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Diagnosis of persistent low back and referred lower extremity pain course
by Rachel Punter-Minns - Friday, 16 December 2016, 9:41 AM
 

Preparations for the 2017 Diagnosis of persistent low back and referred lower extremity pain course which starts mid-April are also well underway and registrations are now open.  To register, complete the registration form below and return it to info@musculoskeletal.courses.  For more information about this course visit http://musculoskeletal.courses/courses/lumbar-spine

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Shoulder Series Course
by Rachel Punter-Minns - Friday, 16 December 2016, 9:38 AM
 

The 2017 Southern Musculoskeletal Seminars calendar is now in place and Angela Cadogan’s Shoulder Series Course starts in January 2017. To register, complete the registration form below and return it to info@musculoskeletal.courses, or visit http://musculoskeletal.courses/courses/shoulder for more information.



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Courses for 2017
by Admin User - Thursday, 21 July 2016, 9:14 AM
 

Upcoming Courses in 2017:

In 2017 SMS will be running Mark Laslett's "Diagnosis of Persistent Low Back Pain" and a Shoulder Course Series run by Dr Angela Cadogan. More information about these courses can be found on the SMS website. Please "Like" the SMS Facebook page to receive immediate notification of when registration is available, or keep checking this page for updates.

 

Available courses

Differential Diagnosis of Shoulder Pain

This is the first module in Southern Musculoskeletal Seminars “Shoulder Series”. This topic will cover aspects of differential diagnosis of shoulder conditions.

The module consists of six lessons. Each lesson includes approx. 2 hours of learning time. Topics include:

  1. Red Flags
  2. Medical Screening
  3. Psychosocial Modifiers
  4. Cervical Spine and Neurological Examination
  5. Shoulder Imaging
  6. Diagnosis of Shoulder Pain

Online Learning Hours: approx. 2-3 hours per lesson (Total of 12-18 hours learning).

Learning time includes pre-reading, video presentations and lesson quiz.

Course Weekend: The course weekend for this module is combined with Module 2 (Stiff Shoulder). If you have registered, or intend to register for the course weekend, be aware that completion of the online module is a pre-requisite for attendance at the Course Weekend. Please see the SMS website for course weekend dates and registration details: www.musculoskeletal.courses/courses

(Note: The Module 1 course weekend has already been run in 2017. Check the SMS website for 2018 course dates).


The Stiff Shoulder

This is the second module in Southern Musculoskeletal Seminars “Shoulder Series”. This topic will cover "The Stiff Shoulder.

The module consists of 3 lessons followed by a quiz, that cover:

  1. Frozen Shoulder
  2. Glenohumeral joint Osteoarthritis
  3. Diagnosis of the Stiff Shoulder
  4. Management of the Stiff Shoulder

Online Learning Hours: 10 (approx.)

Learning hours include pre-reading, video presentations and the module quiz.

Course Weekend: The course weekend for this module is combined with the course weekend for Module 1. The course weekend is optional. If you have registered, or intend to register for the course weekend, be aware that completion of the online module is a pre-requisite for attendance at the Course Weekend. Please see the SMS website for course weekend dates and registration details: www.musculoskeletal.courses/courses 

(The weekend course has already been run in 2017. Check the SMS website for 2018 dates).


The Stiff Shoulder

This is the second module in Southern Musculoskeletal Seminars “Shoulder Series”. This topic will cover "The Stiff Shoulder.

The module consists of 3 lessons followed by a quiz, that cover:

  1. Frozen Shoulder
  2. Glenohumeral joint Osteoarthritis
  3. Diagnosis of the Stiff Shoulder
  4. Management of the Stiff Shoulder

Online Learning Hours: 10 (approx.)

Learning hours include pre-reading, video presentations and the module quiz.

Course Weekend: The course weekend for this module is combined with the course weekend for Module 1. The course weekend is optional. If you have registered, or intend to register for the course weekend, be aware that completion of the online module is a pre-requisite for attendance at the Course Weekend. Please see the SMS website for course weekend dates and registration details: www.musculoskeletal.courses/courses 

(The weekend course has already been run in 2017. Check the SMS website for 2018 dates).


The Unstable Shoulder

This is the third module in Southern Musculoskeletal Seminars “Shoulder Series”. This topic will cover "The Unstable Shoulder".

The module consists of 3 lessons followed by a quiz that will cover:

  1. Pathoaetiology and Classification of Shoulder Instability
  2. Diagnosis of Shoulder Instability
  3. Management of Shoulder Instability

Online Learning Hours: 10 (approx.)

Learning hours include: pre-reading, video presentations and quiz.

Course Weekend: The course weekend is optional. If you have registered, or intend to register for the course weekend, be aware that completion of the online module is a pre-requisite for attendance at the Course Weekend. Please see the SMS website for course weekend dates and registration details: www.musculoskeletal.courses/courses

(Note: The Module 3 course weekend has already been run in 2017. Check the SMS website for 2018 course dates).


Subacromial Conditions

This is the fourth module in Southern Musculoskeletal Seminars “Shoulder Series”. This topic will cover "Subacromial Conditions".

The module consists of 3 lessons followed by a quiz that will cover:

  1. Calcific Tendinosis
  2. Rotator Cuff Tears (traumatic & atraumatic)
  3. Massive Rotator Cuff Tears

Online Learning Hours: 12 (approx.)

Learning hours include: pre-reading, video presentations and quiz.

