Four presentations



direction








Figure 1










Case Presentations

Four presentations














spine



setting



precede 2010

1132019

19








Abstract

OBJECTIVE





chiropractors

METHODS










Author information


Abstract

(CONTINUED)

RESULTS











CONCLUSION






1132019

20


Abstract

OBJECTIVE



METHODS











Abstract

RESULTS








CONCLUSION





capsulitis (AC)



Abstract

BACKGROUND





METHODS










Abstract

RESULTS









INTERPRETATION










Abstract











years (55 to 81))







KEYWORDS



1132019

21



RESULTS






up (SMD -032 95 CI -062 to -001)




CONCLUSION











1132019

22




1132019

23



101186s12891-017-1518-0










Abstract

BACKGROUND








METHODS






RESULTS







CONCLUSIONS




this area




Abstract











Abstract









Introduction



RCT[2ndash5]













1132019

24


Introduction










Introduction


solutions










Introduction


action























Results












Results










1132019

25


Results









Figure 1







resonance imaging


Discussion


visits annually[43]











RCTs




in 14 patients[49]









in the average ROM













SGY



stage (next slide)












Conclusion






1132019

26









Methods







Results






Conclusions





Abstract

Background






Methods








Abstract

Results






Conclusions



Level of Evidence




Red Yeast Rice

bullKey Facts


bullSafety





bullKey References

bullAcknowledgments

1132019

27


Red Yeast Rice

bullKey Facts


bullSafety





bullKey References

bullAcknowledgments







Key Facts


















lovastatin












weeks




SGY



Why is this



Abstract






population











Abstract












1132019

28


Introduction








elderly[4]







Introduction
































scans








definitively

SGY



therapy


side






no better)



Diagnosis

1132019

29

Neerrsquos sign


























1132019

30

1132019

31














Occipital Lift


1132019

32


Abstract

Background



Purpose




Methods








Abstract

Results











Conclusion



trials



Abstract




training (RT)











= 0076)





Manual

Therapy

1132019

33



Subclavius Release


GH Traction

EXERCISES

1132019

34

1132019

35






1132019

36


2) Isotonics

a) Eccentric

b) Concentric

Equipment

1) A wall

2) TheraTube

or Band

3) Dumb bells














DEMONSTRATEWORKSHOP


jamhellip

1132019

37



2) 3 SLOW Reps



capture full ROM)




these




8) BE PATIENT







ABSTRACT






















ear and a line


eye








well








1132019

38


Exercise Form ndash

see

Next 3 slides





Exercise Form


1132019

39

1132019

40

1132019

41

VIDEO (325m)



CODY0NQ--













3 Phases




15deg elev

Phase 2 amp 3

ACJ 20deg

SCJ 40deg



1132019

42

Abstract

Study Design

Prospective cohort

Introduction







Methods






Results






Conclusions




Level of Evidence

1b

VIDEO




VIDEO (428m)













Video link (135m)






neutral pelvis

Video 043s


INSTRUCTIONS



palm down




to down) x3



Abd-Adduction








1132019

43


TrapsRhomboids





1132019

44


1132019

12



Background









pain










ABSTRACT



Results





moderate (000-051)

Conclusion









Handout 4 Abstract









cortisone cream


muscle exercises










Background












cuff tissue [5]





Background





(Table (Table1)1)



[PubMed] [Ref list]



1132019

13

Background






Background





Background






Background






Case Presentations

Four presentations

CASE 1









Case Presentations

Four presentations

CASE 1 (continued)







comfortably







1132019

14

Case Presentations

Four presentations

CASE 1 (continued)






rotation











Case Presentations

Four presentations

CASE 1 (continued)













Case Presentations

Four presentations

CASE 1 (continued)






Case Presentations

Four presentations

CASE 2






manipulation


internal rotation




badge)



(Ibuprofen)




Case Presentations

Four presentations

CASE 2 (continued)


















Case Presentations

Four presentations

CASE 3








scale)






skull


without pain




1132019

15

Case Presentations

Four presentations

CASE 3 (continued)


















Case Presentations

Four presentations

CASE 3 (continued)





Case Presentations

Four presentations

CASE 4















pain)



Case Presentations

Four presentations

CASE 4 (continued)





Neers test








to the left


specific pressure






Case Presentations

Four presentations

CASE 4 (continued)





Neers test








to the left


specific pressure






Case Presentations

Four presentations

CASE 4 (continued)





syndrome


1132019

16

Case Presentations

Four presentations

THE INTERVENTIONS





levator scapulae









Case Presentations

Four presentations









to the patient




Case Presentations

Four presentations











Case Presentations

Four presentations





technique










Case Presentations

Four presentations














objective symptoms


findings


Case Presentations

Four presentations






setting



another choice







1132019

17

Case Presentations

Four presentations






therapies




cuff dysfunction









Case Presentations

Four presentations














method




Case Presentations

Four presentations










[37]


Case Presentations

Four presentations










ultrasound therapy








Case Presentations

Four presentations






















Four presentations



















1132019

18

Case Presentations

Four presentations











patients [23]







Case Presentations

Four presentations













arm






Case Presentations

Four presentations



direction








Figure 1










Case Presentations

Four presentations














spine



setting



precede 2010

1132019

19








Abstract

OBJECTIVE





chiropractors

METHODS










Author information


Abstract

(CONTINUED)

RESULTS











CONCLUSION






1132019

20


Abstract

OBJECTIVE



METHODS











Abstract

RESULTS








CONCLUSION





capsulitis (AC)



Abstract

BACKGROUND





METHODS










Abstract

RESULTS









INTERPRETATION










Abstract











years (55 to 81))







KEYWORDS



1132019

21



RESULTS






up (SMD -032 95 CI -062 to -001)




CONCLUSION











1132019

22




1132019

23



101186s12891-017-1518-0










Abstract

BACKGROUND








METHODS






RESULTS







CONCLUSIONS




this area




Abstract











Abstract









Introduction



RCT[2ndash5]













1132019

24


Introduction










Introduction


solutions










Introduction


action























Results












Results










1132019

25


Results









Figure 1







resonance imaging


Discussion


visits annually[43]











RCTs




in 14 patients[49]









in the average ROM













SGY



stage (next slide)












Conclusion






1132019

26









Methods







Results






Conclusions





Abstract

Background






Methods








Abstract

Results






Conclusions



Level of Evidence




Red Yeast Rice

bullKey Facts


bullSafety





bullKey References

bullAcknowledgments

1132019

27


Red Yeast Rice

bullKey Facts


bullSafety





bullKey References

bullAcknowledgments







Key Facts


















lovastatin












weeks




SGY



Why is this



Abstract






population











Abstract












1132019

28


Introduction








elderly[4]







Introduction
































scans








definitively

SGY



therapy


side






no better)



Diagnosis

1132019

29

Neerrsquos sign


























1132019

30

1132019

31














Occipital Lift


1132019

32


Abstract

Background



Purpose




Methods








Abstract

Results











Conclusion



trials



Abstract




training (RT)











= 0076)





Manual

Therapy

1132019

33



Subclavius Release


GH Traction

EXERCISES

1132019

34

1132019

35






1132019

36


2) Isotonics

a) Eccentric

b) Concentric

Equipment

1) A wall

2) TheraTube

or Band

3) Dumb bells














DEMONSTRATEWORKSHOP


jamhellip

1132019

37



2) 3 SLOW Reps



capture full ROM)




these




8) BE PATIENT







ABSTRACT






















ear and a line


eye








well








1132019

38


Exercise Form ndash

see

Next 3 slides





Exercise Form


1132019

39

1132019

40

1132019

41

VIDEO (325m)



CODY0NQ--













3 Phases




15deg elev

Phase 2 amp 3

ACJ 20deg

SCJ 40deg



1132019

42

Abstract

Study Design

Prospective cohort

Introduction







Methods






Results






Conclusions




Level of Evidence

1b

VIDEO




VIDEO (428m)













Video link (135m)






neutral pelvis

Video 043s


INSTRUCTIONS



palm down




to down) x3



Abd-Adduction








1132019

43


TrapsRhomboids





1132019

44


1132019

13

Background






Background





Background






Background






Case Presentations

Four presentations

CASE 1









Case Presentations

Four presentations

CASE 1 (continued)







comfortably







1132019

14

Case Presentations

Four presentations

CASE 1 (continued)






rotation











Case Presentations

Four presentations

CASE 1 (continued)













