Table Of ContentPhysical Therapy of the Shoulder
FIFTH EDITION
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Physical Therapy of the Shoulder
FIFTH EDITION
Edited by
Robert A. Donatelli, PhD, PT, OCS
National Director of Sports Rehabilitation
Physiotherapy Associates
Las Vegas, Nevada
3251 Riverport Lane
St. Louis, Missouri 63043
PHYSICAL THERAPY OF THE SHOULDER, FIFTH EDITION ISBN: 978-1-4377-0740-3
Copyright # 2012, 2004, 1997, 1991, 1987 by Churchill Livingstone, an imprint of Elsevier Inc.
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Notices
Knowledge and best practice in this field are constantly changing. As new research and experience broaden our
understanding, changes in research methods, professional practices, or medical treatment may become necessary.
Practitioners and researchers must always rely on their own experience and knowledge in evaluating and using
any information, methods, compounds, or experiments described herein. In using such information or methods
they should be mindful of their own safety and the safety of others, including parties for whom they have a
professional responsibility.
With respect to any drug or pharmaceutical products identified, readers are advised to check the most current
information provided (i) on procedures featured or (ii) by the manufacturer of each product to be administered,
to verify the recommended dose or formula, the method and duration of administration, and contraindications.
It is the responsibility of practitioners, relying on their own experience and knowledge of their patients, to make
diagnoses, to determine dosages and the best treatment for each individual patient, and to take all appropriate
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Library of Congress Cataloging-in-Publication Data
Physical therapy of the shoulder / edited by Robert A. Donatelli. – 5th ed.
p. ; cm.
Includes bibliographical references and index.
ISBN 978-1-4377-0740-3 (hard copy)
1. Shoulder–Wounds and injuries. 2. Shoulder–Wounds and injuries–Treatment. 3. Shoulder–Wounds
and injuries–Physical therapy. I. Donatelli, Robert. II. Title.
[DNLM: 1. Shoulder–injuries. 2. Shoulder Joint–injuries. 3. Physical Therapy Modalities. WE 810]
RD557.5.P48 2011
617.5’72044–dc22
2011001297
Executive Editor: Kathy Falk
Developmental Editor: Megan Fennell
US/Chennai Publishing Services Managers: Julie Eddy and Rajendrababu Hemamalini
US/Chennai Project Managers: Celeste Clingan and Srikumar Narayanan
Designer: Jessica Williams
Printed in United States of America
Last digit is the print number: 9 8 7 6 5 4 3 2 1
Dedication
I would like to dedicate this book to my family—my wife Georgi Donatelli, my son,
Robby, and my daughters, Briana and Rachel. They have added a new meaning of love,
joy and happiness to my life.
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Contributors
RANDA A. BASCHARON, DO, AT XAVIER A. DURALDE, MD
Owner, President, Orthopedic and Sports Medicine Peachtree Orthopedics Clinic, Assistant Clinical Professor
Institute Of Las Vegas, Sports Performance Institute of of Orthopedic Surgery, Clinical Instructor, Emory University
Las Vegas, Las Vegas, Nevada School of Medicine, Atlanta, Georgia
MOLLIE BEYERS, DPT RICHARD A. EKSTROM, PT, DSC, MS
Physical Therapist, Biomax Rehabilitation, Effingham, Professor, Department of Physical Therapy, University of
Illinois South Dakota, Vermillion, South Dakota
PETER BONUTTI, MD, FACS, FAAOS, FAANA TODD S. ELLENBECKER, DPT, MS, SCS, OCS, CSCS
Founder and Director, Bonutti Clinic, Founder and Clinic Director, Physiotherapy Associates Scottsdale Sports
Director, Bonutti Technology, Effingham, Illinois, Assistant Clinic, National Director of Clinical Research, Physiotherapy
Clinical Professor, Department of Orthopedic Surgery, Associates, Director of Sports Medicine, ATP World Tour,
University of Arkansas, Fayetteville, Arkansas Scottsdale, Arizona
KENJI C. CARP, MPT, OCS, ATC ROBERT L. ELVEY, BAPPSC, GRAD. DIP. MANIP. THER.