Course Weekend: The course weekend is optional. If you have registered, or intend to register for the course weekend, be aware that completion of the online module is a pre-requisite for attendance at the Course Weekend. Please see the SMS website for course weekend dates and registration details: www.musculoskeletal.courses/courses

This is the fifth and final module in Southern Musculoskeletal Seminars “Shoulder Series”. This topic covers Acromioclavicular Joint conditions.

The module consists of 2 lessons followed by a quiz that cover:

  1. AC Joint Instability
  2. Chronic AC Joint conditions (arthritis and osteolysis).

Online Learning Hours: 6-8 (approx.)

Learning hours include: pre-reading, video presentations and quiz.

Course Day: The course day for Module 5 will be held on Day 1 of the final course weekend (Weekend 4) with the real-time patient assessment taking place during the Patient Assessment Day on Day 2. You can register only for Day 1 if you wish. Completion of Module 5 is a pre-requisite for attendance at Day 1 of the Course Weekend.

The second day of the final course weekend (Weekend 4) consists of a full day of real-time patient assessments and treatment planning for the range of conditions covered during the Shoulder Course Series, including the AC joint. To register for Day 2 of the course weekend you must have completed a minimum of any two online modules.

Please see the SMS website for course weekend dates and registration details: www.musculoskeletal.courses/courses

Course Weekend 1 will cover material from Differential Diagnosis (Module 1) and The Stiff Shoulder (Module 2). Completion of the online lessons in Module 1 and Module 2 are required prior to attending the course. The weekend will be predominantly practical, and will include demonstration and practice of clinical tests, clinical reasoning exercises and patient assessments. The afternoon session on Day 2 will cover surgical management and post-operative rehabilitation of the Stiff Shoulder. Some course information is included below. 

The Unstable Shoulder

Completion of Online Module 3 is a pre-requisite for attendance at this course.

This course will be held on 23rd & 24th June 2018 at Burwood Hospital, Christchurch, NZ. The weekend course will be a practical course during which we will cover:

  • Clinical assessment of the unstable shoulder
  • Assessment of neuromuscular function
  • Non-operative management of the unstable shoulder including specific rehabilitation exercises
  • Real-time patient case: Traumatic instability
  • Real-time patient case: Atraumatic instability
  • Surgical Management of Shoulder Instability (Mr Khalid Mohammed)
  • Post-operative Management of Shoulder Instability

Subacromial Conditions

Completion of Online Module 4 is a pre-requisite for attendance at this course.

This course will be held on 4th & 5th  August 2018 at Burwood Hospital, Christchurch, NZ. The weekend course will be a practical course during which we will cover:

  • Clinical assessment of subacromial conditions
  • Differential diagnosis of subacromial conditions
  • Non-operative management of rotator cuff tears and calcific tendinosis
  • Surgical management of rotator cuff tears and calcific tendinosis (Mr Khalid Mohammed)
  • Post-operative rehabilitation following rotator cuff repair surgery

Acromioclavicular Joint Conditions

Completion of Online Module 5 is a pre-requisite for attendance at this course day.

The course day will be a practical course (Weekend 4) during which we will cover:

  • Clinical assessment of AC joint conditions
  • Differential diagnosis of AC joint conditions
  • Non-operative management of AC joint conditions
  • Surgical management of AC Joint conditions (Mr Khalid Mohammed)
  • Post-operative rehabilitation following AC joint surgery


The second day of this course weekend (Weekend 4) is dedicated to real-time patient assessments and treatment planning for a range of conditions covered in the Shoulder Course Series.

Welcome to the SMS Online Learning system and thanks for registering for this 1/2 Day Seminar.

This Half Day Seminar will cover the surgical management of the Acromioclavicular Joint. Mr Khalid Mohammed (Orthopaedic Surgeon) will discuss surgical indications, procedures and outcomes. Angela Cadogan will cover post-operative management following AC Joint reconstruction. A great opportunity to have an open and informal discussion with an orthoapedic surgeon on rotator cuff-related conditions.

Click to enter this course to see more information about the seminar.

Welcome to the SMS Online Learning system and thanks for registering for this 1/2 Day Seminar.

This Half Day Seminar will cover the surgical management of shoulder instability. Mr Khalid Mohammed (Orthopaedic Surgeon) will discuss shoulder instability management including when to refer, operative procedures and outcomes and managing the risk of recurrent instability. Angela Cadogan will cover post-operative management following shoulder stabilisation procedures. A great opportunity to have an open and informal discussion with an orthoapedic surgeon on issues relating to shoulder instability.

Click to enter this course to see more information about the seminar.

Welcome to the SMS Online Learning system and thanks for registering for this 1/2 Day Seminar.

This Half Day Seminar will cover the surgical management of subacromial conditions. Mr Khalid Mohammed (Orthopaedic Surgeon) will discuss surgical indications, procedures and outcomes. Angela Cadogan will cover post-operative management following rotator cuff repair. A great opportunity to have an open and informal discussion with an orthoapedic surgeon on rotator cuff-related conditions.

Click to enter this course to see more information about the seminar.

Welcome to the SMS Online Learning system and thanks for registering for this 1/2 Day Seminar.

This Half Day Seminar will cover the surgical management of the Acromioclavicular Joint. Mr Khalid Mohammed (Orthopaedic Surgeon) will discuss surgical indications, procedures and outcomes. Angela Cadogan will cover post-operative management following AC Joint reconstruction. A great opportunity to have an open and informal discussion with an orthoapedic surgeon on rotator cuff-related conditions.