Case Presentations

Four presentations

CASE 1 (continued)






Case Presentations

Four presentations

CASE 2






manipulation


internal rotation




badge)



(Ibuprofen)




Case Presentations

Four presentations

CASE 2 (continued)


















Case Presentations

Four presentations

CASE 3








scale)






skull


without pain




1132019

15

Case Presentations

Four presentations

CASE 3 (continued)


















Case Presentations

Four presentations

CASE 3 (continued)





Case Presentations

Four presentations

CASE 4















pain)



Case Presentations

Four presentations

CASE 4 (continued)





Neers test








to the left


specific pressure






Case Presentations

Four presentations

CASE 4 (continued)





Neers test








to the left


specific pressure






Case Presentations

Four presentations

CASE 4 (continued)





syndrome


1132019

16

Case Presentations

Four presentations

THE INTERVENTIONS





levator scapulae









Case Presentations

Four presentations









to the patient




Case Presentations

Four presentations











Case Presentations

Four presentations





technique










Case Presentations

Four presentations














objective symptoms


findings


Case Presentations

Four presentations






setting



another choice







1132019

17

Case Presentations

Four presentations






therapies




cuff dysfunction









Case Presentations

Four presentations














method




Case Presentations

Four presentations










[37]


Case Presentations

Four presentations










ultrasound therapy








Case Presentations

Four presentations






















Four presentations



















1132019

18

Case Presentations

Four presentations











patients [23]







Case Presentations

Four presentations













arm






Case Presentations

Four presentations



direction








Figure 1










Case Presentations

Four presentations














spine



setting



precede 2010

1132019

19








Abstract

OBJECTIVE





chiropractors

METHODS










Author information


Abstract

(CONTINUED)

RESULTS











CONCLUSION






1132019

20


Abstract

OBJECTIVE



METHODS











Abstract

RESULTS








CONCLUSION





capsulitis (AC)



Abstract

BACKGROUND





METHODS










Abstract

RESULTS









INTERPRETATION










Abstract











years (55 to 81))







KEYWORDS



1132019

21



RESULTS






up (SMD -032 95 CI -062 to -001)




CONCLUSION











1132019

22




1132019

23



101186s12891-017-1518-0










Abstract

BACKGROUND








METHODS






RESULTS







CONCLUSIONS




this area




Abstract











Abstract









Introduction



RCT[2ndash5]













1132019

24


Introduction










Introduction


solutions










Introduction


action























Results












Results










1132019

25


Results









Figure 1







resonance imaging


Discussion


visits annually[43]











RCTs




in 14 patients[49]









in the average ROM













SGY



stage (next slide)












Conclusion






1132019

26









Methods







Results






Conclusions





Abstract

Background






Methods








Abstract

Results






Conclusions



Level of Evidence




Red Yeast Rice

bullKey Facts


bullSafety





bullKey References

bullAcknowledgments

1132019

27


Red Yeast Rice

bullKey Facts


bullSafety





bullKey References

bullAcknowledgments







Key Facts


















lovastatin












weeks




SGY



Why is this



Abstract






population











Abstract












1132019

28


Introduction








elderly[4]







Introduction
































scans








definitively

SGY



therapy


side






no better)



Diagnosis

1132019

29

Neerrsquos sign


























1132019

30

1132019

31














Occipital Lift


1132019

32


Abstract

Background



Purpose




Methods








Abstract

Results











Conclusion



trials



Abstract




training (RT)











= 0076)





Manual

Therapy

1132019

33



Subclavius Release


GH Traction

EXERCISES

1132019

34

1132019

35






1132019

36


2) Isotonics

a) Eccentric

b) Concentric

Equipment

1) A wall

2) TheraTube

or Band

3) Dumb bells














DEMONSTRATEWORKSHOP


jamhellip

1132019

37



2) 3 SLOW Reps



capture full ROM)




these




8) BE PATIENT







ABSTRACT






















ear and a line


eye








well








1132019

38


Exercise Form ndash

see

Next 3 slides





Exercise Form


1132019

39

1132019

40

1132019

41

VIDEO (325m)



CODY0NQ--













3 Phases




15deg elev

Phase 2 amp 3

ACJ 20deg

SCJ 40deg



1132019

42

Abstract

Study Design

Prospective cohort

Introduction







Methods






Results






Conclusions




Level of Evidence

1b

VIDEO




VIDEO (428m)













Video link (135m)






neutral pelvis

Video 043s


INSTRUCTIONS



palm down




to down) x3



Abd-Adduction








1132019

43


TrapsRhomboids





1132019

44


1132019

14

Case Presentations

Four presentations

CASE 1 (continued)






rotation











Case Presentations

Four presentations

CASE 1 (continued)













Case Presentations

Four presentations

CASE 1 (continued)






Case Presentations

Four presentations

CASE 2






manipulation


internal rotation




badge)



(Ibuprofen)




Case Presentations

Four presentations

CASE 2 (continued)


















Case Presentations

Four presentations

CASE 3








scale)






skull


without pain




1132019

15

Case Presentations

Four presentations

CASE 3 (continued)


















Case Presentations

Four presentations

CASE 3 (continued)





Case Presentations

Four presentations

CASE 4















pain)



Case Presentations

Four presentations

CASE 4 (continued)





Neers test








to the left


specific pressure






Case Presentations

Four presentations

CASE 4 (continued)





Neers test








to the left


specific pressure






Case Presentations

Four presentations

CASE 4 (continued)





syndrome


1132019

16

Case Presentations

Four presentations

THE INTERVENTIONS





levator scapulae









Case Presentations

Four presentations









to the patient




Case Presentations

Four presentations











Case Presentations

Four presentations





technique










Case Presentations

Four presentations














objective symptoms


findings


Case Presentations

Four presentations






setting



another choice







1132019

17

Case Presentations

Four presentations






therapies




cuff dysfunction









Case Presentations

Four presentations














method




Case Presentations

Four presentations










[37]


Case Presentations

Four presentations










ultrasound therapy








Case Presentations

Four presentations






















Four presentations



















1132019

18

Case Presentations

Four presentations











patients [23]







Case Presentations

Four presentations













arm






Case Presentations

Four presentations



direction








Figure 1










Case Presentations

Four presentations














spine



setting



precede 2010

1132019

19








Abstract

OBJECTIVE





chiropractors

METHODS










Author information


Abstract

(CONTINUED)

RESULTS











CONCLUSION






1132019

20


Abstract

OBJECTIVE



METHODS











Abstract

RESULTS








CONCLUSION





capsulitis (AC)



Abstract

BACKGROUND





METHODS










Abstract

RESULTS









INTERPRETATION










Abstract











years (55 to 81))







KEYWORDS



1132019

21



RESULTS






up (SMD -032 95 CI -062 to -001)




CONCLUSION











1132019

22




1132019

23



101186s12891-017-1518-0










Abstract

BACKGROUND








METHODS






RESULTS







CONCLUSIONS




this area




Abstract











Abstract









Introduction



RCT[2ndash5]













1132019

24


Introduction










Introduction


solutions










Introduction


action























Results












Results










1132019

25


Results









Figure 1







resonance imaging


Discussion


visits annually[43]











RCTs




in 14 patients[49]









in the average ROM













SGY



stage (next slide)












Conclusion






1132019

26









Methods







Results






Conclusions





Abstract

Background






Methods








Abstract

Results






Conclusions



Level of Evidence




Red Yeast Rice

bullKey Facts


bullSafety





bullKey References

bullAcknowledgments

1132019

27


Red Yeast Rice

bullKey Facts


bullSafety





bullKey References

bullAcknowledgments







Key Facts


















lovastatin












weeks




SGY



Why is this



Abstract






population











Abstract












1132019

28


Introduction








elderly[4]







Introduction
































scans








definitively

SGY



therapy


side






no better)



Diagnosis

1132019

29

Neerrsquos sign


























1132019

30

1132019

31














Occipital Lift


1132019

32


Abstract

Background



Purpose




Methods








Abstract

Results











Conclusion



trials



Abstract




training (RT)











= 0076)





Manual

Therapy

1132019

33



Subclavius Release


GH Traction

EXERCISES

1132019

34

1132019

35






1132019

36


2) Isotonics

a) Eccentric

b) Concentric

Equipment

1) A wall

2) TheraTube

or Band

3) Dumb bells














DEMONSTRATEWORKSHOP


jamhellip

1132019

37



2) 3 SLOW Reps



capture full ROM)




these




8) BE PATIENT







ABSTRACT






















ear and a line


eye








well








1132019

38


Exercise Form ndash

see

Next 3 slides





Exercise Form


1132019

39

1132019

40

1132019

41

VIDEO (325m)



