Certificate Program
Orthopedic Excellence of the Upper Quarter (Certificate)
Advance your clinical skills in the evidence-based evaluation and management of patients with upper extremity-related conditions.
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About this Certificate Program
Enhance the quality of care you provide patients who suffer from upper-extremity-related conditions by becoming skilled in the best evidence-based approaches available and expanding the lens through which you view your patients using the Pain and Disability Drivers model. In this certificate program, you will learn examination and treatment fundamentals through a clinical decision-making paradigm for disorders and dysfunctions for the shoulder, elbow, wrist, and hand, and integrate advanced technical concepts to improve clinical outcomes in your practice.
Target audience
The certificate program is designed to improve clinical outcomes for all clinicians who treat orthopedic-related conditions of the shoulder, elbow, wrist, and hand, but it would be especially beneficial for recent graduates, residents in training, individuals who function in a closed system of health care who are interested in designing best treatment pathways, or individuals who are returning to treatment of patients with orthopedic problems.
Goals & objectives
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Demonstrate advanced understanding and clinical competency in the evaluation and treatment of disorders and dysfunction in shoulder-, elbow-, wrist-, and hand-related conditions
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Synthesize course materials to standardize care pathways and reduce clinical variation
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Practice and apply the best clinical tests to maximize clinical efficiency
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Compare and contrast intervention methods for each of the shoulder-, elbow-, wrist-, and hand-related conditions
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Apply the Pain and Disability Drivers model and the latest evidence to optimize treatment choices by clinical presentation
What’s included in the Certificate Program
Accredited Online Courses*
15 hours of online video lectures and patient demonstrations.
Interactive Learning Assessments
Case-based quizzes to evaluate and improve clinical reasoning.
Case Study Interviews
Recorded Q&A sessions between instructors and practice managers.
Certificate Program overview
Section 1
Introduction 3 ItemsA Primer on Examination and Treatment Metrics Course
Chapter 1: Orthopedic Excellence Series Introduction
In this chapter, learners will be introduced to the Orthopedic Excellence Series and the constructs of this series, including the Pain and Disability Drivers Management model. Learners will become familiar with common epidemiological terms and statistics that govern diagnostic accuracy and their clinical application.
Chapter 2: Helpful Epidemiological Terms
In this chapter, learners will be introduced to terms that are helpful to understand when contemplating valuable information from a patient history, like incidence, prevalence, risk, and prognosis.
Chapter 3: Screening and Diagnosis
In this chapter, learners will gain a greater understanding of the language of diagnosis and explore the importance of screening, diagnostic accuracy, and quality of diagnostic accuracy studies.
Chapter 4: Measuring Outcomes and Treatment Effects
In this chapter, learners will become familiar with the categories of outcome measures and the importance of these measures in performing a thorough patient interview as well as an assessment of treatment effect. Statistics such as minimal detectable change, measures of effect, and floor/ceiling effects will be discussed.
Crucial Factors Influencing Health & Recovery in Musculoskeletal Care Course
Chapter 1: Our Outcomes Are Worsening: Why?
Musculoskeletal disorders are the second most common cause of disability. Chronic conditions continue to worsen, and despite millions of dollars in research and thousands of review and guidelines articles, patient-reported outcomes for those with musculoskeletal injuries have worsened. We now recognize that our lack of progress in achieving better treatment results is rooted in the fact that we have failed to focus on identifying and addressing the factors that really do influence patients’ outcomes. This chapter outlines why our outcomes have worsened and what domains are necessary to assess for better outcomes.
Chapter 2: The Pain and Disability Drivers Model
The Pain and Disability Drivers model was created to give clinicians an understanding of which domains influence pain and disability. Five domains are discussed: nociceptive, neuropathic, comorbidity, cognitive-emotional, and social/environmental. Within the five domains, learners will be exposed to subclassifications of conditions that influence severity. Interactions among domains is also discussed.
Chapter 3: Nociceptive Pain Drivers
Nociception and pain are two distinct components. Nociception is the sensory nervous system's response to certain harmful or potentially harmful stimuli. On the other hand, pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage. Nociception can cause the pain experience and is deserving of assessment. In this chapter, we describe key nociceptive triggers and associative examination methods for each.
Chapter 4: Neuropathic Pain Drivers
Neuropathic pain arises as a direct consequence of a lesion or disease affecting the nerves or nervous system. Neuropathic pain may be associated with radiculopathy, myelopathy, and peripheral and/or central nervous system hypersensitivity. In this chapter, we describe the key neuropathic descriptors, tests, and measures used for assessment.
