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Shoulder Rehabilitation

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1. Shoulder Conditions Diagnosis and Treatment Guideline

as an educational resource for health care providers who treat injured workers in the Washington workers’ compensation system under Title 51 RCW and as review criteria for the department’s utilization review team to help ensure treatment of shoulder injuries is of the highest quality. The emphasis is on accurate diagnosis and treatment that is curative or rehabilitative (see WAC 296-20-01002 for definitions). This guideline, focusing on work-related shoulder conditions, was developed in 2013 by a subcommittee (...) case series [46-52] . It does not, however, remedy the underlying imbalance of forces that act on the humeral head caused by an irreparable rotator cuff tear. Thus, the usefulness of superior capsular reconstruction is as a salvage procedure that, with post-operative shoulder rehabilitation, may result in a more functional shoulder. If considering an SCR procedure for an injured worker who meets surgical criteria, L&I recommends that the procedure be performed within the framework of a clinical

2018 Washington State Department of Labor and Industries

2. Shoulder Adhesive Capsulitis Decision Tree and Components

and treatment decision making for rehabilitation. For example, elevated scores on the Tampa Scale of Kinesiophobia or the Fear-Avoidance Beliefs Questionnaire have been associated with a longer recovery, chronic symptoms, and work loss in patients with shoulder pain. 42,59,79 Accordingly, identifying cognitive behavioral tendencies during the patient’s evalua- tion can direct the therapist to employ specific patient edu - cation strategies to optimize patient outcomes to physical therapy interventions (...) Shoulder Adhesive Capsulitis Decision Tree and Components Adhesive Capsulitis: Clinical Practice Guidelines Evaluation/Intervention Component 1: medical screening Evaluation/Intervention Component 2: dierential evaluation of clinical ?ndings suggestive of musculoskeletal impairments of body functioning (ICF) and the associated tissue pathology/disease (ICD) Shoulder pain and mobility de?cits/ adhesive capsulitis Rule in if: • Patient’s age is between 40 and 65 years • Patient reports a gr adual

2017 The Orthopaedic Section of the American Physical Therapy Association (APTA), Inc.

3. Shoulder Pain - Atraumatic

still provides an excellent method to assess repair integrity, as well as potential complications following surgery and during rehabilitation. The ability to perform provocative maneuvers can further demonstrate abnormalities that other forms of imaging would be incapable of performing. Nuclear Medicine Nuclear medicine studies are not routinely used in the evaluation of pain after rotator cuff repair. Variant 8: Atraumatic shoulder pain. Neurogenic pain (excluding plexopathy). Initial imaging (...) Shoulder Pain - Atraumatic New 2018 ACR Appropriateness Criteria ® 1 Shoulder Pain–Atraumatic American College of Radiology ACR Appropriateness Criteria ® Shoulder Pain–Atraumatic Variant 1: Atraumatic shoulder pain. Initial imaging. Procedure Appropriateness Category Relative Radiation Level Radiography shoulder Usually Appropriate ? CT arthrography shoulder Usually Not Appropriate ???? CT shoulder with IV contrast Usually Not Appropriate ??? CT shoulder without and with IV contrast Usually

2018 American College of Radiology

4. Shoulder Pain and Mobility Deficits: Adhesive Capsulitis

outcome scores on the simple shoulder test (SST) and the DASH, but pain with activity rat- ing did correlate with functional loss. Diabetes mellitus and male gender were related to worse ROM outcomes. Seven percent of the patients were eventually treated with manipu- lation under anesthesia and/or capsular release. A history of prior rehabilitation and workers’ compensation or pending litigation was associated with being treated with manipula- tion and/or capsular release. Shaffer et al 119 (...) therapy cal conditions, clinicians should screen for the presence of psychosocial issues that may affect prognostication and treatment decision making for rehabilitation. For example, elevated scores on the Tampa Scale of Kinesiophobia or the Fear-Avoidance Beliefs Questionnaire have been associated with a longer recovery, chronic symptoms, and work loss in patients with shoulder pain. 42,59,79 Accordingly, identifying cognitive behavioral tendencies during the patient’s evalua- tion can direct