CODY0NQ--













3 Phases




15deg elev

Phase 2 amp 3

ACJ 20deg

SCJ 40deg



1132019

42

Abstract

Study Design

Prospective cohort

Introduction







Methods






Results






Conclusions




Level of Evidence

1b

VIDEO




VIDEO (428m)













Video link (135m)






neutral pelvis

Video 043s


INSTRUCTIONS



palm down




to down) x3



Abd-Adduction








1132019

43


TrapsRhomboids





1132019

44


1132019

15

Case Presentations

Four presentations

CASE 3 (continued)


















Case Presentations

Four presentations

CASE 3 (continued)





Case Presentations

Four presentations

CASE 4















pain)



Case Presentations

Four presentations

CASE 4 (continued)





Neers test








to the left


specific pressure






Case Presentations

Four presentations

CASE 4 (continued)





Neers test








to the left


specific pressure






Case Presentations

Four presentations

CASE 4 (continued)





syndrome


1132019

16

Case Presentations

Four presentations

THE INTERVENTIONS





levator scapulae









Case Presentations

Four presentations









to the patient




Case Presentations

Four presentations











Case Presentations

Four presentations





technique










Case Presentations

Four presentations














objective symptoms


findings


Case Presentations

Four presentations






setting



another choice







1132019

17

Case Presentations

Four presentations






therapies




cuff dysfunction









Case Presentations

Four presentations














method




Case Presentations

Four presentations










[37]


Case Presentations

Four presentations










ultrasound therapy








Case Presentations

Four presentations






















Four presentations



















1132019

18

Case Presentations

Four presentations











patients [23]







Case Presentations

Four presentations













arm






Case Presentations

Four presentations



direction








Figure 1










Case Presentations

Four presentations














spine



setting



precede 2010

1132019

19








Abstract

OBJECTIVE





chiropractors

METHODS










Author information


Abstract

(CONTINUED)

RESULTS











CONCLUSION






1132019

20


Abstract

OBJECTIVE



METHODS











Abstract

RESULTS








CONCLUSION





capsulitis (AC)



Abstract

BACKGROUND





METHODS










Abstract

RESULTS









INTERPRETATION










Abstract











years (55 to 81))







KEYWORDS



1132019

21



RESULTS






up (SMD -032 95 CI -062 to -001)




CONCLUSION











1132019

22




1132019

23



101186s12891-017-1518-0










Abstract

BACKGROUND








METHODS






RESULTS







CONCLUSIONS




this area




Abstract











Abstract









Introduction



RCT[2ndash5]













1132019

24


Introduction










Introduction


solutions










Introduction


action























Results












Results










1132019

25


Results









Figure 1







resonance imaging


Discussion


visits annually[43]











RCTs




in 14 patients[49]









in the average ROM













SGY



stage (next slide)












Conclusion






1132019

26









Methods







Results






Conclusions





Abstract

Background






Methods








Abstract

Results






Conclusions



Level of Evidence




Red Yeast Rice

bullKey Facts


bullSafety





bullKey References

bullAcknowledgments

1132019

27


Red Yeast Rice

bullKey Facts


bullSafety





bullKey References

bullAcknowledgments







Key Facts


















lovastatin












weeks




SGY



Why is this



Abstract






population











Abstract












1132019

28


Introduction








elderly[4]







Introduction
































scans








definitively

SGY



therapy


side






no better)



Diagnosis

1132019

29

Neerrsquos sign


























1132019

30

1132019

31














Occipital Lift


1132019

32


Abstract

Background



Purpose




Methods








Abstract

Results











Conclusion



trials



Abstract




training (RT)











= 0076)





Manual

Therapy

1132019

33



Subclavius Release


GH Traction

EXERCISES

1132019

34

1132019

35






1132019

36


2) Isotonics

a) Eccentric

b) Concentric

Equipment

1) A wall

2) TheraTube

or Band

3) Dumb bells














DEMONSTRATEWORKSHOP


jamhellip

1132019

37



2) 3 SLOW Reps



capture full ROM)




these




8) BE PATIENT







ABSTRACT






















ear and a line


eye








well








1132019

38


Exercise Form ndash

see

Next 3 slides





Exercise Form


1132019

39

1132019

40

1132019

41

VIDEO (325m)



CODY0NQ--













3 Phases




15deg elev

Phase 2 amp 3

ACJ 20deg

SCJ 40deg



1132019

42

Abstract

Study Design

Prospective cohort

Introduction







Methods






Results






Conclusions




Level of Evidence

1b

VIDEO




VIDEO (428m)













Video link (135m)






neutral pelvis

Video 043s


INSTRUCTIONS



palm down




to down) x3



Abd-Adduction








1132019

43


TrapsRhomboids





1132019

44


1132019

16

Case Presentations

Four presentations

THE INTERVENTIONS





levator scapulae









Case Presentations

Four presentations









to the patient




Case Presentations

Four presentations











Case Presentations

Four presentations





technique










Case Presentations

Four presentations














objective symptoms


findings


Case Presentations

Four presentations






setting



another choice







1132019

17

Case Presentations

Four presentations






therapies




cuff dysfunction









Case Presentations

Four presentations














method




Case Presentations

Four presentations










[37]


Case Presentations

Four presentations










ultrasound therapy








Case Presentations

Four presentations






















Four presentations



















1132019

18

Case Presentations

Four presentations











patients [23]







Case Presentations

Four presentations













arm






Case Presentations

Four presentations



direction








Figure 1










Case Presentations

Four presentations














spine



setting



precede 2010

1132019

19








Abstract

OBJECTIVE





chiropractors

METHODS










Author information


Abstract

(CONTINUED)

RESULTS











CONCLUSION






1132019

20


Abstract

OBJECTIVE



METHODS











Abstract

RESULTS








CONCLUSION





capsulitis (AC)



Abstract

BACKGROUND





METHODS










Abstract

RESULTS









INTERPRETATION










Abstract











years (55 to 81))







KEYWORDS



1132019

21



RESULTS






up (SMD -032 95 CI -062 to -001)




CONCLUSION











1132019

22




1132019

23



101186s12891-017-1518-0










Abstract

BACKGROUND








METHODS






RESULTS







CONCLUSIONS




this area




Abstract











Abstract









Introduction



RCT[2ndash5]













1132019

24


Introduction










Introduction


solutions










Introduction


action























Results












Results










1132019

25


Results









Figure 1







resonance imaging


Discussion


visits annually[43]











RCTs




in 14 patients[49]









in the average ROM













SGY



stage (next slide)












Conclusion






1132019

26









Methods







Results






Conclusions





Abstract

Background






Methods








Abstract

Results






Conclusions



Level of Evidence




Red Yeast Rice

bullKey Facts


bullSafety





bullKey References

bullAcknowledgments

1132019

27


Red Yeast Rice

bullKey Facts


bullSafety





bullKey References

bullAcknowledgments







Key Facts


















lovastatin












weeks




SGY



Why is this



Abstract






population











Abstract












1132019

28


Introduction








elderly[4]







Introduction
































scans








definitively

SGY



therapy


side






no better)



Diagnosis

1132019

29

Neerrsquos sign


























1132019

30

1132019

31














Occipital Lift


1132019

32


Abstract

Background



Purpose




Methods








Abstract

Results











Conclusion



trials



Abstract




training (RT)











= 0076)





Manual

Therapy

1132019

33



Subclavius Release


GH Traction

EXERCISES

1132019

34

1132019

35






1132019

36


2) Isotonics

a) Eccentric

b) Concentric

Equipment

1) A wall

2) TheraTube

or Band

3) Dumb bells














DEMONSTRATEWORKSHOP


jamhellip

1132019

37



2) 3 SLOW Reps



capture full ROM)




these




8) BE PATIENT







ABSTRACT






















ear and a line


eye








well








1132019

38


Exercise Form ndash

see

Next 3 slides





Exercise Form


1132019

39

1132019

40

1132019

41

VIDEO (325m)



CODY0NQ--













3 Phases




15deg elev

Phase 2 amp 3

ACJ 20deg

SCJ 40deg



1132019

42

Abstract

Study Design

Prospective cohort

Introduction







Methods






Results






Conclusions




Level of Evidence

1b

VIDEO




VIDEO (428m)













