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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 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

3. 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.

4. 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

5. 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

6. 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

7. 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

8. 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

9. 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

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 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

12. 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

13. 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

14. Is the use of chlorhexidine contributing to increased resistance to chlorhexidine and/or antibiotics?

health care settings including acute care, residential aged care, paediatric, neonatal and primary care and rehabilitation as well as the laboratory setting. All forms of use of chlorhexidine in humans and all different exposures (dosage form, duration, stratification of exposure) across different settings. 1. ‘Chlorhexidine Resistance’ (with definition / measures used) to chlorhexidine established. 2. A specific intervention identified as contributing to resistance to Chlorhexidine in a specific (...) Population and setting Intervention Outcome Types of studies Qu. 2 All patients (isolates) / participants (isolates) including children and adults in different health care settings including acute care, residential aged care, paediatric, neonatal and primary care and rehabilitation as well as the laboratory setting All forms of use of chlorhexidine in humans and all different exposures (dosage form, duration, stratification of exposure) across different settings. 1. ‘Resistance against antibiotics

2018 National Health and Medical Research Council

15. Positioning Tests

down, their shoulders will be level with the end of the couch. Ask them to turn their head 45° towards the test ear. 6 6 An assumption is made that 45° places the posterior canal in the plane of maximal stimulation, and that then if the head is turned either more than 45° or less than 45° the sensitivity of the test may be significantly decreased. There is Recommended Procedure Positioning Tests BSA 2016 © BSA 2016 Page11 There are two possible test positions for the Dix-Hallpike test (...) : 185-9. Dix MR, Hallpike CS. The pathology, symptomatology and diagnosis of certain common disorders of the vestibular system. Proc Royal Soc Med 1952; 45: 341-54. Galgon AK. It’s time to consider other signs and tests to determine side of involvement in Horizontal Canal BPPV! Vestibular Rehabilitation Special Interest Group Newsletter: BPPV Special Edition, American Physical Therapy Association / Neurology Section 2012. Gans R, Harrington-Gans P. Treatment efficacy of benign paroxysmal positional

2016 British Society of Audiology

16. Acute Low Back Pain

Acute Low Back Pain 1 Quality Department Guidelines for Clinical Care Ambulatory Low Back Pain Guideline Team Team leader Anthony E. Chiodo, MD Physical Medicine & Rehabilitation Team members David J. Alvarez, DO Family Medicine Gregory P. Graziano, MD Orthopedic Surgery Andrew J. Haig, MD Physical Medicine & Rehabilitation R. Van Harrison, PhD Medical Education Paul Park, MD Neurosurgery Connie J. Standiford, MD General Internal Medicine Consultant Ronald A. Wasserman, MD Anesthesiology, Back (...) activity. • If pain worse: Consider changing/adding medications, increasing restrictions. • Physical therapy. If no improvement, at 1-2 weeks [IIA*] consider manual physical therapy (spinal manipulation). If at Risk: Chronic Disability Prevention (Table 2) • Patient education [IA*] • Minimize restrictions • Recommend aerobic activities such as walking, biking, swimming and core strengthening exercises (Appendix C) to rehabilitate and prevent recurrent low back pain. • At 2 weeks: If work disability

2011 University of Michigan Health System

17. Adolescent Idiopathic Scoliosis: Screening

in spinal curvature. Screening Tests Most screening tests for adolescent idiopathic scoliosis are noninvasive. Screening is usually done by visual inspection of the spine to look for asymmetry of the shoulders, shoulder blades, and hips. In the United States, the forward bend test is commonly used to screen for idiopathic scoliosis. First, a clinician visually inspects the spine of a patient while the patient is standing upright. Next, the patient stands with feet together and bends forward at the waist (...) and Rehabilitation Treatment recommends screening for idiopathic scoliosis through school-based programs, and that screening should be performed by clinicians who specialize in spinal deformities. Members of the U.S. Preventive Services Task Force The US Preventive Services Task Force (USPSTF) members include the following individuals: David C. Grossman, MD, MPH (Kaiser Permanente Washington Health Research Institute, Seattle); Susan J. Curry, PhD (University of Iowa, Iowa City); Douglas K. Owens, MD, MS

2018 U.S. Preventive Services Task Force

18. Management of stable angina

to prevent new vascular events 17 4.4 Medication concordance 18 5 Interventional cardiology and cardiac surgery 19 5.1 Coronary artery anatomy and definitions 19 5.2 Percutaneous coronary intervention 19 5.3 Coronary artery bypass grafting 21 5.4 Choice of revascularisation technique 23 5.5 Postintervention drug therapy 26 5.6 Postintervention rehabilitation 28 5.7 Managing restenosis 28 5.8 Managing refractory angina 28 6 Stable angina and non-cardiac surgery 30 6.1 Assessment prior to surgery 30 6.2 (...) recommended the following list of features to help characterise patient symptoms into typical, atypical and non-anginal pain. 16 Chest pain is: y a constricting discomfort in the front of the chest, or in the neck, shoulders, jaw, or arms y precipitated by physical exertion y relieved by rest or GTN within about five minutes. Typical angina – presence of all three features Atypical angina – presence of two of the three features Non-anginal pain – presence of one or none of the three features. 4 Management

2018 SIGN

19. Treatment of Pediatric Supracondylar Humerus Fractures

Children’s Rehabilitation Center 2270 Ivy Road Charlottsville VA 22903 Stuart Braun, MD 45 Linden Drive Cohasset, MA 02025 Matthew Bueche MD M & M Orthopaedics 1259 Rickert Drive Ste 101 Naperville Il 60540 Howard Epps, MD 7401 S. Main Houston TX 77030-4509 Harish Hosalkar MD Rady Children’s Hospital UCSD 3030 Children’s Way Suite 410 San Diego CA 92123 Charles T. Mehlman, DO, MPH Children's Hospital Medical Center 3333 Burnet Avenue, MLC 2017 Cincinnati, Ohio 45229-3039 Susan Scherl, MD 10506 Burt (...) estimated at 177.3 per 100,000. 1 BURDEN OF DISEASE There are many components to consider when calculating the overall cost of treatment for pediatric supracondylar fractures of the humerus. 2 The main considerations are the relative cost and effectiveness of each treatment option. However, hidden costs for pediatric patients must also be considered. These costs include the additional home care required for a patient, the costs of rehabilitation and of missed school for the patient, child care costs

2011 American Academy of Orthopaedic Surgeons

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