Physical Therapy Considerations in the Management of Individuals with Non-Arthritic Sources of Hip and Shoulder Symptoms: Examination Sequence, Treatment, and Potential Barriers to the Restoration of Function

Abstract

Musculoskeletal conditions are a common reason that patients seek a referral to physical therapy. The hip and shoulder have anatomical similarities and are prone to comparable pathologies. The increased mobility of the hip in the presence of hip dysplasia, increases the anatomical similarities between these 2 joints, and enhances the comparisons that can be made. The examination sequence in individuals with musculoskeletal pain is multifaceted with information obtained through a physical examination and/or the utilization of standardized outcome measures. When performing the physical exam, it can be difficult to differentiate between the potential sources of symptoms when the joints are anatomically adjacent to the spine. Symptom localization (SL) can be used to help determine the region, spinal segment, and/or structure(s) responsible for the source of symptoms. Regional testing is used to rule out the influence one joint has on the other when two adjacent joints could be responsible for causing symptoms. The proximity of the hip and the shoulder to the spine make this line of testing important to rule out the possibility of referred pain and/or neurogenic diagnosis. Once the region has been determined, structural localization can be used to identify the structure(s) contributing to symptoms. Another component of the physical therapy examination includes the use of outcome measures. For the purpose of this dissertation, I am dividing these outcome measures into two categories, functional and psychosocial. The functional questionnaires are used to help identify symptom characteristics, functional tasks, and activities that can be addressed during a course of therapy. Many of the common functional outcome measures used for the assessment of pathologies related to the upper and lower extremities, focus primarily on the ability to perform a task but give little to no consideration of the other factors that may be influencing performance such as psychosocial factors of depression, anxiety, stress, and/or fear-avoidance behaviors. The subsequent chapters of this dissertation will focus on two components of the examination process. First, symptom localization, the examination strategy utilized to differentiate between adjacent body regions to determine the source of symptoms and the sequencing of treatment in a patient with anterior shoulder pain. The second strategy is the use of outcome measures, these are used to investigate psychosocial impairments, using the Fear Avoidance Belief Questionnaire (FABQ), and the Depression Anxiety and Stress Scale (DASS-21) on an individual’s function as measured through the International Hip Outcome Tool (iHOT) in individuals with hip dysplasia.