Instructional Concurrent Session 6

Shoulder pain is a prevalent musculoskeletal condition that significantly limits participation in work, self-care, and meaningful daily activities. While contemporary treatment approaches recognize regional interdependence, rehabilitation often remains focused on local strengthening and mobility. Can outcomes improve if hand therapists expand their lens beyond the shoulder complex?

Optimal shoulder girdle function is intrinsically linked to posture, thoracic mobility, rib cage mechanics, and lower-body alignment. Impaired postural control and dysfunctional breathing patterns alter scapular positioning, disrupt neuromuscular coordination, and contribute to persistent pain. Emerging understanding of the myofascial and neuromotor relationship between the diaphragm and shoulder girdle highlights the diaphragm’s role in postural stabilization and movement efficiency.

As movement specialists, hand therapists are uniquely positioned to assess postural asymmetries, identify dysfunctional breathing strategies, and address kinetic chain contributors that influence shoulder kinematics. Integrating diaphragmatic breathing and postural symmetry training may enhance traditional therapeutic exercises by improving motor control, reducing compensatory patterns, and optimizing movement efficiency.

This presentation will review the anatomical and biomechanical connections between the diaphragm and the upper quarter and demonstrate practical assessment and treatment strategies. Through case examples, demonstrations and lab, participants will explore how integrating diaphragmatic breathing and postural retraining can optimize shoulder rehabilitation outcomes.

Level: Intermediate

Upper extremity injuries present unique challenges in safely returning athletes to sport. Athletes require a varied approach to care based on their specific sport and readiness to return to allow for an appropriate, and safe, return to sport. The session will identify loading principles and examine the most common upper extremity injuries that occur in sport. The session outlines a criteria-based model integrating tissue healing, progressive loading, kinetic chain principles, functional testing, and sport-specific demands. The criterion of return to sport and the principles involved for the upper extremity will be examined through the content. Upper-extremity return to sport testing requires a nuanced approach that addresses not only strength and range of motion but also power, speed, and neuromuscular control and coordination. Without examining all of these concepts appropriately and making evidence-based decisions for return to sport, athletes may return too early and suffer other injuries or more extensive ones requiring prolonged care or further surgical interventions. While athletes are highly competitive and eager to return to sport as quickly as possible, as therapists, we have to ensure they are safe to return to their respective sport, which can only be done through evidence-based return to sport testing.

Level: Intermediate

When musicians experience musculoskeletal pain or focal hand dystonia, hand therapists are often presented with a daunting case for evaluation and treatment. The high repetition of specialized fine motor movements, sustained awkward postures, and psychosocial factors make them a population that places tall orders for the clinician. The FRAME Model for Hand Therapy is an adaptable, evidence-informed, integrative care approach, to assist clinicians in treating these challenging cases. FRAME is an acronym that focuses on foundation, regulation, awareness, movement, and engagement. This assists both therapists and artists as a visual guide from beginning rehabilitation to independence by keeping track of goals and relevant treatment areas.

FRAME integrates evidence on nervous system regulation and proprioception to help musicians return to practice and performance. Proprioception, a new level of postural and movement awareness, is a key component to all exercises and therapeutic activities. Return to Play is the foundation for all education provided in therapy and goes beyond a practice schedule; it helps a musician see their body, music, breath, and daily activity become integrated to restore their occupational identity.

First, this session will explore the mind, body, and occupational disruption of a musician with pain. Then the FRAME Model for Hand Therapy and its utility in practice will be explained with evidence-supported treatment interventions. Case studies will demonstrate application of FRAME with interactive audience participation to optimize outcomes in hand therapy practice.

Level: Intermediate

For decades, the elbow has been called the unforgiving joint due to the high incidence of post-traumatic stiffness following injury. Therapists and surgeons are challenged to optimize motion while maintaining stability for tissue healing. This session will focus on evidence-informed recommendations for the management of elbow and/or forearm fractures with or without dislocation to optimize the early recovery of motion during the protective and return to participation in the post-protective phases of rehabilitation. Contributing factors that may impede recovery including joint stiffness, persistent pain, bone health, and weightbearing challenges will be discussed. The incidence of traumatic elbow injuries is low in comparison to other conditions of the elbow due to bony stability. Many therapists have limited exposure to such injuries. An in-depth review of key concepts in each phase of rehabilitation will improve the clinical reasoning for therapists with limited experience.

Level: Intermediate