Chapter 5: Comorbidity Pain and Disability Drivers
It is well described that comorbidities, sleep hygiene, and severe mental health illness are responsible for mediating health outcomes or worsening outcomes. These factors may influence both pain and disability. Conditions such as osteoarthritis are expected to continue to rise with an increasingly obese, sedentary, and aging population. Standard measurement of these factors should be as principal in a clinical examination as measuring vital signs. In this chapter, we describe key associative examination methods for each.
Chapter 6: Cognitive and Emotional Pain and Disability Drivers
Much research has gone into understanding how moods and cognitions influence pain and disability outcomes. In fact, more than 5,200 peer-reviewed articles per year are published on this specific topic. Moods and cognitions can elicit a pain experience and can mediate outcomes. Moods and cognitions are particularly important when behaviors are changed in the individual. In this chapter, we describe key associative examination methods for cognitions and moods that influence pain and disability. We also discuss the challenges of medicalization of moods and how to reduce this risk in practice.
Chapter 7: Social and Environmental Disability Drivers
Social and environment factors remain the strongest and most elusive of outcomes mediators and moderators. Commonly called "social determinants of health," social and environmental factors can influence outcomes and health-related disability. There is a significant challenge associated with how to measure these factors. In this chapter, we describe key associative examination methods that are transferable for all cultures and populations.
A Primer on Exercise and Treatment Prescription Course
Chapter 1: Navigating the Exercise Prescription Road Map to Healthy Recovery
This chapter will review the principles of therapeutic exercise and the physiological principles behind how exercise can facilitate tissue healing. Viewers will be introduced to terminology, including mechanotherapy, or the turning of movement into repair. Introduction of common tissue healing times and physiological adaptations will be discussed, including a discussion on mechanotherapy/mechanotransduction and how exercise promotes tissue repair.
Chapter 2: Prescription Training Principles and Variables Estimated Length
This chapter will review exercise training principles, including progressive overload, specificity, variation, reversibility, and individualization. Recommendations and basic principles of resistance training in accordance with the American College of Sports Medicine are introduced, including training guidelines for strength, power, endurance, hypertrophy, and plyometric training. Progression in terms of duration, speed, distance, and repetitions will be discussed.
Chapter 3: Load Management
We will discuss the principle of "optimal loading," including characteristics of optimal versus suboptimal loading and tissue-specific loading factors. The POLICE principle is explained with regard to acute injury management.
Chapter 4: Framework for Exercise Prescription and Progression
This chapter will discuss clinical decision-making with regard to initiation, progression, and regression of exercise. Further phases of progression will be focused on extrinsic factors, such as change in stimulus or the environment in which the exercise is performed. A sample exercise progression program is provided to the viewer at the end of this chapter.
Chapter 5: FITTSBALL
This chapter will introduce the viewer to a more holistic approach to exercise prescription that blends the technical domain with the cognitive-behavioral domain and methods for improving patient adherence to exercise.
Section 2
Shoulder 4 ItemsEvidence-Based Examination of the Shoulder: An Update Course
Chapter 1: Prevalence, Incidence, and Etiology of Shoulder Pain/Pathology
In this chapter, learners will evaluate the economic impact of shoulder dysfunction and consider the prevalence/incidence of shoulder pain and how this influences clinical practice. In addition, prognostic factors of positive and negative outcomes will be discussed. The overall burden of shoulder pain is discussed in comparison to other musculoskeletal and nonmusculoskeletal conditions worldwide.
Chapter 2: Patient History and Outcomes Assessment
In this chapter, learners will discuss the imperative patient history elements of a shoulder examination and define which patient history components are affiliated with shoulder pathology. Learners will also discuss the most common forms of self-report patient outcomes measures, as well as their validity.
Chapter 3: Observation
In this chapter, learners will identify the link between observation of posture and shoulder pain or dysfunction. Learners will also identify benefits of general observation of a patient’s expression of fear, anxiety, or distress.
Chapter 4: Triage and Screening
In this chapter, learners will identify the most prevalent red flags germane to the shoulder examination. The chapter will compare and contrast the purposes of each screening test for sinister problems. Learners will also analyze the triggers that would prompt the use of a test for ruling out a condition and evaluate the benefit of performing these “ruling out” actions first within the examination. Lastly, learners will understand structural differentiation.
Chapter 5: Motion Testing
This chapter will synthesize the importance of the movement assessment and will contrast the goals of the three primary phases of the initial examination.
Chapter 6: Palpation, Muscle Testing, and Performance
This chapter will evaluate the benefit of palpation as part of a dedicated clinical examination. Learners will also evaluate the benefit and types of muscle testing for the shoulder.
Special Tests of the Shoulder Course
Chapter 1: What Makes a Test Special?
