Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Ortho 1-first half > Shoulder Pathology > Flashcards

Shoulder Pathology Flashcards

1
Q

Frozen shoulder

A

condition characterized by functional restriction of both active and passive shoulder motion for which radiographs of the GH joint are essentially unremarkable except for the possible presence of osteopenia or calcific tendonitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

what pattern does frozen shoulder follow?

A

loss of ROM often in capsular pattern (Cyriax)

loss of ER > ABD > IR
capsular endfeel

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

frozen shoulder: shortening contracture of?

A

anterio-inferior capsule, rotator interval, coracohumeral ligament

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

frozen shoulder types

A

Primary: adhesive capsulitis (etiology unknown)

Secondary: linked cause

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

adhesive capsulitis

A
  • etiology unknown
  • regional ischemia of the shoulder soft tissues from autonomic sympathetic dysfunction?
  • some genetic tendencies
  • females>males
  • peak incidence in early 50’s
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

defined clinical course of adhesive capsulitis

A 
4 stages: 
1=acute
2=freezing
3=frozen
4=thawing
  • typically takes 1-3 years to run course
  • important that tx be individualized according to stage
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

acute stage- adhesive capsulitis

A

0-3 months

  • pathology=acute synovitis
  • pain on AROM and PROM
  • empty endfeel
  • ROM is normal (anesthesia)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

freezing stage- adhesive capsulitis

A

3-9 months

  • pathology= hypertrophic hypervascular synovitis, proliferation of scar tissue
  • pain on AROM and PROM
  • empty end feel, pain before
  • ROM becomes severely limited

*the shorter the acute & freezing (inflammatory) phase, the shorter the overall course

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

frozen stage- adhesive capsulitis

A

5-9 months

  • pathology= dense mature scar tissue, decreased capsular volume (reduction of redundant fold), contractures of coracohumeral ligament, subscapularis, subacromial bursa
  • no pain on AROM and PROM
  • capsular end feel
  • ROM severely limited
  • prolonged loss of joint ROM causes changes in muscle- loss of sarcomeres
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

thawing stage- adhesive capsulitis

A

15-24 months

  • pathology= restoration of capsular volume
  • no pain on AROM and PROM
  • capsular endfeel
  • ROM gradually improving
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

stage 1 adhesive capsulitis treatment

A

GOAL: interrupt pain and inflammation, promote relaxation, educate

modalities: as needed for: pain, inflammation, relaxation
strengthening: early closed chain

ROM: AAROM, pain free ROM, gentle PROM, pendulum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

stage 2 adhesive capsulitis treatment

A

goal: minimize pain, inflammation, capsular adhesions, and ROM restriction; posture HEP
modalities: as needed to: decrease pain & inflammation, improve tissue extensibility
strengthening: more advanced: scapular training- specific rotator cuff strengthening

ROM: AROM, PROM

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

stage 3 & 4 adhesive capsulitis treatment

A

Goal: increase ROM; posture HEP

modalities: to promote: relaxation, tissue extensibility, reduce tx discomfort
strengthening: more specific: scapular training to reestablish force couples, continued rotator cuff strengthening

ROM: more specific: AROM to reestablish scapular and GH mechanics; more aggressive stretching (PNF, STM, low load prolonged stretch)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

secondary frozen shoulder

A

Loss of ROM: underlying or associated condition can be identified

Intrinsic
Extrinsic
Systemic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Intrinsic secondary frozen shoulder

A

related directly to the GH joint

rotator cuff disorders, bicep tendonopathy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

extrinsic secondary frozen shoulder

A

remote from the GH joint

cervical radioculopathy, breast surgery, humeral or clavical fx, AC DJD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

systemic secondary frozen shoulder

A

DM, hyper/hypothyroidism, hypoadrenalism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

rotator cuff tears/impingement

A

Intrinsic/Primary

Extrinsic/Secondary

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Intrinsic/Primary rotator cuff tears/impingement

A

=subacromial space issues

  • abnormally shaped acromion (hook shaped); rough undersurface
  • degenerative changes in the AC joint
  • decreased vascularity (critical zone)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Extrinsic/Secondary rotator cuff tears/impingement

A

=stength/environment

  • GH force couple dyskinesia
  • ST force couple dyskinesia
  • posture
  • excessive overhead use of arm
  • posterior capsule shortening
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

GH force couple

A
  • deltoid elevates the arm but also produces superior translation of humeral head
  • inferior & medial forces of rotator cuff offset superior translation of deltoid (specifically infraspinatus, teres minor and subscap)
  • RC also assists in limiting anterior/posterior translation of humeral head
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