Certified Vestibular Therapist, Director, Owner, Senior Lecturer, Curkin University, Physiotherapy
Cooperative Performance and Rehabilitation, Eugene, Consultant, Southcare Physiotherapy, Perth, Australia
Oregon
KATHLEEN GEIST, PT, DPT, OCS, COMT
JEFF COOPER, MS, ATC Assistant Professor, Division of Physical Therapy,
Athletic Training Solutions, Wilmington, Delaware, Department of Rehabilitation Medicine, Emory University
Consultant, Player Development, Philadelphia Phillies, School of Medicine, Atlanta, Georgia
Philadelphia, Pennsylvania
JOHN C. GRAY, DPT, OCS, FAAOMPT
DONN DIMOND, PT, OCS Lead Clinical Specialist, Department of Physical
Director of Clinical Operations, Owner, The KOR Physical Therapy, Sharp Rees-Stealy, Clinical Instructor, Ola
Therapy, Portland, Oregon Grimsby Institute, Credentialed Clinical Instructor,
American Physical Therapy Association, Associate Editor,
JAN DOMMERHOLT Journal of Manual and Manipulative Therapy, San Diego,
President and Physical Therapist, Bethesda Physiocare, California
Inc/Myopain Seminars, LLC, Bethesda, Maryland
BRUCE H. GREENFIELD, PT, PHD, OCS
PHILLIP B. DONLEY, PT ATC MS Assistant Professor, Department of Rehabilitation, Center
Optimum Physical Therapy, West Chester, Pennsylvania for Ethics, Emory University, Atlanta, Georgia
viii Contributors
OLA GRIMSBY, PT DOUGLAS M. MURRAY, MD
Chairman of the Board, Ola Grimsby Institute, San Diego, Surgeon, Peachtree Orthopedic Clinic, Consulting
California Physician, Shepherd Center, Atlanta, Georgia
TOBY M. HALL, PHD, MSC, POST GRAD DIP MANIP THER,
ROY W. OSBORN, PT, MS, OCS
ASSOC IN PHYSIOTHERAPY
Associate Professor, Physical Therapist, Physical Therapy
Director Manual Concepts, Perth, Australia, Adjunct
Department, Avera McKennan Hospital and University
Senior Teaching Fellow, School of Physiotherapy, Curtin
Health System, Sioux Falls, South Dakota
Innovation Health Research Institute, Curtin University of
Technology, Bentley, Australia, Senior Teaching Fellow, The
University of Western Australia, Perth, Australia, Director JAIME C. PAZ, PT, DPT, MS
Manual Concepts, Perth, Australia Clinical Associate Professor, Division of Physical Therapy,
Walsh University, North Canton, Ohio
{
SCOT IRWIN, DPT, CCS
Formerly, Associate Professor, Department of Physical
SCOTT D. PENNINGTON, MD
Therapy, North Georgia College and State University,
Surgeon, Peachtree Orthopedic Clinic, Atlanta, Georgia
Dahlonega, Georgia
ROBERT C. MANSKE, PT, DPT, SCS, MED, ATC, CSCSC VIJAY B. VAD, MD
Associate Professor, Department of Physical Therapy, Assistant Professor of Rehabilitation Medicine, Hospital
Wichita State University, Wichita, Kansas for Special Surgery, New York, New York
JOHNSON MCEVOY, PT, BSC, MSC, DPT, MISCP, MCSP
JOSEPH S. WILKES, MD
Chartered Physiotherapist in Private Practice, United
Clinical Associate Professor, Orthopedics, Emory
Physiotherapy Clinic, Limerick, Ireland, Head
University, Active Staff Member, Piedmont Hospital,
Physiotherapist, Irish Boxing High Performance Team,
Specialty Consulting, Crawford Long Hospital, Atlanta,
Dublin, Ireland, External Lecturer, Sports Science, University
Georgia, Active Staff Member, Fayette Community Hospital,
of Limerick, Limerick, Ireland
Fayetteville, Georgia
CRAIG D. MORGAN, MD
Clinical Professor, University of Pennsylvania, Department MICHAEL S. ZAZZALI, DSC, PT, OCS
of Orthopaedics, Philadelphia, Pennsylvania, Morgan Kalman Co-Director and Partner, Physical Therapy Associates of
Clinic, Wilmington, Delaware New York, New York, New York
{
Deceased.