2013 The Orthopaedic Section of the American Physical Therapy Association (APTA), Inc.

5. Shoulder Conditions Diagnosis and Treatment Guideline

workers in the Washington workers’ compensation system under Title 51 RCW and as review criteria for the department’s utilization review team to help ensure treatment of shoulder injuries is of the highest quality. The emphasis is on accurate diagnosis and treatment that is curative or rehabilitative (see WAC 296-20-01002 for definitions). This guideline, focusing on work-related shoulder conditions, was developed in 2013 by a subcommittee of the statutory Industrial Insurance Medical Advisory (...) work require modifications in position, force, repetitions, and/or duration. Those workers returning to jobs with heavy lifting or prolonged overhead work may need additional weeks of rehabilitation to regain full strength. 19 VII. SPECIFIC SHOULDER TEST Specific shoulder tests Rotator cuff impingement ? Neer’s test assesses for possible rotator cuff impingement. Stabilize the scapula (place your hand firmly upon the acromion, or hold the inferior angle of the scapula with your hand

2013 Washington State Department of Labor and Industries

6. Shoulder pain

a short time off work, for example, one week, if there appears to be a direct link between this and the shoulder pain. Advise rest from activities that worsen the shoulder pain for a few weeks, such as sport, and if relevant, advise 'light duties' at work for a few weeks. Explain that although common shoulder problems tend to be self-limiting, the rehabilitation period can be at least 6 months. Consider reviewing the person in 2 weeks. If symptoms are severe, arrange an earlier review. Advise (...) Shoulder pain Shoulder pain - NICE CKS Share Shoulder pain: Summary Causes of pain arising from the shoulder include: Rotator cuff disorders. Frozen shoulder. Instability disorders. Acromioclavicular joint disorders. Glenohumeral joint osteoarthritis. Inflammatory arthritis Septic arthritis Causes of pain which arise from elsewhere include: Malignancy Referred pain from the neck, heart or lungs. Polymyalgia rheumatica Assessment of a person with shoulder pain involves taking a history

2017 NICE Clinical Knowledge Summaries

7. Prosthetic and Amputee Rehabilitation - Standards and Guidelines (3rd Edition)

Prosthetic and Amputee Rehabilitation - Standards and Guidelines (3rd Edition) Amputee and Prosthetic Rehabilitation – Standards and Guidelines (3 rd Edition) A Report of the Working Party of the British Society of Rehabilitation Medicine Published by the British Society of Rehabilitation Medicine in 2018 Amputee and Prosthetic Rehabilitation – Standards and Guidelines (3 rd Edition) A Report of the Working Party of the British Society of Rehabilitation Medicine Co-Chairs: Professor Rajiv (...) Hanspal & Dr Imad Sedki Published by the British Society of Rehabilitation Medicine 2018 (registered charity number 293196) The British Society of Rehabilitation Medicine (BSRM) is the society which represents the specialty of Rehabilitation Medicine. It promotes an understanding of the specialty through education and the development of clinical guidelines and standards. Membership is open to all registered medical practitioners interested and concerned with its objectives. Further information

2018 British Society of Rehabilitation Medicine

8. The Management of Upper Extremity Amputation Rehabilitation (UEAR)

81 Appendix B: Summary of Assessments and Interventions in Rehabilitation Phases 98 Appendix C: Outcome Measures 107 Appendix D: Essential Elements of the Annual Contact 114 Appendix E: Activities of Daily Living 115 Appendix F: Advantages and Disadvantages of Prostheses 120 Appendix G: Surgical Considerations 121 Partial Hand Amputation 121 Wrist Disarticulation Amputation 121 Transradial Amputation 122 Elbow Disarticulation Amputation 122 Transhumeral Amputation 122 Shoulder Disarticulation (...) The Management of Upper Extremity Amputation Rehabilitation (UEAR) VA/DoD CLINICAL PRACTICE GUIDELINE FOR THE MANAGEMENT OF UPPER EXTREMITY AMPUTATION REHABILITATION Department of Veterans Affairs Department of Defense QUALIFYING STATEMENTS The Department of Veterans Affairs and the Department of Defense guidelines are based upon the best information available at the time of publication. They are designed to provide information and assist decision making. They are not intended to define