Click to enter this course to see more information about the seminar.

The first course in this program of instruction eases you into the online learning environment with videos on first activities that you need to complete, like downloading the course manual template, introducing yourself to the Course Forum, and downloading the PDFs of the first reading list.

There are three formal lessons that are essential in understanding the concept of diagnostic triage that is a central part of basic guideline management. The lessons are:

  • Pain drawings and their interpretation
  • Red Flag identification and what these mean
  • The basic neurologic screening examination that is a key part of the physical examination for all patients with back and referral of symptoms into the lower limb

There are two videos to watch. These are of a real patient with persistent low back pain. 

  • The first provides detail of the history taking process
  • The second is the standard physical examination used throughout this program of instruction.

At the end there is a quiz to test your understanding of the material.


The second course in this instructional program gets into the nitty-gritty of diagnostic methodology within the clinic on the real patients we see every day. The focus here is on clinical diagnosis. That is, the diagnosis one can achieve in the clinic using the history and physical examination, and highly selective use of technology.

There are three formal lessons to complete. The lessons are:

  • Sources and causes of Low Back and Referred Lower Limb pain. This is a basic overview of known painful patho-anatomical categories of conditions. Basic knowledge is assumed of course but the idea is to provide a summary of basic categories for context and content needed for the next two lessons
  • The second lesson is Part 1 of the lesson on Diagnosis by Subtraction. Diagnosis by subtraction draws on the concepts of specificity & sensitivity to rule in and rule out different diagnostic categories.
  • The third lesson is Part 2 of the lesson on Diagnosis by subtraction. In this lesson you will see how expert clinicians reduce the pool of possible diagnostic conclusions to one, or a small number of diagnostic possibilities, so that treatment can be initiated or further diagnostic investigation planned.

There is one case study video to watch. This shows the centralization of pain graphically which is important, since centralisers are the largest subgroup within the back pain population.

You will also download the case notes of the patient seen in the introductory course and be encouraged to self test your own clinical reasoning skills using the details of this case and the learning from the three lectures on the principles of clinical diagnosis.

There is only one paper to download and read, and that is the 2017 paper of Petersen, Laslett & Juhl on the systematic reviews we carried out on the latest evidence on diagnosis and classification. You will need to read this thoroughly, because the course quiz will focus on that strongly.

At the end there is a quiz to test your understanding of the material.

Also you will be able to download the PDF forms I have used for clinical records. This documentation may be of use, or may not, but does give you a good idea of the sort of questionnaires I have patients complete, and notes I keep for all cases presenting in the clinic.


The third course in this program looks at radicular syndrome, that is, pain arising from irritation and/or compression of nerve roots, the dorsal root ganglion and dura mater. This is the one condition that international guidelines agree may be diagnosed with some confidence using the history and physical examination. This perspective is a surgical one dating and unchanged from the 1980s. This is an outdated view in my opinion, and you will see as the program develops that we can do much better, given current evidence. However, for now, you must be thoroughly familiar with the standard orthopaedic perspective on radicular syndrome, the terms and concepts that are accepted internationally and the evidence supporting diagnosis, conservative care and surgical intervention.

There are four formal lessons to complete. The lessons are:

  • Introductory concepts of radicular syndrome. Here the distinctions between radicular syndrome, radicular pain and radiculopathy, are clarified using definitions and taxonomy from the international Association for the Study of Pain. The patho-anatomy and physiology of nerve root pain and impairment are covered also.
  • The second lesson looks specifically at disc herniation as the single biggest cause of radicular syndrome
  • The third lesson looks at discectomy, the indications for, and alternatives to discectomy. We look at complications following discectomy also.\
  • The fourth lesson looks at the adherent nerve root. This condition and its treatment was first described by Robin McKenzie. It is probably equivalent to the MRI finding of epidural scarring and occurs in adolescents who develop root compression from disc herniation, and following discectomy

There are three videos to watch. 

  • The first is rare footage from the estate of Dr Stephen Kuslich who reported on the many hundreds of cases he operated on under progressive local anaesthesia on conscious patients. Very important work and fascinating. 
  • The second video is a short video from Rob PT via Utube, on treatment options for adherent nerve root. 
  • The third video shows a rare case where a neurologic deficit is to seen come and go depending on load.

You will also download published guidelines which are an example of accepted international standards for diagnosis and treatment of radicular syndrome.

There is a significant reading list and a quiz to test your understanding.

This is the last of the compulsory courses and completes the realm of what is known as diagnostic triage. The next course you do is entirely up to you. However, regardless of your prior experience, I strongly recommend that the next course you do is the one on mechanical discogenic pain. This course covers the single largest subgroup of the back pain population. That is, those having rapidly reversible and repeatable pain patterns and behaviours. There are several case study videos of the management of cases with acute and persistent deformities.



This course looks at the largest patho-anatomical subgroup in the back pain spectrum. These are patients whose symptoms can be made to centralise, and/or display a repeatable and reversible directional preference when examined using a standardized repeated movement assessment.

The fact that mechanical loading in one direction decreases or centralizes pain, and the opposite direction has the opposite effect, and that this behaviour is both repeatable and rapidly reversible, is what gives rise to the labelling of this group of patients as having mechanical pain.

We know from our own diagnostic accuracy research that only patients with confirmed discogenic pain behave in this way. That is, almost all cases who are categorized as centralisers or show a directional preference will have positive provocation discography, which is the accepted reference standard for discogenic pain.

