Dr Angela Cadogan - Physiotherapy Specialist

04/06/2025

"The Shoulder Needs Chaos". Had great fun co-presenting the Shoulder Instability Masterclass with Prof. Jeremy Lewis this morning. Have seen 2 instability patients in clinic today & looking forward to the Atraumatic Instability session with the Shoulder Academy team tonight. A day full of Instability teaching & learning!

If you're interested in joining the session tonight see comments below. 👇

Agence EBP Physio Academy - Learning

27/05/2025

Looking forward to this one!

Physio Academy - Learning

C’est parti 🔥 Les inscriptions à la nouvelle masterclass EBP sont ouvertes !
📆 Le 3 juin à 20h, on parle d’épaule instable avec Angela Cadogan & Jeremy Lewis 💥
Cas cliniques, outils concrets, Q&A…
🎯 Tarif early bird : 75€ au lieu de 90€ jusqu’au 30 mai
📲 Lien d’inscription: https://www.agence-ebp.com/masterclass-dr-angela-cadogan-pr-jeremy-lewis

13/05/2025

Proximal humerus fracture. (Case study and infographic).
Many patients suffer high levels of persistent pain and stiffness-related disability after proximal humerus fractures. How much is normal and when should you be concerned?

At the Shoulder Academy Q&A last week I presented a case study of a patient with a proximal humerus fracture who was managed non-surgically, the fracture healed but she went on to develop other complications.

The case study highlighted the importance of differential diagnosis and identifying 'lack of progress' and deciding on a course of action. The outcome significantly changed her treatment pathway.

The recording is available for Shoulder Academy members on your Dashboard (Q&A course).

There is also a downloadable infographic for this session: https://learning.physioacademy.courses/products/digital_downloads/Avascular-Necrosis

📅 Next up: Unstable Shoulder 4th June.

If you’re interested in finding out more about Shoulder Academy and learning more about shoulder diagnosis, clinical pathways and rehabilitation, click the link below.
ℹ Shoulder Academy: www.shoulderacademy.co.nz


Physio Academy - Learning

11/04/2025

Another inspiring conference en France! 🇫🇷

A huge merci to SFP-Société Française de Physiothérapie and the committee for the invitation to present at the French national physiotherapy conference in Montpellier last week.

Almost 2000 French physiotherapists attended the national conference to share learnings and experience. As France moves towards direct access I was privileged to share my experiences with them on diagnosis, clinical pathways and triage for shoulder conditions.

A highlight for me was the 'trial' - a presentation where the biopsychosocial model was put on trial. Both the prosecution and the defense made excellent arguments and in the end the jury acquitted the model, but not without some excellent points being made. Very entertaining!

It was also an opportunity also to visit the beautiful, historic city of Montpellier in the south of France. Montpellier is home to the oldest, continuously practicing medical school in the world with its teachings dating back to 1180AD and attended by many scholars and scientists including Nostradamus. The sort of history we just don't experience here in NZ.

As always I learnt much, met many new friends and am very grateful once again to the French physiotherapy community for their hospitality and for the opportunity. À bientôt.

Agence EBP Physio Academy - Learning

13/02/2025

Merci to the Société Française de Physiothérapie for the invitation to present a workshop at their conference in Montpellier, France on 5th April.

As more countries move towards direct access the focus of this workshop will be on clinical diagnosis, imaging indications & treatment pathways for rotator cuff conditions. We'll also cover physiotherapy rehabilitation for rotator cuff disorders.

A bientot! 🇫🇷🙂

24/11/2024

Emerging concepts in posterior shoulder instability.
Could acromial morphology influence posterior shoulder instability?

A few weeks ago I had the absolute privilege and pleasure of hearing Mr Christian Ge**er, MD, PhD speak at a local orthopaedic meeting in Christchurch. He had many insights to share including emerging concepts in posterior shoulder instability.

As physiotherapists we are very familiar with the dynamic stability system of the shoulder. We also know about glenoid structural factors that contribute to posterior instability including glenoid version, and glenoid morphology. But little is known about acromial morphology and shoulder instability.

It was fascinating to hear the story of how Christian began looking at acromial morphology as another possible factor in posterior instability several years ago. He and his colleagues looked further into it and found that a high acromion and flat acromion were strongly associated with both static (in GHJ OA) and dynamic posterior instability. I’ve summarized one of the papers he was involved in below. Other work done since then has supported these findings.

In reflecting on this presentation, could a lower acromial height and tilted acromion have perhaps been an advantage in the evolutionary quadripedal period providing a restraint to posterior translation when walking on all-4 limbs? Perhaps now that we are upright walkers with less posterior forces through the upper limb, could the acromion be evolving accordingly? Or could this affect our primitive reflex integration and/or function of the posterior cuff? No answers here I’m afraid but food for thought.

None of this is likely to change what we do as physiotherapists but it’s fascinating to hear new insights that may help us identify sub-groups of both static (GHJ OA) and dynamic posterior instability and may influence our multidisciplinary management of these patients in the future.

Article link: https://pubmed.ncbi.nlm.nih.gov/31318804/

Thanks to Alpha Medical and Bonebridge for hosting the session.

17/11/2024

📈 Measuring Up: Are Force Measures Adding Value to Shoulder Rehab?

Ahead of the SEPNZ/SMNZ Conference in Hamilton this coming weekend, I’ve put down some thoughts about the value of force technology in shoulder rehab and what it takes to really get the most out of our force testing.

I’ll be diving deeper into this topic in a practical workshop with my Specialist Physiotherapy colleagues at the upcoming Sports and Exercise Physiotherapy New Zealand conference in Hamilton. Hope to see you there!

Check out the blog for some food for thought. Link in comments.