ST force couple

A

rotation of scapula is provided by trapezius force couple (upper, mid, lower) and serratus anterior

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

ST muscle balance

A
  • efficient forces depend on stability of origins of the scapula
  • scapular position affects length-tension properties of rotator cuff
  • scapular upward rotation, posterior tilt, lateral rotation- NECESSARY to maximize subacromial space
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

integrated RC, GH, and ST force couples

A

scapular rotation during arm elevation adds to total ROM

lack of scapular rotation leads to impingement

  • scapular rotation is necessary to keep acromion moving away from deltoid insertion
  • lack of scapular rotation-head of humerus translates superiorly

failure of scapular adduction-head of humerus translates anteriorly

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

neer stage 1

A
  • edema and hemorrhage
  • minimal weakness
  • excessive overhead use
  • usually <25 y/o
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

neer stage 2

A
  • fibrosis and tendonitis of cuff and bursa following repeated mechanical inflammation
  • usually 25-40 y/o
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

neer stage 3

A
  • bone spurs
  • incomplete and complete tears of cuff and biceps tendon
  • degeneration of remaining tendons
  • usually >40 y/o
  • common 5-40% > 60 y/o have evidence of full thickness tears
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

treatment principles for RC dysfunction

A

1: conservative rx for 6 months
2: surgery for RC pathology

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

conservative tx for RC dysfunction

A
  • inflammation in acute phase
  • manual therapy and exercise to address impairments in posture, weakness and stabilization
  • DO NOT ignore the cervico-thoracic spine!
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

surgery for RC dysfunction

A

Primary impingement:

  • subacromial decompression
  • acromioplasty

Primary & secondary impingement:
-capsular repair
-post-op rehab:
modalities for pain relief, inflammation
initial protection from active & passive ms force
PROM->AAROM->AROM
gentle UE closed chain, stabilization ex at 3 wks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

thoracic outlet syndrome

A

=mechanical, non-traumatic compression of the neurovascular bundle

  • largest nerves affected first: sensory first, then motor
  • poorly localized aching pain
  • need to rule out CTS, radiculopathy, distal nerve compression
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

areas at risk for thoracic outlet syndrome

A

1: superior thoracic outlet
2: scalene groove
3: costoclavicular space
4: infracoracoid space

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

TOS: superior thoracic outlet

A
  • cervical rib or long C7 TP
  • often ulnar nerve distribution
  • ^ symptoms with altered posture: forward head; protracted shoulders
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

TOS: scalene groove

A
  • between ant & middle scalene
  • scalene hypertrophy or tightness
  • forward head posture
  • symptoms ^ w/ overhead tasks and some cervical positions

**soft tissue release and posture correction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

TOS: costoclavicular space

A
  • between clavicle and 1st rib
  • elevated ribs
  • depressed, retracted shoulders
  • backpacks, carrying heavy loads
  • symptoms ^ with military postures

**1st rib, posture (scap elevation)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

TOS: infracoracoid space

A
  • beneath coracoid between pec minor and ribs
  • tight pec minor
  • symptoms ^ with overhead activity

**strengthen scap stabilizers, stretch pec minor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

hypermobility/instability of GH joint

A

-GH stability involves articular geometry, the static capsulo-ligamentous complex, dynamix muscular stabilizers and NM control

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

most common abnormal GH motions

A
  • excessive anterior translation during lateral rotation and abduction
  • excessive anterior translation during medial rotation
  • potential for axillary nerve damage
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

continuum of shoulder stability

A

Normal: normal congruity and loading

Lax/hypermobile: congruity maintained, but joint is unloaded

Subluxed: partial contact of articular surfaces- congruity lost

Dislocated: no contact of articular surfaces- congruity lost

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

contribution of shoulder musculature to joint stability

A
  • passive muscle tension from bulk effect of rotator cuff
  • rotator cuff contraction- compression of articular surfaces
  • joint motion that secondarily tightens passive ligamentous restraints
  • barrier or restrain effect of contracted rotator cuff muscle
  • redirection of joint force to center of glenoid surface by coordination of forces from GH and ST joints
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

acute GH dislocation

A

up to 96% are trauma induced, TUBS injury, requiring surgery

  • traumatic-unidirectional-Bankart-surgery
  • > 20% successful without surgery: high re-dislocation rate

associated injuries:

  • Bankart- injury to the glenoid
  • Hill-sachs deformity- humeral head

in general, dislocations with HIll-sachs lesion and/or bankart lesion commonly experience chronic instability (commonly associated with traumatic dislocation)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