2014 VA/DoD Clinical Practice Guidelines

9. AHA/ASA Guidelines for Adult Stroke Rehabilitation and Recovery

tendon and supraspinatus. Hemiplegic shoulder pain is multifactorial. Pain is associated with shoulder tissue injury, abnormal joint mechanics, and central nociceptive hypersensitivity. About one third of patients with acute stroke have abnormal ultrasound findings in the hemiplegic shoulder when studied at the time of admission to acute inpatient rehabilitation, including effusion in biceps tendon or subacromial bursa; tendinopathy of biceps, supraspinatus, or subscapularis; and rotator cuff tear (...) . , Such findings are more prevalent in the hemiplegic shoulder than in the nonhemiplegic shoulder and in those with more severe hemiplegia, subluxation, spasticity, limited joint range, and shoulder pain. The frequency of abnormal ultrasound findings in the hemiplegic shoulder increases over the course of rehabilitation in patients with more severe motor impairment. , Although there is an association between abnormal findings on shoulder ultrasound and hemiplegic shoulder pain in patients with acute stroke

2016 American Heart Association

10. Guidelines for adult stroke rehabilitation and recovery

Guidelines for adult stroke rehabilitation and recovery e1 Purpose—The aim of this guideline is to provide a synopsis of best clinical practices in the rehabilitative care of adults recovering from stroke. Methods—Writing group members were nominated by the committee chair on the basis of their previous work in relevant topic areas and were approved by the American Heart Association (AHA) Stroke Council’s Scientific Statement Oversight Committee and the AHA’s Manuscript Oversight Committee (...) Committee review before consideration and approval by the AHA Science Advisory and Coordinating Committee. Results—Stroke rehabilitation requires a sustained and coordinated effort from a large team, including the patient and his or her goals, family and friends, other caregivers (eg, personal care attendants), physicians, nurses, physical and occupational therapists, speech-language pathologists, recreation therapists, psychologists, nutritionists, social workers, and others. Communication

2016 American Academy of Neurology

11. Management of Stroke Rehabilitation

Management of Stroke Rehabilitation VA/DoD CLINICAL PRACTICE GUIDELINE FOR THE MANAGEMENT OF STROKE REHABILITATION Department of Veterans Affairs Department of Defense And The American Hea rt Association/ American Stroke Association Prepared by: THE MANAGEMENT OF STROKE REHABILITATION Working Group With support from: The Office of Quality and Performance, VA, Washington, DC & Quality Management Division, United States Army MEDCOM QUALIFYING STATEMENTS The Department of Veterans Affairs (VA (...) , and limitations unique to an institution or type of practice. Every healthcare professional making use of these guidelines is responsible for evaluating the appropriateness of applying them in any particular clinical situation. Version 2.0 2010 TABLE OF CONTENTS INTRODUCTION 2 Guideline Update Working Group Participants 7 Key Points 8 Outcome Measures 8 THE PROVISION OF REHABILITATION CARE Algorithm 12 Annotations 15 Rehabilitation Interventions 69 APPENDICES Appendix A: Guideline Development Process 112

2010 VA/DoD Clinical Practice Guidelines

12. Stroke rehabilitation in adults

recommendations 32 2.1 Upper limb electrical stimulation 32 2.2 Intensive rehabilitation after stroke 32 2.3 Neuropsychological therapies 33 2.4 Shoulder pain 33 3 Other information 35 3.1 Scope and how this guideline was developed 35 3.2 Related NICE guidance 35 4 The Guideline Development Group, National Collaborating Centre and NICE project team 37 4.1 Guideline Development Group 37 4.2 National Clinical Guideline Centre 38 4.3 NICE project team 39 About this guideline 41 Strength of recommendations 41 (...) to the shoulder if they are at risk of developing shoulder pain (for example, if they have upper limb weakness and spasticity). 1.9.21 Manage shoulder pain after stroke using appropriate positioning and other treatments according to each person's need. Stroke rehabilitation in adults (CG162) © NICE 2019. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and- conditions#notice-of-rights). Page 27 of 431.9.22 For guidance on managing neuropathic pain follow Neuropathic pain (NICE