28/10/2024

Atraumatic AC joint conditions:
If you're not seeing them, they're seeing you. 👀

Another good Q&A session with the Shoulder Academy team last Thursday night. We covered 4 case studies of atraumatic AC joint pain including differential diagnosis, non-surgical management, rehab principles and prognosis.

Interesting discussion arose about imaging of the AC joint. We all know the high prevalence (pre-test probability) of imaged pathology in asymptomatic populations. Does anyone see asymptomatic patients? We should be more interested in the prevalence (pre-test probability) of AC joint pathology in the symptomatic population as this is the population we see.

Thanks to all of you for attending. It is so valuable having clinicians from different settings join these sessions and contribute their knowledge and experience.

📥 Free Digital Download - link in comments:
How to Modify a Gym Programme for Patients with AC Joint Pain.

📲 Shoulder Academy members: Recording of this session is now available as video or audio file. You can also access the AC joint online course through your membership if you'd like to learn more.

👇 More Shoulder Academy info in comments. These sessions are free for Shoulder Academy members.

Physio Academy - Learning

20/10/2024

Massive Irreparable Rotator Cuff Tears (MIRCT):
Who is likely to do well with physiotherapy?

I was involved in this Delphi study last year along with 88 other physiotherapists and orthopaedic surgeons looking at agreement on the factors that help determine whether someone with a MIRCT will benefit from physiotherapy. Great to see it in print. 👏

This is certainly a patient group where expectations and realistic goal setting are key to a "successful" outcome, and consensus was reached on both these factors being important, and modifiable in this group. Other clinical, anatomic and psychologic factors were also found to be relevant to outcome.

I've summarised the article below.

Ó Conaire E, Rushton A, Jaggi A, Delaney R, Struyf F. What are the predictors of response to physiotherapy in patients with massive irreparable rotator cuff tears? Gaining expert consensus using an international e-Delphi study. BMC Musculoskelet Disord. 2024;25(1):807.

Link to article in comments below (full text available).

13/10/2024

Neck or Shoulder Pain? Who to screen and how?

Establishing Consensus for Spine Screening in Patients with Shoulder Pain: an International Modified Delphi Study.

It was a pleasure to co-author this study and congratulations to Néstor Requejo-Salinas for the publication which I have summarised below.

Currently there are no guidelines on this meaning it is up to the individual therapists' clinical reasoning to decide which patients to screen and what tests to use to do this.

Requejo-Salinas N, Fernández-Matías R, Cadogan A, Chester R, Roy J-S, Struyf F, et al. Neck or Shoulder? Establishing Consensus for Spine Screening in Patients with Shoulder Pain: an International Modified Delphi Study. Physical Therapy. 2024.

Article link in comments.

07/10/2024

Unusual shoulder presentations:

Over the last 2-3 years I've seen a lot of 'complex' shoulder conditions. Some of the presentations have been interesting and really challenged my clinical reasoning. Here's a few examples:

1. A 46 year old male (Syrian refugee), 18 months post- rotator cuff repair surgery with ongoing severe pain, stiffness (referred with 'frozen shoulder') and significant tremor of the c-spine and shoulder on any attempt to move the neck or shoulder respectively.

2. A 24 year old female, 4 year history of chronic, widespread thoracic, shoulder girdle pain and recurrent atraumatic shoulder dislocations. She was completely unable to 'feel' her affected arm. Her arm felt 'missing'.

3. A 22 year old male with hypermobility, autism, ADHD and dyspraxia. His shoulder posteriorly dislocated when reaching above his head at work. Normal imaging. Now can fully flex with a bent arm, but 'long lever' flexion limited to 80 deg with posterior subluxation, marked lat dorsi tone/activity and nothing (and I've tried everything) will inhibit the abnormal muscle patterning.

All had tried strengthening. Things I have learnt about these patients:
- How the brains' sensorimotor cortex changes in presence of trauma/pain.
- How nociplastic pain affects sensory processing and motor control
- How to differentiate functional vs organic tremor
- The impact of psychologic trauma and fear on sensory processing and motor control.
- How dissociative disorders manifest as MSK presentations and their relationship with psychologic trauma.
- The impact of neurodevelopmental factors on motor control.

What a journey! This is the reason I teamed up with Dr Jacqui Clark. Together we try to shortcut the journey for other physiotherapists seeing complex shoulders. So much of what we teach on our course will also give you the tools to fine-tune your rehab with other MSK conditions and anyone with persistent pain.

If you want to learn more about how to assess and manage complex shoulders, Jacqui and I would love to see you in Christchurch on Nov 9th and 10th and fill in some rehab gaps to help you to help your patients.

Course link in comments.

02/10/2024

Peer Mentoring: Are you "mentoring" or "supervising"?

Thanks to the Physiotherapy New Zealand conference committee for the invitation to present a workshop on this topic a few weeks ago with Dr Margaret Potter. We had over 100 attend the session - a fantastic turnout!

At the beginning of the session, we asked how many people were involved in mentoring roles in the workplace. Most of the >100 attendees raised their hands.

Margaret and I then went on to discuss the important and key differences between mentoring, and clinical supervision, professional supervision and preceptorship. After the session many people came us and told us that, on reflection, they actually weren't 'mentoring' at all, but acting more in a clinical supervision role.

We covered the differences in roles, why they are important, why having a mentor independent of the workplace is important, and the different skills required for effective mentoring.

If you want to improve your mentoring skills check out Margaret's "Mentoring on the Run" live online course, the next intake starts this Saturday 5th October. Details in comments.

You also can find a link to more Mentoring resources, including our published study on New Graduate mentoring in the comments below.

Thanks to everyone who attended for your interest and your dedication to supporting others in our profession.