Video link (135m)






neutral pelvis

Video 043s


INSTRUCTIONS



palm down




to down) x3



Abd-Adduction








1132019

43


TrapsRhomboids





1132019

44


1132019

17

Case Presentations

Four presentations






therapies




cuff dysfunction









Case Presentations

Four presentations














method




Case Presentations

Four presentations










[37]


Case Presentations

Four presentations










ultrasound therapy








Case Presentations

Four presentations






















Four presentations



















1132019

18

Case Presentations

Four presentations











patients [23]







Case Presentations

Four presentations













arm






Case Presentations

Four presentations



direction








Figure 1










Case Presentations

Four presentations














spine



setting



precede 2010

1132019

19








Abstract

OBJECTIVE





chiropractors

METHODS










Author information


Abstract

(CONTINUED)

RESULTS











CONCLUSION






1132019

20


Abstract

OBJECTIVE



METHODS











Abstract

RESULTS








CONCLUSION





capsulitis (AC)



Abstract

BACKGROUND





METHODS










Abstract

RESULTS









INTERPRETATION










Abstract











years (55 to 81))







KEYWORDS



1132019

21



RESULTS






up (SMD -032 95 CI -062 to -001)




CONCLUSION











1132019

22




1132019

23



101186s12891-017-1518-0










Abstract

BACKGROUND








METHODS






RESULTS







CONCLUSIONS




this area




Abstract











Abstract









Introduction



RCT[2ndash5]













1132019

24


Introduction










Introduction


solutions










Introduction


action























Results












Results










1132019

25


Results









Figure 1







resonance imaging


Discussion


visits annually[43]











RCTs




in 14 patients[49]









in the average ROM













SGY



stage (next slide)












Conclusion






1132019

26









Methods







Results






Conclusions





Abstract

Background






Methods








Abstract

Results






Conclusions



Level of Evidence




Red Yeast Rice

bullKey Facts


bullSafety





bullKey References

bullAcknowledgments

1132019

27


Red Yeast Rice

bullKey Facts


bullSafety





bullKey References

bullAcknowledgments







Key Facts


















lovastatin












weeks




SGY



Why is this



Abstract






population











Abstract












1132019

28


Introduction








elderly[4]







Introduction
































scans








definitively

SGY



therapy


side






no better)



Diagnosis

1132019

29

Neerrsquos sign


























1132019

30

1132019

31














Occipital Lift


1132019

32


Abstract

Background



Purpose




Methods








Abstract

Results











Conclusion



trials



Abstract




training (RT)











= 0076)





Manual

Therapy

1132019

33



Subclavius Release


GH Traction

EXERCISES

1132019

34

1132019

35






1132019

36


2) Isotonics

a) Eccentric

b) Concentric

Equipment

1) A wall

2) TheraTube

or Band

3) Dumb bells














DEMONSTRATEWORKSHOP


jamhellip

1132019

37



2) 3 SLOW Reps



capture full ROM)




these




8) BE PATIENT







ABSTRACT






















ear and a line


eye








well








1132019

38


Exercise Form ndash

see

Next 3 slides





Exercise Form


1132019

39

1132019

40

1132019

41

VIDEO (325m)



CODY0NQ--













3 Phases




15deg elev

Phase 2 amp 3

ACJ 20deg

SCJ 40deg



1132019

42

Abstract

Study Design

Prospective cohort

Introduction







Methods






Results






Conclusions




Level of Evidence

1b

VIDEO




VIDEO (428m)













Video link (135m)






neutral pelvis

Video 043s


INSTRUCTIONS



palm down




to down) x3



Abd-Adduction








1132019

43


TrapsRhomboids





1132019

44


1132019

18

Case Presentations

Four presentations











patients [23]







Case Presentations

Four presentations













arm






Case Presentations

Four presentations



direction








Figure 1










Case Presentations

Four presentations














spine



setting



precede 2010

1132019

19








Abstract

OBJECTIVE





chiropractors

METHODS










Author information


Abstract

(CONTINUED)

RESULTS











CONCLUSION






1132019

20


Abstract

OBJECTIVE



METHODS











Abstract

RESULTS








CONCLUSION





capsulitis (AC)



Abstract

BACKGROUND





METHODS










Abstract

RESULTS









INTERPRETATION










Abstract











years (55 to 81))







KEYWORDS



1132019

21



RESULTS






up (SMD -032 95 CI -062 to -001)




CONCLUSION











1132019

22




1132019

23



101186s12891-017-1518-0










Abstract

BACKGROUND








METHODS






RESULTS







CONCLUSIONS




this area




Abstract











Abstract









Introduction



RCT[2ndash5]













1132019

24


Introduction










Introduction


solutions










Introduction


action























Results












Results










1132019

25


Results









Figure 1







resonance imaging


Discussion


visits annually[43]











RCTs




in 14 patients[49]









in the average ROM













SGY



stage (next slide)












Conclusion






1132019

26









Methods







Results






Conclusions





Abstract

Background






Methods








Abstract

Results






Conclusions



Level of Evidence




Red Yeast Rice

bullKey Facts


bullSafety





bullKey References

bullAcknowledgments

1132019

27


Red Yeast Rice

bullKey Facts


bullSafety





bullKey References

bullAcknowledgments







Key Facts


















lovastatin












weeks




SGY



Why is this



Abstract






population











Abstract












1132019

28


Introduction








elderly[4]







Introduction
































scans








definitively

SGY



therapy


side






no better)



Diagnosis

1132019

29

Neerrsquos sign


























1132019

30

1132019

31














Occipital Lift


1132019

32


Abstract

Background



Purpose




Methods








Abstract

Results











Conclusion



trials



Abstract




training (RT)











= 0076)





Manual

Therapy

1132019

33



Subclavius Release


GH Traction

EXERCISES

1132019

34

1132019

35






1132019

36


2) Isotonics

a) Eccentric

b) Concentric

Equipment

1) A wall

2) TheraTube

or Band

3) Dumb bells














DEMONSTRATEWORKSHOP


jamhellip

1132019

37



2) 3 SLOW Reps



capture full ROM)




these




8) BE PATIENT







ABSTRACT






















ear and a line


eye








well








1132019

38


Exercise Form ndash

see

Next 3 slides





Exercise Form


1132019

39

1132019

40

1132019

41

VIDEO (325m)



CODY0NQ--













3 Phases




15deg elev

Phase 2 amp 3

ACJ 20deg

SCJ 40deg



1132019

42

Abstract

Study Design

Prospective cohort

Introduction







Methods






Results






Conclusions




Level of Evidence

1b

VIDEO




VIDEO (428m)













Video link (135m)






neutral pelvis

Video 043s


INSTRUCTIONS



palm down




to down) x3



Abd-Adduction








1132019

43


TrapsRhomboids





1132019

44


1132019

19








Abstract

OBJECTIVE





chiropractors

METHODS










Author information


Abstract

(CONTINUED)

RESULTS











CONCLUSION






1132019

20


Abstract

OBJECTIVE



METHODS











Abstract

RESULTS








CONCLUSION





capsulitis (AC)



Abstract

BACKGROUND





METHODS










Abstract

RESULTS









INTERPRETATION










Abstract











years (55 to 81))







KEYWORDS



1132019

21



RESULTS






up (SMD -032 95 CI -062 to -001)




CONCLUSION











1132019

22




1132019

23



101186s12891-017-1518-0










Abstract

BACKGROUND








METHODS






RESULTS







CONCLUSIONS




this area




Abstract











Abstract









Introduction



RCT[2ndash5]













1132019

24


Introduction










Introduction


solutions










Introduction


action























Results












Results










1132019

25


Results









Figure 1







resonance imaging


Discussion


visits annually[43]











RCTs




in 14 patients[49]









in the average ROM













SGY



stage (next slide)












Conclusion






1132019

26









Methods







Results






Conclusions





Abstract

Background






Methods








Abstract

Results






Conclusions



Level of Evidence




Red Yeast Rice

bullKey Facts


bullSafety





bullKey References

bullAcknowledgments

1132019

27


Red Yeast Rice

bullKey Facts


bullSafety





bullKey References

bullAcknowledgments







Key Facts


















lovastatin












weeks




SGY



Why is this



Abstract






population











Abstract












1132019

28


Introduction








elderly[4]







Introduction
































scans








definitively

SGY



therapy


side






no better)