In this chapter, learners will get a very brief review of diagnostic accuracy statistics and what makes a quality test.
Chapter 2: Special Tests for Rotator Cuff Pathology
In this chapter, learners will discover the best special tests to identify rotator cuff pathologies encountered in clinical practice.
Chapter 3: Special Tests for a Torn Glenoid Labrum
In this chapter, learners will discover the best special tests to identify labral tears encountered in clinical practice.
Chapter 4: Special Tests for Instability
In this chapter, learners will discover the best special tests to identify instability of the glenohumeral joint.
Chapter 5: Miscellaneous Special Tests
In this chapter, learners will discover the best special tests to identify less common pathologies.
Evidence-Based Treatment of the Shoulder: An Update Course
Chapter 1: Common Pathologies
In this chapter, learners will recognize the more prevalent shoulder pathologies seen in musculoskeletal practice. One of the key goals is geared toward understanding the etiology behind each of the pathologies and the prognosis of each.
Chapter 2: Key Components of the Pain and Disability Domain
The primary pain and disability drivers for the shoulder include nociceptive pain elements, neuropathic pain elements, comorbidity pain and disability elements, mood and cognitive pain and disability elements, and social and environmental factors that influence disability. Each of the domains specific to the shoulder is discussed.
Chapter 3: Local Interventions Directed at Impairments
This chapter reviews the techniques used to target pain relief or strength specifically toward the region that is impaired within the shoulder. The chapter will analyze the effectiveness of each technique for treatment within the local impairment classification.
Chapter 4: Regional Interventions Directed at Function
In this chapter, learners will review the adjunctive techniques used to target the primary impairment and secondary contributors. Learners will analyze the effectiveness of each technique for treatment within the regional designation.
Chapter 5: Global-Body or Whole-Person Interventions Directed at Participation
Within this chapter, the focus is less upon the impairment and more on motor control, proprioception, cognitions, behaviors, and whole-body conditioning. Learners will review techniques associated with lifestyle medicine, global management, and cognitive-behavioral approaches.
Management of the Shoulder: Case-Based Vignettes Course
Chapter 1: Case One
In this chapter, which represents Case One, learners will evaluate a defined, comprehensive case and will explore key examination and treatment principles based on the Pain and Disability Drivers model, the best examination methods identified from previous coursework, and the best treatment options from previous coursework.
Chapter 2: Case Two
In this chapter, which represents Case Two, learners will evaluate a defined, comprehensive case and will explore key examination and treatment principles based on the Pain and Disability Drivers model, the best examination methods identified from previous coursework, and the best treatment options from previous coursework.
Chapter 3: Case Three
In this chapter, which represents Case Three, learners will evaluate a defined, comprehensive case and will explore key examination and treatment principles based on the Pain and Disability Drivers model, the best examination methods identified from previous coursework, and the best treatment options from previous coursework.
Chapter 4: Case Four
In this chapter, which represents Case Four, learners will evaluate a defined, comprehensive case and will explore key examination and treatment principles based on the Pain and Disability Drivers model, the best examination methods identified from previous coursework, and the best treatment options from previous coursework.
Section 3
Elbow, Wrist, and Hand 3 ItemsEvidence-Based Examination of the Elbow, Wrist, and Hand: An Update Course
Chapter 1: Elbow, Wrist, and Hand Dysfunction: Prevalence and Economic Impact
In this chapter, learners will evaluate the economic impact of elbow, wrist, and hand dysfunction and consider the prevalence/incidence of elbow, wrist, and hand pain and how this influences clinical practice. The overall burden of elbow, wrist, and hand pain is discussed in comparison to other musculoskeletal and nonmusculoskeletal conditions worldwide.
Chapter 2: Patient History and Outcomes Measures
In this chapter, learners will discuss the imperative patient history elements of an upper extremity examination and define which patient history components are affiliated with elbow, wrist, and hand pathology. Learners will also discuss the most common forms of self-reported patient outcomes measures, as well as their validity.
Chapter 3: Observation
In this chapter, learners will identify specific anatomical features available on observation that are related to elbow, wrist, and hand dysfunction. Learners will also identify benefits of general observation of a patient’s expression of fear, anxiety, or distress.
Chapter 4: Triage and Screening
In this chapter, learners will identify the most prevalent red flags germane to the elbow, wrist, and hand examination. The chapter will compare and contrast the purposes of each diagnostic test for sinister problems. Learners will also analyze the triggers that would prompt the use of a test for ruling out a condition and evaluate the benefit of performing these “ruling out” actions first within the examination. Lastly, learners will understand structural differentiation.
