Adhesive capsulitis is a musculoskeletal condition that has a disabling capability. This review discusses the diagnosis and both operative and nonoperative management of this shoulder condition that causes significant morbidity. Issues related to medications, rehabilitation, and post surgical considerations are discussed.

Purpose of Review Because of the epidemiological incidence of anterior cruciate ligament (ACL) injuries, the high reinjury rates that occur when returning back to sports, the actual number of patients that return to the same premorbid level of competition, the high incidence of osteoarthritis at 5-10-year follow-ups, and the effects on the long-term health of the knee and the quality of life for the patient, individualizing the return to sports after ACL reconstruction (ACL-R) is critical. However, one of the challenging but unsolved dilemmas is what criteria and clinical decision making should be used to return an athlete back to sports following an ACL-R. This article describes an example of a functional testing algorithm (FTA) as one method for clinical decision making based on quantitative and qualitative testing and assessment utilized to make informed decisions to return an athlete to their sports safely and without compromised performance. The methods were a review of the best current evidence to support a FTA. Recent Findings In order to evaluate all the complicated domains of the clinical decision making for individualizing the return to sports after ACL-R, numerous assessments need to be performed including the biopsychosocial concepts, impairment testing, strength and power testing, functional testing, and patient-reported outcomes (PROs). Summary The optimum criteria to use for individualizing the return to sports after ACL-R remain elusive. However, since this decision needs to be made on a regular basis with the safety and performance factors of the patient involved, this FTA provides one method of quantitatively and qualitatively making the decisions. Admittedly, there is no predictive validity of this system, but it does provide practical guidelines to facilitate the clinical decision making process for return to sports. The clinical decision to return an athlete back into competition has significant implications ranging from the safety of the athlete, to performance factors and actual litigation issues. By using a multifactorial FTA, such as the one described, provides quantitative and qualitatively criteria to make an informed decision in the best interests of the athlete.

Functional Testing in Human Performance offers clinicians the first-ever compilation of information on clinical and data-based functional testing for sport, exercise, and occupational settings. This unique text serves as a primary resource for accurate assessment of individuals' functional abilities in order to develop program prescriptions to enhance their performance. Functional Testing in Human Performance is a comprehensive learning tool for novices and an essential reference for advanced clinicians. The text defines the role of function in physical performance and how it can be appropriately tested. Especially helpful for novices, the text explains testing criteria, testing terms relevant to research, and selecting the most appropriate test and testing sequence. Common testing mistakes are also presented as well as pitfalls to avoid when testing. The text also includes case studies that illustrate a variety of situations including testing for a client recovering from a lower-extremity injury, discussing preseason testing for a large group of athletes, and presenting the study of a client in an occupational setting. These cases include detailed statistical analysis and normative data, offering clinicians the opportunity to consider the application of functional testing and implementation strategies adaptable to their specific practice setting. After laying a foundation, the text progresses to detailed testing procedures for discrete physical parameters and specific regions of the body. Tests are organized from least to most complex, and each test is presented in a step-by-step manner outlining the purpose of the test, equipment needed, testing procedure and recommendations for performing the test, interpretation of results, and the data to suggest normative values, reliability, and validity for each test. This formatting facilitates quick reference to testing information for on-the-spot use, whether in the clinic, athletic training room, gym, or job site. To enhance understanding, a companion video collection features live-action demonstrations of 40 of the most advanced tests. Icons on those test pages indicate they are modeled in the video collection. Functional Testing in Human Performance offers a unique and comprehensive reference for assessment of physical activities in sport, recreation, work, and daily living. By presenting the theory and detailing the practice, this text assists clinicians in understanding and incorporating functional testing to identify their patients' or clients' limitations and enhance their performance, rehabilitation, and daily functioning.