There are four formal lessons in this course:

  • Lesson one explores the biomechanics and patho-anatomy of the intervertebral disc as a baseline of understanding how it might be, that symptoms can be made to demonstrate this peculiar reversible and repeatable directional preference phenomenon.
  • Lesson 2 looks at the evidence and opinion regarding mechanical discogenic pain and how centralization has been observed and studied over the decades
  • Lesson 3 looks at case studies, mostly drawn from our own diagnostic accuracy research. Here we can see that not all discogenic pain cases centralize, and that discogenic pain is a broad category of painful patho-anatomy, with distinct subgroups of its own
  • Lesson 4 looks at the acquired deformities as distinct from the developmental ones like idiopathic scoliosis. Hypotheses and explanations for the lateral shift, acute lumbar kyphosis and acute fixed lordosis are discussed.
  • There is a 5th lecture which looks specifically at the diagnostic accuracy of directional preference, as distinct from centralization. This is not published in a journal, but was presented to a conference and revised to be put in the public domain.

There are several case study videos of management of the acute lateral shift, the acute kyphosis and acute fixed lumbar lordosis. There is one video of a fixed lumbar lordosis in a patient with more than 10 years of daily severe pain, that was rapidly reversible. He is being followed up still.

There is a quiz to complete so that you may test your understanding of this material.


This course investigates the non-mechanical causes of pain arising from the anterior column. The anterior column refers to all structures anterior to the spinal canal, such as the intervertebral disc, the vertebral endplates and the vertebral body. Understanding these potential causes of pain and being able to identify them in the clinic, depends to a large extent on the material in the course on mechanical discogenic pain. Somewhere between 25 and 75% of anterior column pain cases will be classified as mechanical based on the repeated movement assessment, so it is important that you are familiar with that clinical procedure. Do that course first if you are not confident with the procedure of the repeated movement assessment and the interpretation of patient responses.

Prior to research published in the 2000s, most anterior column pain was referred to as simply internal disc disruption, to distinguish these cases from those with disc protrusions and herniations causing radicular syndrome. These were the cases that were positive to controlled provocation discography. And of course there are those cases with high tech imaging evidence of overt discitis, osteomyelitis, fracture or neoplastic disease affecting the vertebral body. This course addresses those cases that are non-centralisers and show no evidence of repeatable, and rapidly reversible directional preference.

There are two main lessons in this course that refer specifically to anterior column infection

  • The first lesson looks at overt and aggressive anterior column infections presenting as discitis or osteomyelitis. These are often identified by the presence of red flags, but not always. It is important to remain aware that serious medical conditions do slip through the red flag screen. The case studies are those that I have seen myself in recent years.
  • The second lesson looks at the MRI finding of endplate changes referred to as Modic changes. Modic changes may be caused by a low grade, low virulence infection as proposed by Hanne Albert and co-workers, or may be non-responsive to a long course of antibiotics, which means that we simply don’t know whether this is a resistant infection or whether the Modic changes have some other cause. Of course, it must be noted that not all cases with Modic changes are symptomatic.
  • There is a third lesson that has a quite different focus. This topic is dear to my heart and concerns the sudden onset severe low back pain case that presents to the Emergency Department. A significant proportion of these cases do not have acute disc prolapses, fractures or infections, but have acute anterior column disorders that present with sudden onset deformities or annular tears. Best management of these cases involves the material from the course on mechanical discogenic pain.\
There are three case study videos in this course. 

  • One presents with concerns about possible cauda equina symptoms. 
  • There is a case study of management of an acute lateral shift where various management techniques are used that were not seen in the case study seen is the mechanical discogenic pain course. 
  • There is another case study of anterior column pathology in a young man that is not reversible.
  • There is a video of my colleague Dr Charles Aprill discussing provocation discography and demonstrating the technique at three levels in the lumbar spine. 
  • There is a short video demonstrating the movement of disc material during flexion and extension over a variety of age groups using cadaver specimens.

There is a quiz to test your understanding of the material.

Module 1 focuses on the most common sources of low back pain, the anterior column and the spinal nerve roots. There are 16 formal audio-enhanced PowerPoint lessons that are accessed through private YouTube Channels. In addition there 9 case studies some of which are short and others that are full videoed assessment and treatment sessions. There are other videos of relevant subjects as well. 

The program is strongly evidence based and you will need to download and read over many scientific papers in the form of pdf documents. The course manual matches the content of the online material but is completed by you, in that you record all your activities, questions and readings as you proceed through the course. Module 1 should take you 2 months to complete, but plan on a three month study program of at least 5-6 hours a week. There is an Excel(TM)  workbook that already has all activities entered with adjacent check boxes for you to activate as soon as you have completed an activity. make a habit of opening this spreadsheet immediately after completing an activity (watch a lesson, video or read a paper). The spreadsheet keep a record of the number of hours you spend, which makes it easy for you to document the continuing education credits. Do not wait until the end of the course to do this as you will almost certainly under estimate the number of credits you have earned.

As you near completion of this Module, take time to consider when you wish to start Module 2. It is Modules 2 & 3 that contain the less common complaints, and mastery of the diagnosis of these conditions is what will make you a bone fide diagnostician of painful lumbar musculoskeletal conditions. It is consistency that get you through the material in time. If you run out of time, don't panic! You can purchase additional access time to the material for a modest amount at any time. Good luck, and work on the course material every week.

