Physical Therapy of the Shoulder - E-Book

Robert A. Donatelli

• Publisher: Churchill Livingstone
• Year: 2011
• ISBN:
  9781437715316
• Edition: 5
• Topic: Medizin
• Subtopic: Physiotherapie, Physikalische & Rehabilitative Medizin

The leading reference on shoulder rehabilitation, Physical Therapy of the Shoulder, 5th Edition provides complete information on the functional anatomy of the shoulder, the mechanics of movement, and the evaluation and treatment of shoulder disorders. It promotes current, evidence-based practice with coverage of the latest rehabilitation and surgical techniques. Case studies show the clinical application of key principles, and follow the practice patterns from the APTA Guide to Physical Therapist Practice, 2nd Edition, relating to shoulder disorders. Edited by Robert Donatelli, a well-known lecturer and consultant for professional athletes, this book includes a companion website with video clips demonstrating shoulder therapy techniques and procedures.

• State-of-the-art coverage details the latest rehabilitation and surgical techniques and procedures of shoulder disorders.
• The integration of practice patterns from the APTA Guide to Physical Therapist Practice, 2nd Edition, demonstrates APTA guidelines for managing shoulder disorders.
• Case studies in each clinical chapter show the management of real-life situations.
• Video clips on the companion website demonstrate examination techniques, function tests, treatment techniques, and exercises.

• Updated neurology and surgery sections provide the most current, evidence-based practice parameters.
• New case studies are added to show the clinical application of therapy principles.
• Video clips on the companion Evolve website demonstrate additional techniques, exercises, and tests.

CHAPTER 1 The Guide to Practice

Scot Irwin, Jaime C. Paz

In this fifth edition of Donatelli’s Physical Therapy of the Shoulder, the clinical cases continue to be written in the format of Guide to Physical Therapist Practice¹ (the Guide) of the American Physical Therapy Association (APTA). This format was developed and has been promoted by the APTA, which is the largest professional representative for physical therapists, physical therapy assistants, and physical therapy students in the United States.

This chapter is designed to orient the reader to the origins, purposes, content, and nature of the Guide. In this way, the intent of this chapter is to encourage clinicians and students who use this current book to incorporate the Guide’s language and philosophy into the examination, evaluation, diagnosis, prognosis, intervention, and outcome provided for their patients with shoulder dysfunction.

Origins

To speak at any length about the origins of this document would take most of this text. For the abbreviated yet complete review, the reader is encouraged to read the Guide.¹ Since Mary McMillan first constructed and presided over the Women’s Physiotherapy Association in the early 1920s—and until the first edition of the Guide in 1997—the reconstruction aides, general practitioners, and certified clinical specialists all intuitively have known the value and importance of rehabilitation services. Throughout that short but illustrious history, the association members have professed the uniqueness and talent within the physical therapy profession to any who cared to listen. The scientific evidence of this effectiveness, in contrast, remains to be presented. No defined body of knowledge for physical therapists exists. The Guide provides a foundation for developing the evidence for the effectiveness of physical therapist interventions. The body of knowledge will be defined from the evidence that proves the value of these interventions.

Physical therapy originated from many facets of health care and health sciences, nursing, physical education, medicine, pathology, and rehabilitation—yet physical therapists claim none alone. For most of the decade of the 1980s and early 1990s, the APTA debated the merits and even the existence of physical therapy diagnoses. The term diagnosis is so fraught with interpretations that, within the APTA, confusion and debate have consumed an inordinate amount of the association’s governance time. Finally, the APTA House of Delegates came to an agreement that physical therapists did diagnose and that those diagnoses were directed at movement and movement dysfunction.