Diagnosis

1132019

29

Neerrsquos sign


























1132019

30

1132019

31














Occipital Lift


1132019

32


Abstract

Background



Purpose




Methods








Abstract

Results











Conclusion



trials



Abstract




training (RT)











= 0076)





Manual

Therapy

1132019

33



Subclavius Release


GH Traction

EXERCISES

1132019

34

1132019

35






1132019

36


2) Isotonics

a) Eccentric

b) Concentric

Equipment

1) A wall

2) TheraTube

or Band

3) Dumb bells














DEMONSTRATEWORKSHOP


jamhellip

1132019

37



2) 3 SLOW Reps



capture full ROM)




these




8) BE PATIENT







ABSTRACT






















ear and a line


eye








well








1132019

38


Exercise Form ndash

see

Next 3 slides





Exercise Form


1132019

39

1132019

40

1132019

41

VIDEO (325m)



CODY0NQ--













3 Phases




15deg elev

Phase 2 amp 3

ACJ 20deg

SCJ 40deg



1132019

42

Abstract

Study Design

Prospective cohort

Introduction







Methods






Results






Conclusions




Level of Evidence

1b

VIDEO




VIDEO (428m)













Video link (135m)






neutral pelvis

Video 043s


INSTRUCTIONS



palm down




to down) x3



Abd-Adduction








1132019

43


TrapsRhomboids





1132019

44


1132019

20


Abstract

OBJECTIVE



METHODS











Abstract

RESULTS








CONCLUSION





capsulitis (AC)



Abstract

BACKGROUND





METHODS










Abstract

RESULTS









INTERPRETATION










Abstract











years (55 to 81))







KEYWORDS



1132019

21



RESULTS






up (SMD -032 95 CI -062 to -001)




CONCLUSION











1132019

22




1132019

23



101186s12891-017-1518-0










Abstract

BACKGROUND








METHODS






RESULTS







CONCLUSIONS




this area




Abstract











Abstract









Introduction



RCT[2ndash5]













1132019

24


Introduction










Introduction


solutions










Introduction


action























Results












Results










1132019

25


Results









Figure 1







resonance imaging


Discussion


visits annually[43]











RCTs




in 14 patients[49]









in the average ROM













SGY



stage (next slide)












Conclusion






1132019

26









Methods







Results






Conclusions





Abstract

Background






Methods








Abstract

Results






Conclusions



Level of Evidence




Red Yeast Rice

bullKey Facts


bullSafety





bullKey References

bullAcknowledgments

1132019

27


Red Yeast Rice

bullKey Facts


bullSafety





bullKey References

bullAcknowledgments







Key Facts


















lovastatin












weeks




SGY



Why is this



Abstract






population











Abstract












1132019

28


Introduction








elderly[4]







Introduction
































scans








definitively

SGY



therapy


side






no better)



Diagnosis

1132019

29

Neerrsquos sign


























1132019

30

1132019

31














Occipital Lift


1132019

32


Abstract

Background



Purpose




Methods








Abstract

Results











Conclusion



trials



Abstract




training (RT)











= 0076)





Manual

Therapy

1132019

33



Subclavius Release


GH Traction

EXERCISES

1132019

34

1132019

35






1132019

36


2) Isotonics

a) Eccentric

b) Concentric

Equipment

1) A wall

2) TheraTube

or Band

3) Dumb bells














DEMONSTRATEWORKSHOP


jamhellip

1132019

37



2) 3 SLOW Reps



capture full ROM)




these




8) BE PATIENT







ABSTRACT






















ear and a line


eye








well








1132019

38


Exercise Form ndash

see

Next 3 slides





Exercise Form


1132019

39

1132019

40

1132019

41

VIDEO (325m)



CODY0NQ--













3 Phases




15deg elev

Phase 2 amp 3

ACJ 20deg

SCJ 40deg



1132019

42

Abstract

Study Design

Prospective cohort

Introduction







Methods






Results






Conclusions




Level of Evidence

1b

VIDEO




VIDEO (428m)













Video link (135m)






neutral pelvis

Video 043s


INSTRUCTIONS



palm down




to down) x3



Abd-Adduction








1132019

43


TrapsRhomboids





1132019

44


1132019

21



RESULTS






up (SMD -032 95 CI -062 to -001)




CONCLUSION











1132019

22




1132019

23



101186s12891-017-1518-0










Abstract

BACKGROUND








METHODS






RESULTS







CONCLUSIONS




this area




Abstract











Abstract









Introduction



RCT[2ndash5]













1132019

24


Introduction










Introduction


solutions










Introduction


action























Results












Results










1132019

25


Results









Figure 1







resonance imaging


Discussion


visits annually[43]











RCTs




in 14 patients[49]









in the average ROM













SGY



stage (next slide)












Conclusion






1132019

26









Methods







Results






Conclusions





Abstract

Background






Methods








Abstract

Results






Conclusions



Level of Evidence




Red Yeast Rice

bullKey Facts


bullSafety





bullKey References

bullAcknowledgments

1132019

27


Red Yeast Rice

bullKey Facts


bullSafety





bullKey References

bullAcknowledgments







Key Facts


















lovastatin












weeks




SGY



Why is this



Abstract






population











Abstract












1132019

28


Introduction








elderly[4]







Introduction
































scans








definitively

SGY



therapy


side






no better)



Diagnosis

1132019

29

Neerrsquos sign


























1132019

30

1132019

31














Occipital Lift


1132019

32


Abstract

Background



Purpose




Methods








Abstract

Results











Conclusion



trials



Abstract




training (RT)











= 0076)





Manual

Therapy

1132019

33



Subclavius Release


GH Traction

EXERCISES

1132019

34

1132019

35






1132019

36


2) Isotonics

a) Eccentric

b) Concentric

Equipment

1) A wall

2) TheraTube

or Band

3) Dumb bells














DEMONSTRATEWORKSHOP


jamhellip

1132019

37



2) 3 SLOW Reps



capture full ROM)




these




8) BE PATIENT







ABSTRACT






















ear and a line


eye








well








1132019

38


Exercise Form ndash

see

Next 3 slides





Exercise Form


1132019

39

1132019

40

1132019

41

VIDEO (325m)



CODY0NQ--













3 Phases




15deg elev

Phase 2 amp 3

ACJ 20deg

SCJ 40deg



1132019

42

Abstract

Study Design

Prospective cohort

Introduction







Methods






Results






Conclusions




Level of Evidence

1b

VIDEO




VIDEO (428m)













Video link (135m)






neutral pelvis

Video 043s


INSTRUCTIONS



palm down




to down) x3



Abd-Adduction








1132019

43


TrapsRhomboids





1132019

44


1132019

22




1132019

23



101186s12891-017-1518-0










Abstract

BACKGROUND








METHODS






RESULTS







CONCLUSIONS




this area




Abstract











Abstract









Introduction



RCT[2ndash5]













1132019

24


Introduction










Introduction


solutions










Introduction


action























Results












Results










1132019

25


Results









Figure 1







resonance imaging


Discussion


visits annually[43]











RCTs




in 14 patients[49]









in the average ROM













SGY



stage (next slide)












Conclusion






1132019

26









Methods







Results






Conclusions





Abstract

Background






Methods








Abstract

Results






Conclusions



Level of Evidence




Red Yeast Rice

bullKey Facts


bullSafety





bullKey References

bullAcknowledgments

1132019

27


Red Yeast Rice

bullKey Facts


bullSafety





bullKey References

bullAcknowledgments







Key Facts


















lovastatin












weeks




SGY



Why is this



Abstract






population











Abstract












1132019

28


Introduction








elderly[4]







Introduction
































scans








definitively

SGY



therapy


side






no better)



Diagnosis

1132019

29

Neerrsquos sign


























1132019

30

1132019

31














Occipital Lift


1132019

32


Abstract

Background



Purpose




Methods








Abstract

Results











Conclusion



trials



Abstract




training (RT)











= 0076)





Manual

Therapy

1132019

33



Subclavius Release


GH Traction

EXERCISES

1132019

34

1132019

35






1132019

36


2) Isotonics

a) Eccentric

b) Concentric

Equipment

1) A wall

2) TheraTube

or Band

3) Dumb bells














DEMONSTRATEWORKSHOP


jamhellip

1132019

37



2) 3 SLOW Reps



capture full ROM)




these




8) BE PATIENT







ABSTRACT






















ear and a line


eye








well








1132019

38


Exercise Form ndash

see

Next 3 slides





Exercise Form


1132019

39

1132019

40

1132019

41

VIDEO (325m)