Welcome to Module 2 of the course "Diagnosis of Persistent Low Back and Referred Lower Extremity Pain! You have already complete Module 1 and now are ready to extend that knowledge to more advanced anterior column material in the form of more case studies, consideration of the sacroiliac joint and the posterior column as sources of pain. 

The first part of this Module is aimed to getting your mind back into learning mode, and starts with a simple Module 1 review lesson. This leads directly into a case study that will complete the material of Module 1: the anterior column. This case was diagnostically simple enough but the patient was more complex in management and well worth the time and effort to explore in detail.

Following that case study, you will then look at the sacroiliac joint as a source of pain, After that, the posterior column, which will include the Zygapophyseal (facet) joint, spondylolisthesis and spondylolysis. The issue of lumbar instability follows and all of these parts of the puzzle have relevant case studies in support.

At the end of this Module, some 3 months later, you will have much of the base material necessary to start seeing the bigger picture. That is the role of Module 3, which looks at the claudicant patient (stenosis and peripheral vascular disease), the hip and buttock, and the confounders of sensitization, psychosocial distress and illness behaviours. Make sure you put in at least 5 hours per week, continue to build your course manual, and maintain your Excel(TM) worksheet for CEU documentation.


Welcome to Module 3 of the course "Diagnosis of Persistent Low Back and Referred Lower Extremity Pain"! You are now ready to see the bigger picture. In this Module you will explore the claudicant patient who may have spinal stenosis, peripheral vascular disease or a hip/buttock related problem. You will see some unusual cases, and consider the issue of the how a psychosocial dimension may act to confound diagnosis & treatment.

It is this Module that puts all the pieces of the puzzle together and enables you to start seeing yourself as a true diagnostician in regards to the lumbar spine and pelvis. 

During this Module you must start to consider how you can attend one of the Module 4 seminars that will be arranged in various places throughout the world. While most of the content of this course can quite reasonably be explored online, there is no substitute for a face-to-face seminar environment for learning exactly how to do the sacroiliac joint tests or neurologic screening examination. Just how hard do you push when correcting a lateral shift deformity. Seeing patients being assessed on video is always less powerful that seeing patients in-the-flesh and in real time, which the seminar organizers can hopefully arrange as part of that course. Perhaps the most important part of a Module 4 seminar, is the opportunity to interact directly with the instructor, and with other colleagues in real time for a few days.

Once you have successfully completed this Module, you should then consider receiving formal instruction of the science of diagnostics as such - as distinct from the science of therapeutics. That course will be much shorter than this four Module course on the lumbar spine & pelvis and will hopefully be available from SMS sometime in 2018. The course on the science of diagnostics will teach you where the values for diagnostic accuracy come from, how to calculate them from data yourself, and how to read and understand diagnostic accuracy study reports. In short, it will complete your education as a practical and theoretical diagnostician.

Don't forget to continue to maintain and update your course manual, and keep ticking off those items in the Excel(TM) workbook so you have a complete CEU record for submission to licensing agencies. You will receive your certificate of course completion once you have submitted that Excel spreadsheet and the course evaluation to SMS. 

Thanks for your time and commitment!

Introduction to the Shoulder Course Series

Dr Angela Cadogan, Ph.D, NZRP

This is a series of three courses covering all aspects of shoulder screening, diagnosis and management.

Thank you for enrolling in the Shoulder Course Series. In this section you will find a general overview of the shoulder course series and other activities, as well as important contact information if you have any questions along the way.

Thanks for enrolling in our online courses and we hope you enjoy the online learning experience. 

Dr Angela Cadogan, Ph.D, NZRPS.

Identification of red flag indicators of serious and life-threatening pathology is critical in primary health care.

In this module, we cover:

  • Definition of 'red flags'
  • Red flag identifiers: screening and assessment
  • Presentation and risk factors for serious conditions presenting with shoulder pain
  • Referral prioritisation.

Study time: 3-4 hrs (approx.)

Health screening is important to help identify modifiable lifestyle factors that may help prevent chronic diseases, and to identify patients whose symptoms may be part of a systemic medical condition.

This module covers:
  • Health screening processes.
  • Health risk factors associated with medical conditions that may present with shoulder girdle pain.
  • Current health guidelines for physical activity and other lifestyle factors.
Study time: 3-4 hours (approx.)


Identifying the type of pain, mechanisms contributing to persistent pain and the influence of psychosocial factors are critical in the diagnostic process, and in selection of appropriate treatment interventions.

In this module we cover:

  • Features of different pain types
  • Mechanisms of persistent pain
  • Identification and management of psychosocial modifiers
  • Indications for referral

Study time: 4 hrs (approx.)

Upper limb pain can have many causes, and thorough examination of the cervical spine and associated neurology is critical in differentiating cervical spine referred pain and guiding management.

In this module we cover: 

  • Somatic vs referred pain
  • Cervical radiculopathy
  • Examination of the cervical spine
  • Neurological examination
  • Criteria for imaging and referral

Study time: 4 hrs (approx.)

The ability to appropriately refer for, and interpret the results of diagnostic imaging investigations is critical in primary health care. 

In this module we cover:

  • Diagnostic imaging modalities
  • Indications for imaging
  • How to read basic x-ray views
  • Interpretation of the symptomatic relevance of imaging findings.

Study time: 3-4 hrs (approx.)

Having excluded other causes of shoulder pain, we now look at the clinical classification of shoulder conditions to help guide management. 