Bankart

A

=injury to the glenoid

  • Soft: avulsion of ant int GH ligament and labrum from anterior rim of glenoid
  • Hard: fx of the glenoid rim
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

chronic GH dislocation

A

=progression from instability/subluxation

  • usually due to increased passive laxity
  • instability -> subluxation -> dislocation
  • success rate w/out surgery >80%
  • AMBRI: rarely requires inferior capsular shift
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

AMBRI

A

Atraumatic
Multidirectional
Bilateral
Rehabilitation Indicated

*rarely requires inferior capsular shift

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

GH dislocation presentation

A

Presentation (after reduction):

  • (+)apprehension sign, anterior tenderness
  • RTC weakness (if tear)
  • deltoid weakness and/or lateral shoulder sensory loss if axillary nerve injured
  • acute -> UE in ER with anterior prominence of humeral head
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

conservative treatment of GH dislocation

A
  • improve dynamic stability/ proprioception of GH joint
  • immobilize for up to 3 weeks? in IR or ER
  • avoid forceful ER; no PROM/stretching
  • focus on neuromuscular coordination/ re-education
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

surgical treatment for GH dislocation

A

anterior capsular shift or anterior capsulo-labral reconstruction if Bankart present

Predictors:
- if 40 y/o minimize immobilization, look for RTC tears if no response to tx after 2 wks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

AC injury

A

trauma
disruption of AC ligs
no dynamic stability possible

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

AC trauma

A
  • direct blow to lateral shoulder

- FOOSH driving humeral head into acromion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

disruption of AC ligaments

A

1st deg: no instability
2nd deg: AP instability
3rd deg:: gross instability, distal clavicle high riding

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

AC joint treatment

A
  • pain control, protected ROM, isometrics
  • progress to strengthening ex, dynamic strengthening, sport/occupation specific activities
  • perform ex sidelying, seated, or standing. avoid supine- scap pinned, results in greated clavicular rotation at AC
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

SC injury

A
  • blunt force to sternum or clavicle
  • lateral compression from clavicle
  • usually dislocate anterior/inferior
  • posterior more serious-can compromise NV, breathing/swallowing problems
  • rare, less than 3% of shoulder injuries
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

labral tears

A

mechanism of injury

  • FOOSH
  • consequence of dislocation
  • strong bicep contraction
  • range from minor fraying to Bankart to SLAP lesions
  • stable (pain but no locking/clicking) to unstable (pain with locking/clicking)
  • symptoms often similar to AC joint pathology
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

SLAP lesions

A

4 types:

1: rough edge
2: labrum torn off glenoid (common)
3: bucket handle
4: tear includes bicep tendon

PT can treat symptoms and rebalance muscles

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

stable labral tears

A

stable=pain but no locking/clicking

  • NSAID’s/ cortisone injection
  • scapular stabilizer and RTC re-training
  • limit strengthening to <90%
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

unstable labral tears

A
  • conservative tx is rarely successful

- arthroscopic debridement and stabilization of unstable tears

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

subacromial bursitis

A

MECHANICAL:

  • MOI= impingement- primary or secondar
  • precurser to RC injury?

CHEMICAL:
-inflammation spread from RC injury

TX:

  • rest, ice, gentle, pain-free AROM
  • correct abnormal mechanics
  • improve GH, ST control/conditioning
58
Q

joint arthroplasties are indicated when..

A
  • conservative management fails

- no other options to restore relatively pain-free joint function

59
Q

destructive arthidities

A 
OA
RA
ankyl spond
marfan
lyme
60
Q

shoulder replacement

A

destructive arthidities
trauma/fx
avascular necrosis

61
Q

shoulder replacement types

A

1: surface replacement
2: hemiarthroplasty
3: total

62
Q

hemiarthroplasty

A

humeral component

  • unipolar (old)
  • bipolar: head moves in shell, shell moves in glenoid
63
Q

total shoulder replacement

A

=both sides

CONSTRAINT= stability in plan of glenoid- usually refers to glenoid depth
constrained-ball in deep socket; increased stability, decreased mobility

REVERSED= semi-constrained 
cemented?
-TSA type
-soft tissue
-bone block
64
Q

humeral fracture

A

complete displaced- ORIF

  • pins, wires, screws, plates
  • soft tissue damage
  • AVN

incomplete non-displaced-conservative
-sling

65
Q

shoulder evaluation

A

1: intake and hx
2: systems review
3: pain rating
4: observation:
- posture: cervico-thoracic spine, shoulder girdle
- atrophy/edema/girth
- spasm/guarding
- skin condition/hair distribution
5: palpation (look for asymmetry)
- soft tissue tension
- joint lines, trigger/tender points
- temp/swelling
6: clear jt above and below
7: neuro: derma/myo/DTR/proprioception
8: AROM: ability/willingness
- scapulohumeral rhythm (con/ecc/slow/fast/weighted)
9: PROM w/ overpressure (endfeel)
10: isometric break tests (if deficit, do formal MMT)
11: accessory motion eval
12: special tests
13: outcomes/functional tests
- ADL
- simple shoulder test, SPADI, DASH