CODY0NQ--













3 Phases




15deg elev

Phase 2 amp 3

ACJ 20deg

SCJ 40deg



1132019

42

Abstract

Study Design

Prospective cohort

Introduction







Methods






Results






Conclusions




Level of Evidence

1b

VIDEO




VIDEO (428m)













Video link (135m)






neutral pelvis

Video 043s


INSTRUCTIONS



palm down




to down) x3



Abd-Adduction








1132019

43


TrapsRhomboids





1132019

44


1132019

23



101186s12891-017-1518-0










Abstract

BACKGROUND








METHODS






RESULTS







CONCLUSIONS




this area




Abstract











Abstract









Introduction



RCT[2ndash5]













1132019

24


Introduction










Introduction


solutions










Introduction


action























Results












Results










1132019

25


Results









Figure 1







resonance imaging


Discussion


visits annually[43]











RCTs




in 14 patients[49]









in the average ROM













SGY



stage (next slide)












Conclusion






1132019

26









Methods







Results






Conclusions





Abstract

Background






Methods








Abstract

Results






Conclusions



Level of Evidence




Red Yeast Rice

bullKey Facts


bullSafety





bullKey References

bullAcknowledgments

1132019

27


Red Yeast Rice

bullKey Facts


bullSafety





bullKey References

bullAcknowledgments







Key Facts


















lovastatin












weeks




SGY



Why is this



Abstract






population











Abstract












1132019

28


Introduction








elderly[4]







Introduction
































scans








definitively

SGY



therapy


side






no better)



Diagnosis

1132019

29

Neerrsquos sign


























1132019

30

1132019

31














Occipital Lift


1132019

32


Abstract

Background



Purpose




Methods








Abstract

Results











Conclusion



trials



Abstract




training (RT)











= 0076)





Manual

Therapy

1132019

33



Subclavius Release


GH Traction

EXERCISES

1132019

34

1132019

35






1132019

36


2) Isotonics

a) Eccentric

b) Concentric

Equipment

1) A wall

2) TheraTube

or Band

3) Dumb bells














DEMONSTRATEWORKSHOP


jamhellip

1132019

37



2) 3 SLOW Reps



capture full ROM)




these




8) BE PATIENT







ABSTRACT






















ear and a line


eye








well








1132019

38


Exercise Form ndash

see

Next 3 slides





Exercise Form


1132019

39

1132019

40

1132019

41

VIDEO (325m)



CODY0NQ--













3 Phases




15deg elev

Phase 2 amp 3

ACJ 20deg

SCJ 40deg



1132019

42

Abstract

Study Design

Prospective cohort

Introduction







Methods






Results






Conclusions




Level of Evidence

1b

VIDEO




VIDEO (428m)













Video link (135m)






neutral pelvis

Video 043s


INSTRUCTIONS



palm down




to down) x3



Abd-Adduction








1132019

43


TrapsRhomboids





1132019

44


1132019

24


Introduction










Introduction


solutions










Introduction


action























Results












Results










1132019

25


Results









Figure 1







resonance imaging


Discussion


visits annually[43]











RCTs




in 14 patients[49]









in the average ROM













SGY



stage (next slide)












Conclusion






1132019

26









Methods







Results






Conclusions





Abstract

Background






Methods








Abstract

Results






Conclusions



Level of Evidence




Red Yeast Rice

bullKey Facts


bullSafety





bullKey References

bullAcknowledgments

1132019

27


Red Yeast Rice

bullKey Facts


bullSafety





bullKey References

bullAcknowledgments







Key Facts


















lovastatin












weeks




SGY



Why is this



Abstract






population











Abstract












1132019

28


Introduction








elderly[4]







Introduction
































scans








definitively

SGY



therapy


side






no better)



Diagnosis

1132019

29

Neerrsquos sign


























1132019

30

1132019

31














Occipital Lift


1132019

32


Abstract

Background



Purpose




Methods








Abstract

Results











Conclusion



trials



Abstract




training (RT)











= 0076)





Manual

Therapy

1132019

33



Subclavius Release


GH Traction

EXERCISES

1132019

34

1132019

35






1132019

36


2) Isotonics

a) Eccentric

b) Concentric

Equipment

1) A wall

2) TheraTube

or Band

3) Dumb bells














DEMONSTRATEWORKSHOP


jamhellip

1132019

37



2) 3 SLOW Reps



capture full ROM)




these




8) BE PATIENT







ABSTRACT






















ear and a line


eye








well








1132019

38


Exercise Form ndash

see

Next 3 slides





Exercise Form


1132019

39

1132019

40

1132019

41

VIDEO (325m)



CODY0NQ--













3 Phases




15deg elev

Phase 2 amp 3

ACJ 20deg

SCJ 40deg



1132019

42

Abstract

Study Design

Prospective cohort

Introduction







Methods






Results






Conclusions




Level of Evidence

1b

VIDEO




VIDEO (428m)













Video link (135m)






neutral pelvis

Video 043s


INSTRUCTIONS



palm down




to down) x3



Abd-Adduction








1132019

43


TrapsRhomboids





1132019

44


1132019

25


Results









Figure 1







resonance imaging


Discussion


visits annually[43]











RCTs




in 14 patients[49]









in the average ROM













SGY



stage (next slide)












Conclusion






1132019

26









Methods







Results






Conclusions





Abstract

Background






Methods








Abstract

Results






Conclusions



Level of Evidence




Red Yeast Rice

bullKey Facts


bullSafety





bullKey References

bullAcknowledgments

1132019

27


Red Yeast Rice

bullKey Facts


bullSafety





bullKey References

bullAcknowledgments







Key Facts


















lovastatin












weeks




SGY



Why is this



Abstract






population











Abstract












1132019

28


Introduction








elderly[4]







Introduction
































scans








definitively

SGY



therapy


side






no better)



Diagnosis

1132019

29

Neerrsquos sign


























1132019

30

1132019

31














Occipital Lift


1132019

32


Abstract

Background



Purpose




Methods








Abstract

Results











Conclusion



trials



Abstract




training (RT)











= 0076)





Manual

Therapy

1132019

33



Subclavius Release


GH Traction

EXERCISES

1132019

34

1132019

35






1132019

36


2) Isotonics

a) Eccentric

b) Concentric

Equipment

1) A wall

2) TheraTube

or Band

3) Dumb bells














DEMONSTRATEWORKSHOP


jamhellip

1132019

37



2) 3 SLOW Reps



capture full ROM)




these




8) BE PATIENT







ABSTRACT






















ear and a line


eye








well








1132019

38


Exercise Form ndash

see

Next 3 slides





Exercise Form


1132019

39

1132019

40

1132019

41

VIDEO (325m)



CODY0NQ--













3 Phases




15deg elev

Phase 2 amp 3

ACJ 20deg

SCJ 40deg



1132019

42

Abstract

Study Design

Prospective cohort

Introduction







Methods






Results






Conclusions




Level of Evidence

1b

VIDEO




VIDEO (428m)













Video link (135m)






neutral pelvis

Video 043s


INSTRUCTIONS



palm down




to down) x3



Abd-Adduction








1132019

43


TrapsRhomboids





1132019

44


1132019

26









Methods







Results






Conclusions





Abstract

Background






Methods








Abstract

Results






Conclusions



Level of Evidence




Red Yeast Rice

bullKey Facts


bullSafety





bullKey References

bullAcknowledgments

1132019

27


Red Yeast Rice

bullKey Facts


bullSafety





bullKey References

bullAcknowledgments







Key Facts


















lovastatin












weeks




SGY



Why is this



Abstract






population











Abstract












1132019

28


Introduction








elderly[4]







Introduction
































scans








definitively

SGY



therapy


side






no better)



Diagnosis

1132019

29

Neerrsquos sign


























1132019

30

1132019

31














Occipital Lift


1132019

32


Abstract

Background



Purpose




Methods








Abstract

Results











Conclusion



trials



Abstract




training (RT)











= 0076)