2013 National Institute for Health and Clinical Excellence - Clinical Guidelines

13. Management of patients with stroke: rehabilitation, prevention and management of complications, and discharge planning

General rehabilitation principles 12 4.2 Gait, balance and mobility 15 4.3 Upper limb function 19 4.4 Cognition 22 4.5 Visual problems 23 4.6 Communication 25 4.7 Nutrition and swallowing 26 4.8 Continence 29 4.9 Post-stroke spasticity 31 4.10 Prevention and treatment of shoulder subluxation 34 4.11 Pain 35 4.12 Prevention of post-stroke shoulder pain 36 4.13 Treatment of post-stroke shoulder pain 39 4.14 Post-stroke fatigue 42 4.15 Disturbances of mood and emotional behaviour 43 4.16 Sexuality 46 (...) ? Recurrent stroke ? Shoulder pain ? Shoulder subluxation ? Spasticity ? Venous thromboembolism 4.1 Gene Ral Rehabilitation PRin CiPles 4.1.1 SUMMARy OF RECOMMENDATIONS Recommended ? early mobilisation ? therapeutic positioning ? personal ADL training1 + 1 ++ 3 2 + 2 + 13 4.1.2 EARLy MObILISATION A number of post-stroke complications are associated with immobility. In the systematic review of stroke unit trials, there was a high degree of consistency in the reporting of policies of early mobilisation

2010 SIGN

14. Management of Stroke Rehabilitation

Management of Stroke Rehabilitation VA/DoD CLINICAL PRACTICE GUIDELINE FOR THE MANAGEMENT OF STROKE REHABILITATION Department of Veterans Affairs Department of Defense QUALIFYING STATEMENTS The Department of Veterans Affairs and the Department of Defense guidelines are based upon the best information available at the time of publication. They are designed to provide information and assist decision making. They are not intended to define a standard of care and should not be construed as one (...) and/or therapeutic interventions within these guidelines does not guarantee coverage of civilian sector care. Additional information on current TRICARE benefits may be found at www.tricare.mil or by contacting your regional TRICARE Managed Care Support Contractor. Version 4.0 – 2019VA/DoD Clinical Practice Guideline for the Management of Stroke Rehabilitation July 2019 Page 2 of 170 Prepared by: The Management of Stroke Rehabilitation Work Group With support from: The Office of Quality, Safety and Value, VA

2019 VA/DoD Clinical Practice Guidelines

15. Achilles Pain, Stiffness, and Muscle Power Deficits; Midportion Achilles Tendinopathy Revision

and function and soft tissue mobilization to increase range of motion for patients with midportion Achilles tendinopathy. INTERVENTIONS – PATIENT EDUCATION: ACTIVITY MODIFICATION B For patients with nonacute midportion Achilles tendinopathy, clinicians should advise that complete rest is not indicated and that they should continue with their recreational activity within their pain tolerance while participating in rehabilitation. INTERVENTIONS – PATIENT COUNSELING E Clinicians may counsel patients (...) recommendations to support evidence-based practice. The authors of this guideline revision worked with the CPG Editors and medical librarians for methodological guidance. The research librarians were chosen for their expertise in systematic review and rehabilitation literature search and to perform systematic searches for concepts associated with classification, examination, and intervention strategies for Achilles Pain, Stiffness, and Muscle Power Deficits: Midpor - tion Achilles Tendinopathy. 22 Briefly