66
Q

visceral referral to the shoulder

A

can’t change the pain with any positions or postures. if pain occurs upon contractions
-should be able to effect pain by movement of the musculoskeletal position

67
Q

locking position

A

outside hand on elbow to control flexion/rotation
close hand protracts shoulder and cups palm over spine of scapula.
drop pt. arm into extension and abduction.
locking position when won’t abduct anymore w/o ER

    • would not do for impingement, anterior instability or acute/freezing stages
  • *would use for thawing stage and for limited ROM
68
Q

quadrant position

A

once elbow goes over the “hill” to continue abduction from the locking position

69
Q

general tests for impingement/tear

A

1: rent test
2: supine impingement
3: empty can test

70
Q

Rent test

A

indicates rotator cuff tear and impingement

PT behind seated pt.
PT palpates anterior to anterior edge of acromion with 1 hand and other grasps pt’s relaxed flexed elbow with other
PT extends pt’s arm and slowly internally and externally rotates the shoulder

*for infraspinatus palpate posterior to acromion

positive test=eminence (prominent greater tuberosity) and a rent (depression of about 1 finger width) will be felt

71
Q

supine impingement test

A

indicates rotator cuff tear and impingement

positive test=significant increase in shoulder pain

pt supine
PT grasps pt’s wrist and distal humerus and elevates arm to end range (close to ear)
PT moves pt’s arm into ER to IR

72
Q

supraspinatus impingement tests

A

1: empty can test
2: drop arm test
3: neer’s test
4: Hawkins-kennedy

73
Q

empty can test

A

indicates general impingement and rotator cuff tear (*most common supraspinatus)

positive test= pain, more weakness in empty can than in full can position
*cheating, if possible in PROM but not AROM

pt. standing, AROM test
abduction in scapular plane (30deg). pt “empties cans” while abducting
**thumbs pointed down

74
Q

Drop arm test

A

indicates supraspinatus tear, subacromial impingement

positive test= inability of pt. to lower arm smoothly and controlled

pt standing.
passively lift pt’s arm to 90 deg abduction and release.
*can also apply pressure??

75
Q

Subscapularis impingement tests

A

1: lift off test
2: IR lag sign

76
Q

Lift-off test

A

indicates subscap tear, impingement

positive test=inability to lift arm off back

pt is seated with arm behind back; as them to lift off

77
Q

IR lag sign

A

indicates subscapularis tear, impingement

positive test=inability to maintain arm off back

pt seated with arm behind back.
PT grasps elbow and wrist and passively lifts pt’s arm off their back and asks them to maintain the position

78
Q

infraspinatus/teres minor impingement tests

A

1: ER lag sign
2: Hornblower’s sign
3: drop sign

79
Q

ER lag sign

A

indicates supra/infra tear, impingement

positive test=inability to maintain arm near full ER

pt seated.
PT behind, grasps pt’s elbow and wrist.
PT places elbow is 90 flexion and shoulder in 20 deg scapular plane.
PT passively ER shoulder to NEAR end range and asks pt to maintain position

**overpressure at end range can causes false positives!!

80
Q

Hornblower’s sign

A

indicates teres minor fatty degeneration and impingement

positive test=inability to maintain ER against resistance

pt seated.
PT supports pt’s shoulder in 90 deg flexion in the scapular plane and 90 deg elbow flexion while resisting ER

81
Q

Drop sign

A

indicates infraspinatus tear or fatty degeneration, impingement

positive test=inability to maintain arm near full ER

pt seated.
PT behind, grasps elbow and wrist. places elbow in 90 deg flexion and shoulder in 90 deg abduction in scapular plane. PT passively ER shoulder to NEAR end range and asks pt to maintain position

82
Q

painful ARC test

A

all stages of subacromial impingement

PT faces standing pt.
pt actively abducts involved shoulder

positive test=pt reports pain in the 60-120 degree range. pain outside of this range is considered a negative test

83
Q

Posterior impingement sign

A

indicates: rotator cuff tear, post labral tear, impingement

positive test= complaints of pain in the deep post shoulder

pt supine. should in 90-110 deg abduction, 10-15 deg extension and max ER

  • if pain in ant shoulder could be tight muscles
  • *common in overhead throwing athletes
84
Q

internal rotation resisted strength test

A

indicates internal impingement (subacromial) and impingement

pt standing.
PT stands behind. places pt’s shoulder in 90 deg abduction and 80 deg ER w/ 90deg elbow flexion
PT tests isometric ER and then IR

positive test=IR weaker than ER

85
Q

labral tear special tests

A

1: Biceps load II test
2: Yergason’s test
3: crank test
4: kim test
5: jerk test
5: speed’s test