Chapter 5: The Motion Examination
This chapter will synthesize the importance of the movement assessment and will contrast the goals of the three primary phases of the initial examination.
Chapter 6: Palpation, Muscle Endurance, and Physical Performance Measures
This chapter will evaluate the benefit of palpation as part of a dedicated clinical examination. Learners will also evaluate the benefit and types of manual muscle testing for the elbow, wrist, and hand.
Chapter 7: Confirmation-Based Special Tests
In this chapter, learners will understand the language of diagnostic accuracy and will identify the most diagnostic elbow-, wrist-, and hand-oriented special tests. The purpose of the chapter is to apply the tests to the appropriate diagnoses for better patient management.
Evidence-Based Treatment of the Elbow, Wrist, and Hand: An Update Course
Chapter 1: Common Pathologies of the Elbow, Wrist, and Hand
In this chapter, learners will recognize the most prevalent elbow, wrist, and hand pathologies seen in musculoskeletal practice. One of the key goals is understanding the etiology behind each of the pathologies and the prognosis of each.
Chapter 2: Pain and Disability Drivers of the Elbow, Wrist, and Hand
The primary pain and disability drivers for the elbow, wrist, and hand include: (1) nociceptive pain elements, (2) neuropathic pain elements, (3) comorbidity pain and disability elements, (4) mood and cognitive pain and disability elements, and (5) social and environment factors that influence disability. Each of the domains that is specific to the elbow, wrist, and hand is discussed.
Chapter 3: Interventions Directed at Impairments and to the Joint Experiencing the Impairment
This chapter reviews the techniques used to target pain relief or strength specifically toward the targeted region that is impaired within the elbow, wrist, and hand. The chapter will analyze the effectiveness of each technique for treatment within the local impairment classification.
Chapter 4: Regional Interventions Directed at Structures That Mediate the Impaired Level
In this chapter, learners will review the adjunctive techniques used to target the primary impairment and secondary contributors. Learners will analyze the effectiveness of each technique for treatment within the regional designation.
Chapter 5: Global Interventions for the Elbow, Wrist, and Hand
Within this chapter, the focus is less on the impairment and more on motor control, proprioception, cognitions, behaviors, and whole-body conditioning. Learners will review techniques associated with lifestyle medicine, global management, and cognitive-behavioral approaches.
Elbow, Wrist, and Hand Examination and Treatment: Cases to Synthesize Learning Course
Chapter 1: Case One
In this chapter, which represents Case One, learners will evaluate a defined, comprehensive case. Learners will explore key examination and treatment principles based on the Pain and Disability Drivers Management model, the best examination methods identified from previous coursework, and the best treatment options identified from previous coursework.
Chapter 2: Case Two
In this chapter, which represents Case Two, learners will evaluate a defined, comprehensive case. Learners will explore key examination and treatment principles based on the Pain and Disability Drivers Management model, the best examination methods identified from previous coursework, and the best treatment options identified from previous coursework.
Chapter 3: Case Three
In this chapter, which represents Case Three, learners will evaluate a defined, comprehensive case. Learners will explore key examination and treatment principles based on the Pain and Disability Drivers Management model, the best examination methods identified from previous coursework, and the best treatment options identified from previous coursework.
Chapter 4: Case Four
In this chapter, which represents Case Four, learners will evaluate a defined, comprehensive case. Learners will explore key examination and treatment principles based on the Pain and Disability Drivers Management model, the best examination methods identified from previous coursework, and the best treatment options identified from previous coursework.
Instructors
Eric Hegedus
PT, DPT, PhD, MHSc, OCS
Chad Cook
PT, PhD, MBA, FAPTA, FAAOMPT
Alexis Wright
PT, PhD, DPT, OCS, FAAOMPT
CEU approved
15
total hours*
of accredited coursework.
Medbridge accredits each course individually so you can earn CEUs as you progress.
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Browse PlansFrequently asked questions
Everything you need to know about Certificate Programs.
Accreditation Hours
Each course is individually accredited and exact hours will vary by state and discipline. Check each course for specific accreditation for your license.
When do I get my certificate?
You will receive accredited certificates of completion for each course as you complete them. Once you have completed the entire Certificate Program you will receive your certificate for the program.
Do I get CEU credit?
Each course is individually accredited. Please check each course for your state and discipline. You can receive CEU credit after each course is completed.
Do I have to complete the courses in order?
It is not required that you complete the courses in order. Each Certificate Program's content is built to be completed sequentially but it is not forced to be completed this way.
How long do I have access to the Certificate Program?
You will have access to this Certificate Program for as long as you are a subscriber. Your initial subscription will last for one year from the date you purchase.
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