2018 The Orthopaedic Section of the American Physical Therapy Association (APTA), Inc.

16. All-Terrain Vehicle Injuries, Prevention of

protective equipment on injury severity and none studying any possible effect independent of helmet use. [ ],[ ] There was one pediatric and one adult study including drivers and riders in both organized sport and recreational environments with contradictory results (Table 3). Protective equipment including vests, boots, shin guards, and pads for the shoulders, knees, and elbows are currently marketed for ATV riders. No study could be found which only separated helmets from other protective gear; however (...) of change between the two time periods. McBride et al. [ ] furthered investigated the outcomes of ATV legislation in North Carolina by comparing a larger time period (2003–2008), and found that children without helmets were five times more likely to have a head or neck injury ( p = 0.01). Passengers were five times more likely to die or require discharge to a rehabilitation facility ( p = 0.03) and 13 times more likely to suffer a head and neck injury ( p < 0.01) when compared to drivers. The authors

2018 Eastern Association for the Surgery of Trauma

17. Perineal care

of anal sphincter defect (e.g. defect > 30 degrees) o Low anorectal manometric pressures (e.g. incremental squeeze pressure 4 kg · OP position · Instrumental birth · Shoulder dystocia · Prolonged second stage · Midline episiotomy · Previous OASIS Woman elects vaginal birth? Elective CS Yes Yes No No Yes *Experienced clinician: The clinician best able to provide the required clinical care in the context of the clinical circumstances and local and HHS resources and structure. May include clinicians (...) and pelvic floor muscles. Pelvic floor muscle training A program of exercises used to rehabilitate the function of the pelvic floor muscles. Perineal injury Includes perineal soft tissue damage, tearing and episiotomy. Perineal tears Includes perineal tearing but not injury such as bruising, swelling, surgical incision (episiotomy). Reinfibulation Procedure to narrow the vaginal opening in a woman after she has been deinfibulated; also known as re-suturing. 1 Restrictive use episiotomy Where episiotomy

2018 Queensland Health

18. Carpal Tunnel Syndrome (CTS) Guideline

. Buschbacher, R., Median nerve motor conduction to the abductor pollicis brevis. American journal of physical medicine & rehabilitation/Association of Academic Physiatrists, 1999. 78(6 Suppl): p. S1. 12. Sander, H.W., et al., Median and ulnar palm-wrist studies. Clinical neurophysiology, 1999. 110(8): p. 1462-1465. 13. Grossart, E.A., N.D. Prahlow, and R.M. Buschbacher, Acceptable differences in sensory and motor latencies between the median and ulnar nerves. Journal of long-term effects of medical (...) implants, 2006. 16(5). 14. Berkson, A., J. Lohman, and R.M. Buschbacher, Comparison of median and radial sensory studies to the thumb. Journal of long-term effects of medical implants, 2006. 16(5). 15. Robinson, L.R., P.J. Micklesen, and L. Wang, Strategies for analyzing nerve conduction data: superiority of a summary index over single tests. Muscle & nerve, 1998. 21(9): p. 1166-1171. 16. Robinson, L.R., Electrodiagnosis of carpal tunnel syndrome. Physical medicine and rehabilitation clinics of North

2017 Washington State Department of Labor and Industries

20. AIM Clinical Appropriateness Guidelines for Joint Surgery

AIM Clinical Appropriateness Guidelines for Joint Surgery Appropriate.Safe.Affordable © 2017 AIM Specialty Health 2062-0617 v.1 Joint Surgery Guidelines Musculoskeletal Program Joint Surgery EFFECTIVE NOVEMBER 1, 2017 LAST REVIEWED JULY 17, 2017 Copyright © 2017. AIM Specialty Health. All Rights Reserved. Joint Surgery 2 Table of Contents Description and Application of the Guidelines 4 Shoulder Arthroplasty 5 Description & Scope 5 General Requirements and Documentation 5 Indications (...) and Criteria 7 Contraindications 8 Exclusions 8 Selected References 9 CPT Codes 9 Shoulder Arthroscopy and Open Procedures 10 Description 10 General requirements 10 Indications and Criteria 11 Selected References 16 CPT Codes 16 Hip Arthroplasty 18 Description & Scope 18 General Requirements and Documentation 18 Indications and Criteria 20 Contraindications 20 Selected References 21 CPT Codes 21 Appendix 22 Hip Arthroscopy 23 Description 23 General requirements 23 Indications 24 Exclusions 25 Selected

2017 AIM Specialty Health

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