Prevalence of cuff injuries. Concept and types of impingement. Pain syndrome related to the rotator cuff.

Subjective examination (“what the patient explains”) and objective examination (“what the patient does or perceives”).

Most relevant aspects of the behavior of symptoms and their relationship with the affected structure/tissue (mechanical pain, inflammatory pain, ischemic pain, neuropathic pain, nociplastic pain, identification of parameters for patient reassessment: concordant signs and non-concordant signs.

Clinical presentation of the most prevalent conditions, epidemiology, possible medical and physiotherapy diagnoses. Decision algorithms. Pain maps of the structures of the shoulder girdle. Importance of psychosocial factors in shoulder pain.

Identification of alarm signals (red flags). Evaluation of possible sources of symptoms in the shoulder girdle. Functional demonstration and possibilities of differential diagnosis.

Cervical spine screening, thoracic spine screening, neural structure screening.

Manual differential diagnosis between intraarticular, periarticular or acromiohumeral dysfunction. Strategies to assess the modification of shoulder symptoms from the cervical spine and thoracic spine.

Manual assessment of passive range of motion of the glenohumeral joint. Normal distribution of rotation range. Identification of impairments of the acromioclavicular, sternoclavicular and scapulothoracic joints

Definition and clinical interest. Evaluation of scapulohumeral rhythm (SHR) impairments: articular component and muscular component of the SHR. Types of dyskinesias and strategies for assessing the competence of the scapular muscles. Scapular assistance test. Scapular retraction test. Role of the pectoralis minor: extensibility test and stretching techniques.

Some of the most common tests, their objective, the criteria for assessing the test response, the data available in relation to their usefulness and clinical validity, the variations of the tests and the interpretation of the result in the patient's reeducation are included. Concept and interpretation of sensitivity, specificity and LR (likelihood ratio) of shoulder tests.

Considerations for interpreting an isometric test. Criteria for a “good” specific test for the cuff. Are orthopedic shoulder tests useful and reliable? Proposals for the most recommended test combinations in the literature.

Decision-making diagram based on the result of the orthopedic examination of the shoulder.

Review of tests related to the rotator cuff and adjacent structures. Tests related to situations of instability.

Degrees of movement. Criteria for choosing the degrees of movement based on the patient's clinical presentation (pain, stiffness or both).

• Biomechanical and clinical implication of loss of extensibility of the tissues of the posterior aspect of the glenohumeral joint.
• Posterior capsule tension test.
• Posterior capsule stretching techniques.
• Proposals for manual treatment to stretch structures of the posterior face based on the evaluation of accessory and physiological movement deficits.
• Self-treatment techniques.

Rapid assessment of the thoracic spine. Proposals for mobilization of the middle and upper thoracic spine: accessory movements and passive physiological movements.

• Importance of the cervical spine in shoulder girdle dysfunctions. Rapid assessment of the cervical spine.
• Proposals for mobilization of the middle and lower cervical spine: spinal mobilization with upper extremity movement, bridge technique, lateral glide, unilateral anteroposterior mobilization.

General criteria for the exercises. Role of the cuff or short depressors in the centering of the humeral head. Role of long-acting depressants. Role of the deltoid. Exercise proposals aimed at:

• Descent or depression of the humeral head.
• Descent of the humeral head integrated into a movement.
• Muscles of the cuff. Review of reference studies for the Supraspinatus, Infraspinatus/Tertus minor, Subscapularis. Adaptation of exercises to clinical practice.
• Protocol at Sant Antoni. How to do the exercises correctly?
• Importance of the kinetic chain: lower limbs, trunk and upper limbs.
• Strategies to increase activation of the wrist muscles. Infraspinatus-subscapular co-contraction; prehension; trunk rotation; lumbopelvic control; involvement of the lower extremities.
• Scapular muscles. Review of reference studies for the scapular stabilizer muscles (Lower/Middle Trapezius, Serratus Anterior). Adaptation of exercises to clinical practice.
• Middle deltoid and long depressors. Its role in humeral descent and centering.
• Programs for training degenerative or long-term rotator cuff tears. MOON Shoulder Program, Edwards Program, Cuff unloading program (Cools).
  What makes a candidate for the programs? Criteria for choosing the appropriate exercise and progression.
• Muscle training programs in case of irreparable ruptures. Levy program, Torbay program.