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A 16-year-old elite-level volleyball player was participating in a regional tournament when she sustained an injury to her dominant left upper extremity while attempting to spike a ball. The patient continued to play despite left shoulder pain, a feeling of the shoulder "slipping in and out," and a decrease in striking power. Immediately following the tournament, she sought the care of her family physician that performed x-rays, which were negative for shoulder dislocation and bony pathology. The athlete's medical history was positive for vague left shoulder pain over the past season and an eating disorder, for which she is currently under the care of a sports psychiatrist. She now presents to physical therapy 3 days after her injury with a referring diagnosis of a "SLAP tear." You are asked to evaluate and treat the patient for a safe return to volleyball activities.

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What are the examination priorities?

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What are the key examination tests that should be performed to identify the specific pathology and impairments?

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What are the most appropriate physical therapy interventions?

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What precautions should be taken during physical therapy?

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What are possible complications interfering with the patient's progress in physical therapy?

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BICEPS-LABRAL COMPLEX: Integration of the long head of the biceps tendon into the superior glenoid labrum

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CONCAVITY-COMPRESSION: Stabilizing mechanism in which compression provided by the rotator cuff muscles is applied through the convex humeral head into the concave glenoid fossa, thereby resisting translational forces

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SHOULDER INSTABILITY: Clinical condition in which excessive translation of the humeral head occurs on the glenoid fossa, potentially resulting in subluxation or dislocation

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  1. Understand the functional anatomy of the glenohumeral joint and biceps-labral complex.

  2. Ask relevant patient history questions to elucidate the prognosis and treatment plan of care.

  3. Identify critical examination findings that should be evaluated prior to patient treatment.

  4. Identify reliable and valid physical examination tools to aid in patient diagnosis and prognosis.

  5. Provide appropriate interventions that will allow the patient to safely return to sport.

  6. Determine when the athlete is prepared to return to volleyball competition with functional return-to-sport tests.

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PT considerations during management of the athlete with a labral tear:

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  • General physical therapy plan of care/goals: Protect patient from incurring subsequent injury; identify anatomical source(s) of pathology; improve muscular balance and flexibility to restore shoulder stability
  • Physical therapy interventions: Patient education regarding local anatomy, pathomechanics, and activity modifications; modalities to manage pain; manual therapy and selective stretching to improve identified areas of hypomobility; increase joint stability through rotator cuff and periscapular muscle strengthening
  • Precautions during physical therapy: Avoid aggressive overhead activity that places excessive stress on the labrum in early phases of therapy; careful progression from a neutral position to full overhead shoulder elevation as strength and ...

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