In this module we cover:

  • Definition of "diagnosis"
  • Diagnostic process
  • Types of diagnosis
  • Evidence for the diagnosis of shoulder pain
  • Clinical classification of shoulder conditions

Study time: 3-4 hrs (approx.)

Congratulations on completing the Shoulder Screening Course!

In this section find out how you can continue to collaborate with other students and keep up to date with latest research and clinical developments in this area with activities including:

  • Online forum
  • Shoulder Screening Facebook Group
Please complete the evaluation form found in this section. Your CPD certificate will be sent after we receive your evaluation.

Welcome to the Stiff Shoulder module. 

This section provides you with information about the course structure, activities, resources and opportunities for keeping up to date with current evidence-based practice after you have completed the course. 


This is the first lesson in the "Stiff Shoulder" Module.

Many conditions can present with a 'stiff shoulder', and an accurate differential diagnosis is important in guiding management. 

In this lesson, we cover:

  • Definition of the 'stiff shoulder'
  • Diagnosis of glenohumeral joint pain
  • Diagnosis of glenohumeral joint stiffness
  • Differential diagnosis of 'stiff shoulder' conditions.

Study time: 3-4 hrs (approx.)

This is the second lesson in the Stiff Shoulder module.

In this lesson, we look at Frozen Shoulder. We will cover:

  • Pathoaetiology
  • Natural history
  • Diagnosis of frozen shoulder
  • Non-operative management
  • Evidence-informed physiotherapy management
  • Referral criteria

Study time: 3-4 hrs (approx.)

This is the third lesson in the Stiff Shoulder module.

In this lesson, we look at glenohumeral osteoarthritis. We will cover:

  • Pathoaetiology of osteoarthritis
  • Natural history of GHJ osteoarthritis
  • Diagnosis of GHJ osteoarthritis
  • Non-operative management
  • Referral criteria

Study time: 3-4 hrs (approx.)

Congratulations on completing the Stiff Shoulder Module!

In this section, find out how you can continue to collaborate with other students and keep up to date with latest research and clinical developments in this area with activities including:

  • Online forum
  • Stiff Shoulder Workshop
  • Stiff Shoulder Facebook Group
Please complete the evaluation form found in this section. Your CPD certificate will be sent after we receive your evaluation.

This one-day, practical workshop will enable you to apply your knowledge of stiff shoulder conditions to clinical practice.

Completion of all lessons in the Stiff Shoulder module is a pre-requisite for workshop registration. The workshop includes:

  • Physical examination test demonstration and practice
  • Differential diagnosis and clinical reasoning exercises
  • Real-time patient assessment
  • Physiotherapy treatment and rehabilitation case studies

Workshop date: 29th June 2019

Location: North Shore Hospital, Auckland, NZ

Welcome to the Unstable Shoulder module. 

This section provides you with information about the course structure, activities, resources and opportunities for keeping up to date with current evidence-based practice after you have completed the course. 


This is the first lesson in the "Unstable Shoulder" Module.

Accurate classification of shoulder instability is essential in determining appropriate management, and whether imaging or orthopaedic referral required.  

In this lesson, we cover:

  • Classification of traumatic and atraumatic shoulder instability
  • Pathoaetiology and mechanisms of traumatic and atraumatic instability
  • Pathological basis of the clinical presentations in shoulder instability

Study time: 3-4 hrs (approx.)

This is the second lesson in the "Unstable Shoulder" Module.

Traumatic and atraumatic instability differ in the structural and neuromuscular mechanisms. An accurate diagnosis is required to ensure appropriate treatment is provided.

In this lesson, we cover:

  • Pathological basis for clinical presentations of shoulder instability
  • Clinical diagnosis of shoulder instability
  • Imaging diagnosis of shoulder instability
  • Orthopaedic referral criteria

Study time: 3-4 hrs (approx.)


This is the third lesson in the "Unstable Shoulder" Module.

Non-surgical management forms the basis of treatment for many patients with instability. Understanding, and being able to assess specific neuromuscular impairments is essential in the physiotherapy management of shoulder instability.  

In this lesson, we cover:

  • Evidence-based non-surgical management of shoulder instability
  • Evidence-based physiotherapy management of shoulder instability
  • Neuromuscular rehabilitation in shoulder instability

Study time: 3-4 hrs (approx.)

Congratulations on completing the Unstable Shoulder Module!

In this section, find out how you can continue to collaborate with other students and keep up to date with latest research and clinical developments in this area with activities including:

  • Online forum
  • Unstable Shoulder Workshop
  • Unstable Shoulder Facebook Group
Please complete the evaluation form found in this section. Your CPD certificate will be sent after we receive your evaluation.

This one-day, practical workshop will enable you to apply your knowledge of shoulder instability to clinical practice.

Completion of all lessons in the Unstable Shoulder module is a pre-requisite for workshop registration. The workshop includes:

  • Physical examination test demonstration and practice
  • Differential diagnosis and clinical reasoning exercises
  • Real-time patient assessment
  • Physiotherapy treatment and rehabilitation case studies

Workshop date: 30th June 2019

Location: North Shore Hospital, Auckland, NZ

Welcome to the Rotator Cuff module. 

This section provides you with information about the course structure, activities, resources and opportunities for keeping up to date with current evidence-based practice after you have completed the course. 


This is the first lesson in the "Rotator Cuff" Module.

The ability to first differentiate the subacromial region as the source of pain is the first step in the diagnostic process for symptomatic subacromial pathology.  