Manual

Therapy

1132019

33



Subclavius Release


GH Traction

EXERCISES

1132019

34

1132019

35






1132019

36


2) Isotonics

a) Eccentric

b) Concentric

Equipment

1) A wall

2) TheraTube

or Band

3) Dumb bells














DEMONSTRATEWORKSHOP


jamhellip

1132019

37



2) 3 SLOW Reps



capture full ROM)




these




8) BE PATIENT







ABSTRACT






















ear and a line


eye








well








1132019

38


Exercise Form ndash

see

Next 3 slides





Exercise Form


1132019

39

1132019

40

1132019

41

VIDEO (325m)



CODY0NQ--













3 Phases




15deg elev

Phase 2 amp 3

ACJ 20deg

SCJ 40deg



1132019

42

Abstract

Study Design

Prospective cohort

Introduction







Methods






Results






Conclusions




Level of Evidence

1b

VIDEO




VIDEO (428m)













Video link (135m)






neutral pelvis

Video 043s


INSTRUCTIONS



palm down




to down) x3



Abd-Adduction








1132019

43


TrapsRhomboids





1132019

44


1132019

27


Red Yeast Rice

bullKey Facts


bullSafety





bullKey References

bullAcknowledgments







Key Facts


















lovastatin












weeks




SGY



Why is this



Abstract






population











Abstract












1132019

28


Introduction








elderly[4]







Introduction
































scans








definitively

SGY



therapy


side






no better)



Diagnosis

1132019

29

Neerrsquos sign


























1132019

30

1132019

31














Occipital Lift


1132019

32


Abstract

Background



Purpose




Methods








Abstract

Results











Conclusion



trials



Abstract




training (RT)











= 0076)





Manual

Therapy

1132019

33



Subclavius Release


GH Traction

EXERCISES

1132019

34

1132019

35






1132019

36


2) Isotonics

a) Eccentric

b) Concentric

Equipment

1) A wall

2) TheraTube

or Band

3) Dumb bells














DEMONSTRATEWORKSHOP


jamhellip

1132019

37



2) 3 SLOW Reps



capture full ROM)




these




8) BE PATIENT







ABSTRACT






















ear and a line


eye








well








1132019

38


Exercise Form ndash

see

Next 3 slides





Exercise Form


1132019

39

1132019

40

1132019

41

VIDEO (325m)



CODY0NQ--













3 Phases




15deg elev

Phase 2 amp 3

ACJ 20deg

SCJ 40deg



1132019

42

Abstract

Study Design

Prospective cohort

Introduction







Methods






Results






Conclusions




Level of Evidence

1b

VIDEO




VIDEO (428m)













Video link (135m)






neutral pelvis

Video 043s


INSTRUCTIONS



palm down




to down) x3



Abd-Adduction








1132019

43


TrapsRhomboids





1132019

44


1132019

28


Introduction








elderly[4]







Introduction
































scans








definitively

SGY



therapy


side






no better)



Diagnosis

1132019

29

Neerrsquos sign


























1132019

30

1132019

31














Occipital Lift


1132019

32


Abstract

Background



Purpose




Methods








Abstract

Results











Conclusion



trials



Abstract




training (RT)











= 0076)





Manual

Therapy

1132019

33



Subclavius Release


GH Traction

EXERCISES

1132019

34

1132019

35






1132019

36


2) Isotonics

a) Eccentric

b) Concentric

Equipment

1) A wall

2) TheraTube

or Band

3) Dumb bells














DEMONSTRATEWORKSHOP


jamhellip

1132019

37



2) 3 SLOW Reps



capture full ROM)




these




8) BE PATIENT







ABSTRACT






















ear and a line


eye








well








1132019

38


Exercise Form ndash

see

Next 3 slides





Exercise Form


1132019

39

1132019

40

1132019

41

VIDEO (325m)



CODY0NQ--













3 Phases




15deg elev

Phase 2 amp 3

ACJ 20deg

SCJ 40deg



1132019

42

Abstract

Study Design

Prospective cohort

Introduction







Methods






Results






Conclusions




Level of Evidence

1b

VIDEO




VIDEO (428m)













Video link (135m)






neutral pelvis

Video 043s


INSTRUCTIONS



palm down




to down) x3



Abd-Adduction








1132019

43


TrapsRhomboids





1132019

44


1132019

29

Neerrsquos sign


























1132019

30

1132019

31














Occipital Lift


1132019

32


Abstract

Background



Purpose




Methods








Abstract

Results











Conclusion



trials



Abstract




training (RT)











= 0076)





Manual

Therapy

1132019

33



Subclavius Release


GH Traction

EXERCISES

1132019

34

1132019

35






1132019

36


2) Isotonics

a) Eccentric

b) Concentric

Equipment

1) A wall

2) TheraTube

or Band

3) Dumb bells














DEMONSTRATEWORKSHOP


jamhellip

1132019

37



2) 3 SLOW Reps



capture full ROM)




these




8) BE PATIENT







ABSTRACT






















ear and a line


eye








well








1132019

38


Exercise Form ndash

see

Next 3 slides





Exercise Form


1132019

39

1132019

40

1132019

41

VIDEO (325m)



CODY0NQ--













3 Phases




15deg elev

Phase 2 amp 3

ACJ 20deg

SCJ 40deg



1132019

42

Abstract

Study Design

Prospective cohort

Introduction







Methods






Results






Conclusions




Level of Evidence

1b

VIDEO




VIDEO (428m)













Video link (135m)






neutral pelvis

Video 043s


INSTRUCTIONS



palm down




to down) x3



Abd-Adduction








1132019

43


TrapsRhomboids





1132019

44


1132019

30

1132019

31














Occipital Lift


1132019

32


Abstract

Background



Purpose




Methods








Abstract

Results











Conclusion



trials



Abstract




training (RT)











= 0076)





Manual

Therapy

1132019

33



Subclavius Release


GH Traction

EXERCISES

1132019

34

1132019

35






1132019

36


2) Isotonics

a) Eccentric

b) Concentric

Equipment

1) A wall

2) TheraTube

or Band

3) Dumb bells














DEMONSTRATEWORKSHOP


jamhellip

1132019

37



2) 3 SLOW Reps



capture full ROM)




these




8) BE PATIENT







ABSTRACT






















ear and a line


eye








well








1132019

38


Exercise Form ndash

see

Next 3 slides





Exercise Form


1132019

39

1132019

40

1132019

41

VIDEO (325m)



CODY0NQ--













3 Phases




15deg elev

Phase 2 amp 3

ACJ 20deg

SCJ 40deg



1132019

42

Abstract

Study Design

Prospective cohort

Introduction







Methods






Results






Conclusions




Level of Evidence

1b

VIDEO




VIDEO (428m)













Video link (135m)






neutral pelvis

Video 043s


INSTRUCTIONS



palm down




to down) x3



Abd-Adduction








1132019

43


TrapsRhomboids





1132019

44


1132019

31














Occipital Lift


1132019

32


Abstract

Background



Purpose




Methods








Abstract

Results











Conclusion



trials



Abstract




training (RT)











= 0076)





Manual

Therapy

1132019

33



Subclavius Release


GH Traction

EXERCISES

1132019

34

1132019

35






1132019

36


2) Isotonics

a) Eccentric

b) Concentric

Equipment

1) A wall

2) TheraTube

or Band

3) Dumb bells














DEMONSTRATEWORKSHOP


jamhellip

1132019

37



2) 3 SLOW Reps



capture full ROM)




these




8) BE PATIENT







ABSTRACT






















ear and a line


eye








well








1132019

38


Exercise Form ndash

see

Next 3 slides





Exercise Form


1132019

39

1132019

40

1132019

41

VIDEO (325m)



CODY0NQ--













3 Phases




15deg elev

Phase 2 amp 3

ACJ 20deg

SCJ 40deg



1132019

42

Abstract

Study Design

Prospective cohort

Introduction







Methods






Results






Conclusions




Level of Evidence

1b

VIDEO




VIDEO (428m)













Video link (135m)






neutral pelvis

Video 043s


INSTRUCTIONS



palm down




to down) x3



Abd-Adduction








1132019

43


TrapsRhomboids





1132019

44


1132019

32


Abstract

Background



Purpose




Methods








Abstract

Results











Conclusion



trials



Abstract




training (RT)











= 0076)





Manual

Therapy

1132019

33



Subclavius Release


GH Traction

EXERCISES

1132019

34

1132019

35






1132019

36


2) Isotonics

a) Eccentric

b) Concentric

Equipment

1) A wall

2) TheraTube

or Band

3) Dumb bells














DEMONSTRATEWORKSHOP


jamhellip

1132019

37



2) 3 SLOW Reps



capture full ROM)




these




8) BE PATIENT







ABSTRACT






















ear and a line


eye








well








1132019

38


Exercise Form ndash

see

Next 3 slides





Exercise Form


1132019

39

1132019

40

1132019

41

VIDEO (325m)