Preface
The first edition of Physical Therapy of the Shoulder was pub- Part 2, Neurologic Considerations, has been updated with
lished in 1987, and now we are publishing the fifth edition new information and references. John C. Gray and Ola Grimsby’s
nearly 25 years later. I would like to thank my readers for chapter, Interrelationship of the Spine, Rib Cage, and Shoulder,
their support throughout the years that has made this book along with Neural Tension Testing by Tobby Hall and Bob
successful. The fifth edition has kept up with the tradition Elvy have been revised, and Bruce H. Greenfield and Kathleen
of Physical Therapy evidence-based practice. It is amazing Geist did a great job updating the chapter on Evaluation and
how the literature now has developed our profession from Treatment of Brachial Plexus Lesions. A new chapter, Sensory
and art to a science. Each chapter is a excellent example of Integration and Neuromuscular Control of the Shoulder by
how the science of Physical Therapy continues to grow. Kenji Carp has been added to the neurological section. I think
The shoulder joint is a complicated structure consisting of you will find that Kenji did an excellent job on defining
three synovial joints, the scapula thoracic articulation, and 17 neuromuscular control in the upper limb. The chapter is an
muscles. The shoulder complex hangs off the rib cage and is excellent representation of state of the art information that is
connected to the cervical and thoracic spine. The complexity of critical to the rehabilitation of shoulder patients.
the shoulder makes many rehabilitation students and clinicians Part 3, Special Considerations, was highlighted by the
uncertain in assessing shoulder pathomechanics and in establish- separation of Chapter 10 into two chapters, Impingement
ing treatment approaches for different shoulder pathologies. Syndrome and Shoulder Instabilities. Bruce Greenfield did
In keeping up to date with new and innovative treatment an excellent job on describing the mechanisms of impinge-
techniques, surgical procedures, and evaluation methods for ment and the new chapter, on shoulder instabilities, by
the shoulder, this fifth edition of Physical Therapy of the Shoulder Michael Zazzali, focused on the conservative approach to the
has been updated appropriately. There are 7 new chapters and evaluation and treatment of shoulder instabilities. The Frozen
8 new authors. The fifth edition is once again divided into five Shoulder chapter was update by Mollie Beyers and Peter
parts; Mechanics of Movement and Evaluation, Neurologic Bonutti. This chapter provides an excellent summary of the
Considerations, Special Considerations, Treatment Approaches, evidence-based research on treatment of frozen shoulder
and Surgical Considerations. pathology. John C. Gray’s chapter on Visceral Referred Pain
In honor of the memory of the late Scot Irwin, Jaime Paz to the Shoulder, was rewritten, along with important updates
helped to revise the Guide to Physical Therapist Practice. from Todd S. Ellenbecker on rotator cuff pathology.
The chapter is an overview of the Guide. Chapter 2 was In the Treatment Approaches Section, Richard A. Ekstrom
updated with new anatomic and biomechanical information and Roy W. Osborn did an excellent job on adding addition
on how the shoulder moves. Chapter 3 was rewritten by Jeff research on Muscle Length Testing and Electromyographic
Cooper with all the new information on the throwing injuries Evidence for Manual Strength Testing and Exercises for the
to the shoulder. Jeff has included new research data that he Shoulder. The Manual Therapy Techniques was updated with
has collected over the past several years on professional baseball additional illustrations of new manual procedures for the
pitchers. His approach to evaluation and treatment is state shoulder, with a section on evidence-based manual therapy
of the art. Chapter 4 is a new chapter by Donn Dimond treatment approaches. The treatment section was highlighted
that finishes the first section with updates on all the new- by one of two new chapters by Donn Dimond on strength
evidenced-based special tests for the shoulder. The special tests training in the shoulder. As previously noted the shoulder
on the shoulder greatly assist the clinician in the development has 17 muscle that allow it to move in multiple planes.
of a differential soft tissue diagnosis. In addition, manual Therefore this chapter is long awaited as the strength of
muscle testing to isolate the shoulder muscles is illustrated. the shoulder muscles is critical to the overall function. Finally,