The basic premise here is that human movement, like digestion, is a system. The movement system has normal behaviors that can become dysfunctional, and a physical therapist can provide remedies for those dysfunctions. Eventually, because of a need to describe the scope of a physical therapist’s practice more clearly for many health care agencies and for the physical therapy profession, the APTA undertook the development of the Guide. From 1992 through the completion of the current edition, a handful of physical therapists and staff members of the APTA constructed this document. Those who have tried to produce anything by committee can imagine the amount of time and effort required to write the Guide. The authors of the Guide are too numerous to list, but they are acknowledged within the Guide itself, and they deserve the respect and thanks of every physical therapist. All the authors were chosen for their expertise and knowledge in a particular practice pattern arena (musculoskeletal, neuromuscular, cardiovascular/pulmonary, and integumentary). Each of those authors is quick to point out that this document is not written on a stone tablet. Its origins derive from the cataclysmic changes that have occurred in health care delivery and reimbursement in the United States. Those driving forces, along with the dynamic growth and development of the profession of physical therapy, created an environment that required this document’s publication and demanded that the Guide be in constant evolution. Evidence of this evolution is electronic access to the revised second edition of the Guide in compact disk format, which includes a catalog of tests and measures employed by physical therapists. Furthermore, the APTA has provided Internet access to the latest edition of the Guide.²

The challenge for future physical therapists is to continue to amend and edit the Guide by documenting errors and omissions and by providing new practice patterns for impairments and functional limitations yet to be identified or discovered. A future edition of the Guide is likely to include the International Classification of Functioning, Disability, and Health (ICF) developed by the World Health Organization (WHO) to promote human functioning with a standardized framework and language. The APTA House of Delegates endorsed this model in 2008.³

Purposes

The list of purposes for the Guide can be found in the first section, “About the Guide,” of the revised second edition.¹ Throughout the document, these purposes are reiterated. Each of the diagnostic patterns described in the Guide uses terminology found in the list of purposes. Although many readers find this constant redundancy a distracting feature of the Guide, it is used to demonstrate the basic constructs of a physical therapist’s approach to patient management. The authors of the Guide also used the combined term patient/client throughout the Guide. For this chapter, the term client is used.

A summary of the purposes is as follows: The Guide was developed to assist internal (physical therapists) and external (all others involved in health care delivery and reimbursement) individuals in understanding the scope of a physical therapist’s practice. As stated in the Guide, this list includes—but is not limited to—practice settings, roles, terminology, tests and measures, and interventions used by physical therapists in the delivery of physical therapy. Perhaps most important, the Guide establishes preferred practice patterns based on the Nagi model of disablement.⁴ Common themes within the purposes listed in the Guide are the promotion of health, wellness, and fitness along with prevention of movement dysfunction and the appropriate use of physical therapy services as provided by physical therapists.

The authors of the Guide clearly describe what the Guide is not. To quote the authors: “The Guide does not provide specific protocols for treatments, nor are the practice patterns contained in the Guide intended to serve as clinical guidelines.”¹ The authors go on to state that the Guide is only an initial step in the development of clinical guidelines. Clinical guideline development requires evidence from peer-reviewed research. The current edition of the Guide was not written to provide that level of information.

In this book, the case examples have been “Guideized,” including formatting and terminology. It is the intention that the reader should become familiar with this system of patient evaluation and treatment and incorporate it into his or her daily practice. It is also hoped that academic and clinical faculty will use the Guide approach when instructing future generations of physical therapists and will thus fulfill the purpose of the Guide.

Content

The Guide was developed with three key concepts in mind: (1) the Nagi model of disablement⁴ (Table 1-1); (2) the variety of work settings for physical therapists; and (3) the provision of services by physical therapists through the continuum of health care.

Table 1-1 Nagi Model of Disablement

To understand the Guide, a good understanding of the disablement model is required. Articles by Guccione⁵ and Jette⁶ have provided the background for understanding disablement. The reader can find these articles in the journal Physical Therapy from 1991 and 1994, respectively. The Nagi model⁴ was selected by the authors of the Guide because it provides the best fit for the development of physical therapy practice patterns and diagnoses. As Guccione’s diagram (Fig. 1-1) so aptly demonstrates, the Nagi model encompasses the entire spectrum of health care. Pathology and pathophysiology lead to impairment, which can either cause more pathology or lead to functional limitations. These functional limitations may revert back to impairments or progress to disability. The domain of a physical therapist’s practice is outlined by the dotted lines in Figure 1-1. The Guide was developed to address the delivery of health care services by physical therapists from pathology to impairment to functional limitation and to disability with the greatest emphasis on identification and rectification of impairments and functional limitations. In effect, the Guide is saying that physical therapists are the diagnosticians of movement impairments and provide interventions to p...