In this lesson, we cover:

  • Definition of subacromial pain
  • Clinical diagnosis of subacromial pain
  • Imaging diagnosis of subacromial pain
  • Imaging indications and interpretation


Study time: 2-3 hrs (approx.)

This is the second lesson in the "Rotator Cuff" module.

Atraumatic, rotator cuff-related pain (RCRP) encompasses a number of subacromial conditions that are managed non-operatively.   


In this lesson, we cover:

  • Pathoaetiology
  • Natural history
  • Clinical diagnosis
  • Imaging diagnosis
  • Non-surgical management
  • Referral criteria

Study time: 3-4 hrs (approx.)

This is the third lesson in the "Rotator Cuff" module.

Identification and appropriate referral for orthopaedic review is important for traumatic rotator cuff tears. 


In this lesson, we cover:

  • Classification
  • Pathoaetiology
  • Natural history
  • Clinical diagnosis
  • Imaging diagnosis
  • Non-surgical management
  • Referral criteria

Study time: 3-4 hrs (approx.)


This is the fourth lesson in the "Rotator Cuff" module.

Massive or inoperable rotator cuff tears require specific rehabilitation, and many patients regain good upper limb function. 

In this lesson, we cover:

  • Classification
  • Pathoaetiology
  • Natural history
  • Clinical diagnosis
  • Imaging diagnosis
  • Non-surgical management and specific rehabilitation
  • Referral criteria

Study time: 3-4 hrs (approx.)

This is the fifth lesson in the "Rotator Cuff" module.

Calcific tendinopathy is a cell-mediated process that may be self-limiting, or may require specific intervention.  


In this lesson, we cover:

  • Pathoaetiology
  • Natural history
  • Clinical diagnosis
  • Imaging diagnosis
  • Non-surgical management
  • Referral criteria

Study time: 3-4 hrs (approx.)


Congratulations on completing the Rotator Cuff Module!

In this section, find out how you can continue to collaborate with other students and keep up to date with latest research and clinical developments in this area with activities including:

  • Online forum
  • Rotator Cuff Workshop
  • Rotator Cuff Facebook Group
Please complete the evaluation form found in this section. Your CPD certificate will be sent after we receive your evaluation.

This one-day, practical workshop will enable you to apply your knowledge of Rotator Cuff conditions to clinical practice.

Completion of all lessons in the Rotator Cuff module is a pre-requisite for workshop registration. The workshop includes:

  • Physical examination test demonstration and practice
  • Real-time patient assessment
  • Patient management
  • Physiotherapy treatment and rehabilitation case

Workshop date: 23rd November 2019

Location: North Shore Hospital, Auckland, NZ


Welcome to the Acromioclavicular Joint module. 

This section provides you with information about the course structure, activities, resources and opportunities for keeping up to date with current evidence-based practice after you have completed the course. 

This is the first lesson in the "Acromioclavicular Joint" Module.

The ability to first differentiate the AC joint as the source of pain, then sub-differente specific pathologies that vary significantly in both investigations, management and prognosis, is essential in the effective management of AC joint conditions. 


In this lesson, we cover:

  • Anatomy and pathomechanics of the acromioclavicular joint
  • Clinical diagnosis
  • Imaging diagnosis
  • Diagnostic injections


Study time: 2-3 hrs (approx.)

This is the second lesson in the "Acromioclavicular Joint" Module.

AC joint instability is a common injury, with varying correlation between symptoms and grade of injury. In this lesson we look at the classification of AC joint instability and how this guides management.  


In this lesson, we cover:

  • Pathoaetiology of acromioclavicular joint instability
  • Classification and natural history
  • Clinical and imaging diagnosis
  • Non-surgical management
  • Referral criteria


Study time: 3-4 hrs (approx.)

This is the third lesson in the "Acromioclavicular Joint" Module.

The two most common arthropathies affecting the acromioclavicular joint are osteoarthritis and osteloysis. In this lesson we look at the  differences in the pathoaetiology, diagnosis and management of both these conditions. 


In this lesson, we cover:

  • Pathoaetiology of acromioclavicular joint arthropathy
  • Classification and natural history
  • Clinical and imaging diagnosis
  • Non-surgical management
  • Referral criteria


Study time: 3-4 hrs (approx.)

This is the fourth lesson in the "Acromioclavicular Joint" Module.

The sternoclavicular joint can be affected by a wide range of primary pathologies, and is involved in a number of systemic disease processes. Differential diagnosis is critical in identifying red flags and guiding appropriate medical and non-surgical management. 


In this lesson, we cover:

  • Anatomy & pathoaetiology
  • Classification and natural history
  • Clinical diagnosis
  • Diagnostic investigations
  • Non-surgical management
  • Referral criteria


Study time: 2-3 hrs (approx.)

Congratulations on completing the Acromioclavicular Joint Module!

In this section, find out how you can continue to collaborate with other students and keep up to date with latest research and clinical developments in this area with activities including:

  • Online forum
  • Acromioclavicular Joint Workshop
  • Acromioclavicular Joint  Facebook Group

Please complete the evaluation form found in this section. Your CPD certificate will be sent after we receive your evaluation.

Welcome to the "Surgical Management of the Stiff Shoulder" module. 

This section provides you with information about the module structure, activities, resources and opportunities for keeping up to date with current, evidence-based practice after you have completed the module. 


Mr Khalid Mohammed (Shoulder and Upper Limb Specialist) presents on "Surgical Management" of the stiff shoulder. 

