Clinical pearls

Clinical implications of past shoulder research, directly applicable in your practice from the next day!

  • From research to clinic: how do injury prevention programs work to decrease shoulder injuries in sports?
    Although we don’t know their real interaction, common risk factors for sportsrelated shoulder pain have been described, such as range of motion deficits, mainly into internal rotation (IR), external rotator ER) strength deficits, scapular dysfunction, but also a lack of core stability, hip stability and mobility.  (Clarsen et al. BJSM 2014, Chalmers et al. Sports […]
  • Return to sports after shoulder injury: progressive performance training
    During the RTP phase of rehabilitation, the practitioner must balance 2 conflicting components, on one hand the knowledge that premature RTP increases the risk for re-injury and on the other hand that the player as well as the team desire return to participation as quickly as possible. Combining evidence with clinical expertise, the clinician plans […]
  • Gentle exercises for Parsonage Turner
    Parsonage-Turner syndrome (PTS) is an uncommon neurological disorder characterized by rapid and idiopathic onset of severe pain in the shoulder and arm. It involves mainly the plexus brachialis and/or the n. thoracicus longus or accessorius. Often the patient reports getting up in the morning with a painful arm and a substantial scapular malpositioning (“I felt […]
  • Message in a physio-bottle: what can we tell our patients and more importantly, how?
    Efficient communication with patients is challenging but crucial in our shared pathway through rehabilitation. There is a great body of evidence highlighting the importance of acknowledging the psycho-social and emotional context of the patient (De Baets et al. 2019), efficient communication (Bukstein et al. 2016),  shared decision making, and patient centered approach (Wijma et al. […]
  • Gentle progression of closed chain shoulder exercises: which variables to consider?
    Closed chain exercises (where the hand is supported on a moveable or fixed surface) are considered to be safe in the early stages of rehab in patients with shoulder instability, and are supposed to increase proprioceptive quality and neuromuscular control. Many variables determine the level of difficulty of these exercises, such as the body weight […]
  • Measuring shoulder range of motion and strength: why, what and how?
    In our decision-making regarding return to sports after an injury, we try as much as possible to have objective criteria that are measurable and based on scientific evidence. A science-based RTS model for overhead athletes after a shoulder injury is still lacking, however at the level of ROM and strength, 2 major components of shoulder […]
  • Exercises for biceps related pathology: from low over moderate to high load
    During the rehabilitation of biceps related pathology, such as tenosynovitis, SLAP lesions, or postoperative treatment after a biceps tenodesis or tenotomy, we have to take into account biceps load during the different stages of the rehabilitation. During the protective phase, or the phase of high irritability, minimal load should be put on the biceps, whereas […]
  • Frozen shoulder: towards a new name and a more tailored approach
    Frozen shoulder is a common shoulder disorder, characterized by gradual decrease of range of motion (ROM) in the glenohumeral joint, accompanied by increasing pain. In spite of many investigations, the origin and mechanism are still poorly understood. Multiple labels have been attributed to this condition, from “adhesive capsulitis”, over “waste can diagnosis” to the more […]
  • Clinical examination of the shoulder: time to change direction from diagnosing the structural diagnosis towards symptom modification tests.
    The purpose of the physical examination of a patient with shoulder pain is multifactorial. The clinician seeks information about tissue irritability, pain mechanisms, activity and participation limits, the patient’s expectations and goals etc…During the clinical examination, one of the purposes it to examine possible underlying biomechanical factors causing or perpetuating the current movement limitations and/or […]
  • Exercise Therapy in the non-operative treatment of degenerative rotator cuff tears: which exercises should we prescribe?
    Recent studies have shown that patients with degenerative rotator cuff (RC) tears have similar good results from an exercise program compared to surgical intervention (Jeanfavre M et al. IJSPT 2018). In the conservative treatment of RC tears, it is advised to use function-based rather than structure-based exercises. In other words it is much more important […]
  • How to avoid pectoralis minor activity during exercises?
    Patients with shoulder pain often exhibit hyperactivity in the muscles surrounding the scapula. In particular, the pectoralis minor seems to be prone to hyperactivity or tension related to shoulder dysfunction. (Castelein et al. Manual Therapy 2016). In case a patient with shoulder disorders shows a dysfunction in the scapular muscles, it is important to restore […]

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