Background:Posterior shoulder tightness, as demonstrated by limited internal rotation range of motion, is a suggested factor in many shoulder pathologies. Methods to increase posterior shoulder mobility may be beneficial.Hypothesis:Shoulder internal rotation range of motion will not change with either of 2 interventions: cross-body stretch alone and cross-body stretch plus posterior capsule joint mobilization.Study Design:Randomized controlled single-blinded clinical trial.Methods:The study comprised 39 college-age asymptomatic participants (7 men, 32 women) who were randomly assigned to 1 of 2 groups: stretching only (n, 20) and stretching plus posterior joint mobilizations (n, 19). All had a between-shoulder difference of internal rotation of 10° or more. Shoulder internal and external rotation was measured before and after a 4-week intervention period and 4 weeks postintervention. Participants in the stretching-only group performed the cross-body stretch on the limited side. Those in the other group (cross-body stretch plus joint mobilization) were treated with posterior joint mobilization techniques on the limited side.Results:Overall means for internal rotation of the treated shoulders significantly increased over baseline at the end of the intervention period and at 4 weeks postintervention. External rotation in all shoulders remained unchanged. By the end of intervention, total motion increased significantly from baseline but decreased significantly from the end of intervention to 4 weeks postintervention. Although not statistically significant, the second group (cross-body stretch plus joint mobilization) had greater increases in internal rotation. At 4 weeks postintervention, the second group had maintained its internal rotation gains to a greater degree than those of the stretching-only group.Conclusion:Internal rotation increased in both groups. Inclusion of joint mobilization in a rehabilitation program created trends toward increased shoulder internal rotation mobility.Clinical Relevance:Both methods—cross-body stretch and cross-body stretch plus joint mobilization—may be beneficial for those with limited internal rotation range of motion.

Snapping scapula is a painful crepitus of the scapulothoracic articulation. This crepitus is a grinding or snapping noise with scapulothoracic motion that may or may not accompany pain. This condition is commonly seen in overhead-throwing athletes. Treatment of patients with this syndrome begins with nonoperative methods; when nonoperative treatment fails, several surgical options exist. This article will discuss both nonoperative and operative management of this common shoulder condition.

Testing for outcome or performance can take many forms; including multiple iterations of self-reported measures of function (an assessment of the individual's perceived dysfunction) and/or clinical special tests (which are primarily assessments of impairments). Typically absent within these testing mechanisms is whether or not one can perform a specific task associated with function. The paper will operationally define function, discuss the construct of function within the disablement model, will overview the multi-dimensional nature of 'function' as a concept, will examine the current evidence for functional testing methods, and will propose a functional testing continuum. Limitations of functional performance testing will be discussed including recommendations for future research.

Context:Functional performance testing of athletes can determine physical limitations that may affect sporting activities. Optimal functional performance testing simulates the athlete’s activity.Evidence Acquisition:A Medline search from 1960 to 2012 was implemented with the keywords functional testing, functional impairment testing, and functional performance testing in the English language. Each author also undertook independent searches of article references.Conclusion:Functional performance tests can bridge the gap between general physical tests and full, unrestricted athletic activity.

Brumitt, J, Heiderscheit, B, Manske, R, Niemuth, PE, Mattocks, A, and Rauh, MJ. Preseason functional test scores are associated with future sports injury in female collegiate athletes. J Strength Cond Res 32(6): 1692-1701, 2018-Recent prospective cohort studies have reported preseason functional performance test (FPT) measures and associations with future risk of injury; however, the findings associated with these studies have been equivocal. The purpose of this study was to determine the ability of a battery of FPTs as a preseason screening tool to identify female Division III (D III) collegiate athletes who may be at risk for a noncontact time-loss injury to the lower quadrant (LQ = low back and lower extremities). One hundred six female D III athletes were recruited for this study. Athletes performed 3 FPTs: standing long jump (SLJ), single-leg hop (SLH) for distance, and the lower extremity functional test (LEFT). Time-loss sport-related injuries were tracked during the season. Thirty-two (24 initial and 8 subsequent) time-loss LQ injuries were sustained during the study. Ten of the 24 initial injuries occurred at the thigh and knee. At-risk athletes with suboptimal FPT measures (SLJ ≤79% ht; (B) SLH ≤64% ht; LEFT ≥118 seconds) had significantly greater rates of initial (7.2 per 1,000 athletic exposures [AEs]) and total (7.6 per 1,000 AEs) time-loss thigh or knee injuries than the referent group (0.9 per 1,000 AEs; 1.0 per 1,000 AEs, respectively). At-risk athletes were 9 times more likely to experience a thigh or knee injury (odds ratio [OR] = 9.7, confidence interval [CI]: 2.3-39.9; p = 0.002) than athletes in the referent group. At-risk athletes with a history of LQ sports injury and lower off-season training habits had an 18-fold increased risk of a time-loss thigh or knee injury during the season (adjusted OR = 18.7, CI: 3.0-118.1; p = 0.002). This battery of FPTs appears useful as a tool for identifying female D III athletes at risk of an LQ injury, especially to the thigh or knee region.