This lesson covers:

  • Pathoaetiology and clinical presentation
  • Clinical examination
  • Imaging
  • Orthopaedic referral criteria
  • Surgical procedures
  • Surgical outcomes
  • Post-operative rehabilitation considerations.

Study time: 1 hour (approx.)

Dr Angela Cadogan (Physiotherapy Specialist) presents the post-operative rehabilitation of the stiff shoulder.

This lesson covers rehabilitation following:

  • Manipulation under anaesthesia
  • Arthroscopic capsular release
  • Total shoulder arthroplasty
  • Reverse shoulder arthroplasty

Study time: 2 hrs (approx.)

Congratulations on completing the Surgical Management of the Stiff Shoulder Module!

In this section, find out how you can continue learning about "Stiff Shoulder" conditions, including differential diagnosis, surgical and non-surgical management. 

We hope you enjoyed the module. Please complete the evaluation form found in this section. Your CPD certificate will be sent after we receive your evaluation.

Welcome to the "Surgical Management of the Unstable Shoulder" module. 

This section provides you with information about the module structure, activities, resources and opportunities for keeping up to date with current, evidence-based practice after you have completed the module. 

A manual is provided in this section containing slides from the video presentations.


Mr Khalid Mohammed (Shoulder and Upper Limb Specialist) presents on "Surgical Management" of the unstable shoulder. 

This lesson covers:

  • Clinical examination
  • Imaging
  • Surgical techniques
  • Surgical decision-making
  • Post-operative rehabilitation considerations.

Study time: 1 hour (approx.)

Dr Angela Cadogan (Physiotherapy Specialist) presents the post-operative rehabilitation of the unstable shoulder.

This lesson covers rehabilitation following:

  • Arthroscopic labral repair
  • Latarjet procedure
  • Return to sport considerations


Study time: 1.5 hrs (approx.)

Congratulations on completing the Surgical Management of the Unstable Shoulder Module!

In this section, find out how you can continue learning about "Unstable Shoulder" conditions, including differential diagnosis, surgical and non-surgical management. 

We hope you enjoyed the module. Please complete the evaluation form found in this section. Your CPD certificate will be sent after we receive your evaluation.


The "Surgical Management of the Stiff Shoulder" seminar. 

In this seminar Mr Khalid Mohammed (Shoulder and Upper Limb Specialist) will cover the surgical management of frozen shoulder and glenohumeral osteoarthritis including:

  • Pathoaetiology and clinical presentation
  • Clinical examination and imaging investigations
  • Orthopaedic referral criteria
  • Surgical techniques and outcomes

Dr Angela Cadogan (Physiotherapy Specialist) will cover post-operative rehabilitation for:

  • MUA and arthroscopic capsular release
  • Anatomic Total Shoulder Arthroplasty
  • Reverse Total Shoulder Arthroplasty

If you have already registered, click to enter the online learning site where you will find more information about this, and other courses and seminars.  To register for this Seminar click here.


The "Surgical Management of the Unstable Shoulder" seminar. 

Mr Khalid Mohammed (Orthopaedic Surgeon) talks about the surgical management of frozen shoulder and glenohumeral joint osteoarthritis including:

  • Clinical differential diagnosis
  • Orthopaedic referral criteria
  • Surgical techniques and outcomes
  • Post-operative considerations

 Dr Angela Cadogan (Physiotherapy Specialist) will then cover post-operative rehabilitation principles for:

  • arthroscopic anterior shoulder stabilisation
  • Latarjet surgery

If you have already registered, click to enter the online learning site where you will find more information about this, and other courses and seminars.  To register for this Seminar click here.


The "Surgical Management of the Rotator Cuff" seminar. 

Mr Khalid Mohammed (Orthopaedic Surgeon) talks about the surgical management of the Rotator Cuff including:

  • Clinical differential diagnosis
  • Orthopaedic referral criteria
  • Surgical techniques and outcomes
  • Post-operative considerations

 Dr Angela Cadogan (Physiotherapy Specialist) will then cover post-operative rehabilitation principles for arthroscopic rotator cuff repair surgery. 

If you have already registered, click to enter the online learning site where you will find more information about this, and other courses and seminars.  To register for this Seminar click here.



The "Surgical Management of the Rotator Cuff" seminar. 

Mr Khalid Mohammed (Orthopaedic Surgeon) talks about the surgical management of the Rotator Cuff including:

  • Clinical differential diagnosis
  • Orthopaedic referral criteria
  • Surgical techniques and outcomes
  • Post-operative considerations

 Dr Angela Cadogan (Physiotherapy Specialist) will then cover post-operative rehabilitation principles for arthroscopic rotator cuff repair surgery. 

If you have already registered, click to enter the online learning site where you will find more information about this, and other courses and seminars.  To register for this Seminar click here.



The "Surgical Management of the  Acromioclavicular Joint seminar. 

Mr Khalid Mohammed (Orthopaedic Surgeon) talks about the surgical management of the Acromioclavicular Joint including:

  • Clinical diagnosis and classification
  • Orthopaedic referral criteria
  • Surgical techniques and outcomes
  • Post-operative considerations

 Dr Angela Cadogan (Physiotherapy Specialist) will then cover post-operative rehabilitation principles for acromioclavicular joint stabilisation surgery. 

If you have already registered, click to enter the online learning site where you will find more information about this, and other courses and seminars.  To register for this Seminar click here.