Sports Injuries of the Shoulder – Conservative Management

In the preface of this new textbook, editor and primary author Thomas Souza states, whereas the 1980s was the decade of the knee, the 1990s is the decade of the shoulder.” Recently published textbooks (ie, The Shoulder, by Andrews and Wilk) and journal articles, along with increasing numbers of continuing education courses on the shoulder, would seem to lend credence to this statement. Souza, a chiropractor, enlists a cross-section of clinical specialists (orthopedic surgery, physical therapy, athletic train-radiology, and chiropractic) to provide a clinical guide to those practitioners treating shoulder dysfunction. The text aims to synthesize current information regarding conservative (nonsurgical) management of sports-related injuries. Souza achieves this goal by producing a fairly comprehensive, well-written text that has applications for all health care professions.

The 20 chapters (14 written by the author) are divided into five sections: functional anatomy and biomechanics; history and physical examination; radiographic and special imaging specific disorders and treatment, rehabilitation, and preventions. The first 2 chapters on anatomy and general biomechanics are well written and illustrated. The chapter on the shoulder in throwing sports adequately, if not exhaustively, covers the mechanics of throwing. Other sports such as tennis an golf are also included in this chapter. The topics of swimming and weight training are given separate chapters that detail proper technique and the most frequent pitfalls in training. Another great resource regarding the shoulder and reviews of various recovery aides like braces, slings, and immobilizers can be found at http://sprainedshoulder.org 

Special mention should be made of the chapter on positional examination, as it provides an efficient model and rationale for the physical examination. Also included in the section on history and physical examination is a chapter on isokinetic testing and exercise. in addition to providing testing protocols, treatment principles, and an extensive reference list, the authors give normative muscle performance data for a variety of athletic populations.

Of the chapters containing information on diagnostic imaging, the magnetic resonance imaging (MRI) chapter may be most beneficial to physical therapists. Along with a brief anatomy overview, the authors list specific benefits and potential pitfalls of (MRI) in a clear, concise fashion. A very cursory chapter on arthroscopic surgery is included.

A majority of the text is dedicated to specific disorders and their treatment. Separate chapters cover glenohumeral instability; impingement; frozen shoulder; sternoclavicular, acromioclavicular, and scapular disorders; and other extrinsic causes of shoulder pain. Uses of electrical modalities are very limited, whereas specific treatments of myofascial trigger points, cross-friction massage, and acupuncture/acupressure are given in greater detail. The chapter on mobilization and adjustive procedures will be of interest to manual therapists.

In summary, some members of the physical therapy community may disregard this text because it is primarily written by a chiropractor. Others will find it a refreshing example of a diverse array of clinical specialties finding a common ground, in this case the shoulder. Regardless, this is a worthy text for the orthopedic physical therapist treating shoulder dysfunction.

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