CODY0NQ--













3 Phases




15deg elev

Phase 2 amp 3

ACJ 20deg

SCJ 40deg



1132019

42

Abstract

Study Design

Prospective cohort

Introduction







Methods






Results






Conclusions




Level of Evidence

1b

VIDEO




VIDEO (428m)













Video link (135m)






neutral pelvis

Video 043s


INSTRUCTIONS



palm down




to down) x3



Abd-Adduction








1132019

43


TrapsRhomboids





1132019

44


1132019

33



Subclavius Release


GH Traction

EXERCISES

1132019

34

1132019

35






1132019

36


2) Isotonics

a) Eccentric

b) Concentric

Equipment

1) A wall

2) TheraTube

or Band

3) Dumb bells














DEMONSTRATEWORKSHOP


jamhellip

1132019

37



2) 3 SLOW Reps



capture full ROM)




these




8) BE PATIENT







ABSTRACT






















ear and a line


eye








well








1132019

38


Exercise Form ndash

see

Next 3 slides





Exercise Form


1132019

39

1132019

40

1132019

41

VIDEO (325m)



CODY0NQ--













3 Phases




15deg elev

Phase 2 amp 3

ACJ 20deg

SCJ 40deg



1132019

42

Abstract

Study Design

Prospective cohort

Introduction







Methods






Results






Conclusions




Level of Evidence

1b

VIDEO




VIDEO (428m)













Video link (135m)






neutral pelvis

Video 043s


INSTRUCTIONS



palm down




to down) x3



Abd-Adduction








1132019

43


TrapsRhomboids





1132019

44


1132019

34

1132019

35






1132019

36


2) Isotonics

a) Eccentric

b) Concentric

Equipment

1) A wall

2) TheraTube

or Band

3) Dumb bells














DEMONSTRATEWORKSHOP


jamhellip

1132019

37



2) 3 SLOW Reps



capture full ROM)




these




8) BE PATIENT







ABSTRACT






















ear and a line


eye








well








1132019

38


Exercise Form ndash

see

Next 3 slides





Exercise Form


1132019

39

1132019

40

1132019

41

VIDEO (325m)



CODY0NQ--













3 Phases




15deg elev

Phase 2 amp 3

ACJ 20deg

SCJ 40deg



1132019

42

Abstract

Study Design

Prospective cohort

Introduction







Methods






Results






Conclusions




Level of Evidence

1b

VIDEO




VIDEO (428m)













Video link (135m)






neutral pelvis

Video 043s


INSTRUCTIONS



palm down




to down) x3



Abd-Adduction








1132019

43


TrapsRhomboids





1132019

44


1132019

35






1132019

36


2) Isotonics

a) Eccentric

b) Concentric

Equipment

1) A wall

2) TheraTube

or Band

3) Dumb bells














DEMONSTRATEWORKSHOP


jamhellip

1132019

37



2) 3 SLOW Reps



capture full ROM)




these




8) BE PATIENT







ABSTRACT






















ear and a line


eye








well








1132019

38


Exercise Form ndash

see

Next 3 slides





Exercise Form


1132019

39

1132019

40

1132019

41

VIDEO (325m)



CODY0NQ--













3 Phases




15deg elev

Phase 2 amp 3

ACJ 20deg

SCJ 40deg



1132019

42

Abstract

Study Design

Prospective cohort

Introduction







Methods






Results






Conclusions




Level of Evidence

1b

VIDEO




VIDEO (428m)













Video link (135m)






neutral pelvis

Video 043s


INSTRUCTIONS



palm down




to down) x3



Abd-Adduction








1132019

43


TrapsRhomboids





1132019

44


1132019

36


2) Isotonics

a) Eccentric

b) Concentric

Equipment

1) A wall

2) TheraTube

or Band

3) Dumb bells














DEMONSTRATEWORKSHOP


jamhellip

1132019

37



2) 3 SLOW Reps



capture full ROM)




these




8) BE PATIENT







ABSTRACT






















ear and a line


eye








well








1132019

38


Exercise Form ndash

see

Next 3 slides





Exercise Form


1132019

39

1132019

40

1132019

41

VIDEO (325m)



CODY0NQ--













3 Phases




15deg elev

Phase 2 amp 3

ACJ 20deg

SCJ 40deg



1132019

42

Abstract

Study Design

Prospective cohort

Introduction







Methods






Results






Conclusions




Level of Evidence

1b

VIDEO




VIDEO (428m)













Video link (135m)






neutral pelvis

Video 043s


INSTRUCTIONS



palm down




to down) x3



Abd-Adduction








1132019

43


TrapsRhomboids





1132019

44


1132019

37



2) 3 SLOW Reps



capture full ROM)




these




8) BE PATIENT







ABSTRACT






















ear and a line


eye








well








1132019

38


Exercise Form ndash

see

Next 3 slides





Exercise Form


1132019

39

1132019

40

1132019

41

VIDEO (325m)



CODY0NQ--













3 Phases




15deg elev

Phase 2 amp 3

ACJ 20deg

SCJ 40deg



1132019

42

Abstract

Study Design

Prospective cohort

Introduction







Methods






Results






Conclusions




Level of Evidence

1b

VIDEO




VIDEO (428m)













Video link (135m)






neutral pelvis

Video 043s


INSTRUCTIONS



palm down




to down) x3



Abd-Adduction








1132019

43


TrapsRhomboids





1132019

44


1132019

38


Exercise Form ndash

see

Next 3 slides





Exercise Form


1132019

39

1132019

40

1132019

41

VIDEO (325m)



CODY0NQ--













3 Phases




15deg elev

Phase 2 amp 3

ACJ 20deg

SCJ 40deg



1132019

42

Abstract

Study Design

Prospective cohort

Introduction







Methods






Results






Conclusions




Level of Evidence

1b

VIDEO




VIDEO (428m)













Video link (135m)






neutral pelvis

Video 043s


INSTRUCTIONS



palm down




to down) x3



Abd-Adduction








1132019

43


TrapsRhomboids





1132019

44


1132019

39

1132019

40

1132019

41

VIDEO (325m)



CODY0NQ--













3 Phases




15deg elev

Phase 2 amp 3

ACJ 20deg

SCJ 40deg



1132019

42

Abstract

Study Design

Prospective cohort

Introduction







Methods






Results






Conclusions




Level of Evidence

1b

VIDEO




VIDEO (428m)













Video link (135m)






neutral pelvis

Video 043s


INSTRUCTIONS



palm down




to down) x3



Abd-Adduction








1132019

43


TrapsRhomboids





1132019

44


1132019

40

1132019

41

VIDEO (325m)



CODY0NQ--













3 Phases




15deg elev

Phase 2 amp 3

ACJ 20deg

SCJ 40deg



1132019

42

Abstract

Study Design

Prospective cohort

Introduction







Methods






Results






Conclusions




Level of Evidence

1b

VIDEO




VIDEO (428m)













Video link (135m)






neutral pelvis

Video 043s


INSTRUCTIONS



palm down




to down) x3



Abd-Adduction








1132019

43


TrapsRhomboids





1132019

44


1132019

41

VIDEO (325m)



CODY0NQ--













3 Phases




15deg elev

Phase 2 amp 3

ACJ 20deg

SCJ 40deg



1132019

42

Abstract

Study Design

Prospective cohort

Introduction







Methods






Results






Conclusions




Level of Evidence

1b

VIDEO




VIDEO (428m)













Video link (135m)






neutral pelvis

Video 043s


INSTRUCTIONS



palm down




to down) x3



Abd-Adduction








1132019

43


TrapsRhomboids





1132019

44


1132019

42

Abstract

Study Design

Prospective cohort

Introduction







Methods






Results






Conclusions




Level of Evidence

1b

VIDEO




VIDEO (428m)













Video link (135m)






neutral pelvis

Video 043s


INSTRUCTIONS



palm down




to down) x3



Abd-Adduction








1132019

43


TrapsRhomboids





1132019

44


1132019

43


TrapsRhomboids





1132019

44


1132019

44


Documents

What is “…the shoulder?” Definition...throwing athlete in association with internal impingement and SLAP (superior labral anterior posterior) lesions.2,3 • These tears tend