Transcript Post-operative shoulder instructions visual/audio

SHOULDER ANALYSIS OF
PRACTICE RESEARCH
PROJECT
REGIS UNIVERSITY DOCTOR OF PHYSICAL
THERAPY PROGRAM
Jason Chi, Bryce Crenshaw, Paul Killoren, Andy
Kittleson, Elizabeth Ostrand, Austin Woods,
Martina Young
Faculty Advisor: Mike Keirns
Shoulder Practice
• The shoulder is a complex joint
• It has varied interactions with different
pathologies making diagnosis difficult
• Treatment strategies are diverse
• Strong outcome measures exist to
evaluate shoulder differential diagnosis
and best practice
• However there is a lack of consistency
from healthcare providers
Shoulder Analysis of Practice
Goals:
• Evaluate clinical practice patterns
• Compound the best evidence for
outcomes in post operative shoulder
surgeries.
Data Collection Process
• 1 page form for each patient
– No patient identification data collected
• 3 sections of data form:
– Demographics/Comorbidities
– Examination information
– Interventions applied
PostOperative
Data
Collection
Form
Demographics Section
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Sex
Age
Involved shoulder
Dominant arm
Surgery ( Rotator Cuff, Labral Repair, Instability, Slap)
Date of injury
Date of surgery
Other symptoms
Comorbidities
Medications
Additional information (Scar healing, Sling, Protocol used)
Interventions
Outcome Measures
Outcome Measures
Outcome Measures
Elevation AROM
• Standing
• Active elevation in the
scapular plane
• Thumb facing ceiling
• Measured using a
goniometer
ER 90 Deg ABD PROM
(Post-Op Only)
• Supine
• Measure External
Rotation at 90
degrees of Abduction
Hand to Neck
• Patient is standing
• Shoulder abducted to
90 degrees
• Elbow flexed
maximally
Hand to Scapula
• Shoulder internally
rotated
• Elbow flexed greater
than 90 degrees
• Dorsal surface of
hand to contralateral
scapula
Hand to Opposite Scapula
• Shoulder flexed to 90
degrees and
horizontally adducted
• Flex elbow greater
than 90 degrees
• Hand to contralateral
spine of scapula
IR AROM
• Patient slides back of
hand up the spine as far
as possible
• Measured by level
reached
– “Unable” - pt unable to
reach to buttock
– “Buttock” - pt can place
hand on buttock
– “L-spine” - pt can reach
lumbar spine
– “T-spine” - pt can reach
thoracic region but not as
high as on the opposite
side
– “Full” - motion is
symmetrical on both sides
Resistive External Rotation
• Standing
• Resist ER with elbow
bent to 90 degrees and
shoulder in 0 degrees of
flexion and abduction
– “Unable” - pt cannot hold
position
– “Diminished” - pt cannot
resist as much force as in
the opposite arm
– “Normal” - pt can resist
same amount of force as
on opposite arm
NPRS (0-10)
• Patient is asked to rate worst pain
experienced over previous 24 hours
• 0 (no pain) to 10 (worst pain imaginable)
QuickDASH
• Abbreviated form of the Disabilities of the
Arm, Shoulder and Hand (DASH)
Questionnaire
• 11 questions about ability to perform
functional activities
• EVERY QUESTION MUST BE ANSWERED!
• If the activity has not been recently
performed, make best estimate of an
accurate response
• Does not matter which arm is used to perform
the task, answer based on ability regardless
of how task is performed
QuickDASH Scoring
DASH Disability/Symptom Score
 sum of responses 1 x 25
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GROC
• Patient is asked to fill out global rating
scale
• Overall condition should be rated from first
treatment to current time
• Any rating lower than than somewhat
worse requires comment from the
therapist
GROC Form
Date:
Rate overall condition of shoulder
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A very great deal worse
A great deal worse
Quite a bit worse
Moderately worse
Somewhat worse
A little bit worse
A tiny bit worse (almost
the same)
• About the same
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A very great deal better
A great deal better
Quite a bit better
Moderately better
Somewhat better
A little bit better
A tiny bit better (almost
the same)
Any rating lower than somewhat worse requires comment from therapist
Additional Info
How the process works…
• Project members available to answer any
questions. For assistance email Mike
Keirns @ [email protected]
• Complete the data form for a patient
– Fax to Mike Keirns @ 303-964-5474
• Clinicians who submit at least one form
will receive a summary of the data
collected for the project