SLAP Repairs and Posterior Shoulder Tightness
Over the past few weeks, I have had the opportunity to work with three patients, who underwent SLAP (Superior Labrum Anterior Posterior) repairs and were nine months out from surgery. All of these patients had been discharged from physical therapy yet were still having complaints of shoulder discomfort and tightness. Without fail, the one consistent finding that I documented in all three of these patients was unresolved posterior shoulder tightness. This is simply inexcusable! When one considers the body of research on labral pathology, the first item that a therapist should assess for is posterior shoulder tightness. A tight posterior shoulder has been linked to increased humeral head translation (Tyler et al 1999) as well as superior migration of the humeral head with arm elevation (Matsen & Arntz 1990). Left untreated, this may result in attenuation of the anterior capsule and shoulder impingement. To properly assess for posterior shoulder tightness, a therapist can look at the following items: 1) Glenohumeral internal rotation (IR) ROM at 90 degrees of abduction 2) The Tyler Test 3) Posterior glide of the glenohumeral joint. If muscle inflexibility is identified, then stretching the posterior shoulder elements is indicated and can be accomplished via a horizontal adduction and/or IR stretch . If there is restricted joint hypomobility, then a capsular contribution exists and may be treated with posterior glides of the glenohumeral joint. In either case, assessing for and treating unresolved posterior shoulder tightness is critical to engender optimal shoulder function.
Author: Christopher Johnson
5 Comments
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Comments
I bet the PTs that d/c these pts based on none functional criteria and never had a manual leading to functional treatment program. What did the doctor order?How many visits are covered? Not what can I do to help my pt fully recover.
Thanks for your comment re: this post Bruce. As you and I know, common problems commonly happen. So with labral tears, posterior shoulder tightness is a common impairment so we always need to make sure it’s addressed. Hope you are kickin it live in Miami.
Good commentary Chris. I am not sure why clinicians wouldn’t address the posterior capsule when there is such great documented evidence that patients have better outcomes when we mobilize it. And not only should we be mobilizing it, but the patient should stretch it and work on postural mechanics to create a posterior translation of the humeral head. My thoughts are that some PTs see SLAP repairs as having initial restrictions and are overly cautious when those restrictions are lifted. I am seeing a patient who had a SLAP repair in February, who saw 2 other clinicians prior to being referred to my facility, and got no manual therapy (except passive ROM) . We should be held accountable for knowing how to address these patients and if we don’t feel comfortable treating them, we need to refer to the proper PTs (I don’t treat hands and when I get a hand consult, I refer to a hand therapist. )
I think it is sad you do not feel comfortable treating hands but do other regions. In Miami most CHTs work for POPTS or kick back facilities and provide very low quality rehab. I love taking of these pts and find hand therapy very easy. The structures are easy aces sable and lighter to work as the PT. Hips and lumbar are hard physically as the operator bu this is how I made my practice!
What a great resource!