86
Q

Apprehension position

A 
supine
shoulder in 120 degrees abduction
elbow in 90 degrees flexion
supinated
end-range ER
87
Q

biceps load II test

A

indicates SLAP lesion, labral tear

pt supine
PT sits at side of pt
PT places pt’s shoulder in apprehension position and resists elbow flexion

positive test= pain with resisted elbow flexion

88
Q

yergason’s test

A

indicates subacromial impingement, SLAP lesion, any labral lesion, long head of biceps pathology

pt sitting or standing. shoulder neutral, elbow 90 deg flexion, pronated
PT resists supination

positive test=pain localized to bicipital groove

89
Q

Crank test

A

Indicates SLAP lesion, labral tear

pt supine
PT passively abducts shoulder into 160 deg and 90 deg elbow flexion.
PT first applies a compression force to the humerus and then rotates repeatedly into IR and ER trying to pinch the torn labrum

positive test= production of pain, with or without clicking, catching

90
Q

Kim test

A

indicates posterio-inferior labral lesion, labral tear

pt seated.
PT grasps elbow and mid humeral region. elevates pt’s arm to 90 degrees abduction.
simultaneously PT provides axial load to the humerus and a 45 degree diagonal elevation to the humerus (concurrent with a post-inf glide to the proximal humerus)

positive test=sudden onset of posterior shoulder pain

91
Q

Jerk test

A

indicates posterio-inferior labral lesion

pt supine (to maintain position)
PT grasps elbow and scapula. elevates pt's arm to 90 deg abduction and IR
PT provides axial compression to humerus through elbow, maintaining horizontally abducted arm
axial compression maintained as pt's arm is moved into horizontal adduction

positive test=sharp shoulder pain (possibly with clunk/click)

92
Q

Speed’s test

A

indicates:
- subacromial impingement (all stages)
- SLAP lesion
- biceps pathology
- labral lesion

pt standing. elbow fully extended and supinated.
PT stands in front and resists shoulder flexion for 0-60deg. **stop at 60!

positive test=pain in bicipital groove

93
Q

SLAP lesion

A

superior labral anterior to posterior lesion

94
Q

instability special tests

A

1: anterior release/surprise test
2: apprehension test
3: apprehension/relocation test
4: load and shift test

95
Q

Anterior release/surprise test

A

indicates anterior instability

pt supine
PT applies posterior force on humerus. maintains force while place arm in apprehension position and then release

positive test=sudden pain, increased pain, or reproduction of symptoms

96
Q

apprehension test

A

indicates anterior shoulder instability (& SLAP)

pt supine.
PT grasps wrist and elbow. places shoulder in apprehension position.
PT then applies pressure to post aspect of humeral head (my examiner if standing, by table is supine)

positive test= show of apprehension by patient, reports of pain, muscle guarding, facial expression of concern

**move quickly, can use a block or fist to move head anteriorly. make sure to go to endrange ER!

97
Q

Apprehension/relocation test

A

indicates anterior instability (also SLAP)

perform apprehension test.
if pain is felt then apply pressure anteriorly

positive test= decrease in pain or apprehension

  • no change in pain symptoms indicates impingement
98
Q

Load and shift test

A

indicates anterior, posterior instability

pt supine
PT grasps proximal humerus with one hand providing a compression force and loading the humerus into the glenoid fossa. other hand stabilizing the scapula
PT provides ant to post force nothing amount of translation.
PT then provides post to ant force
grade translation as 1 or 2
1: to the post/ant rim of glenoid OR
2: beyond the rim of the glenoid

positive test=translation beyond the glenoid rim, excessive translation
*do sulcus sign to assess inferior instability

99
Q

sulcus sign

A

indicates inferior laxity, superior labral tear

pt seated.
PT stands behind. grasps elbow and pulls down causing inferior traction force. notes the distance between inferior surface of acromion and superior portion of humeral head
repeat the test in supine, 20 deg and

positive test=distance

100
Q

AC joint special tests

A

check tender specific point

1: AC resisted extension
2: cross over sign

101
Q

AC resisted extension

A

indicates AC joint abnormality

pt seated. shoulder in 90 flexion and IR. elbow flexed 90deg
PT resists horizontal abduction

positive test=pain at the AC joint

102
Q

Cross over sign

A

indicates AC joint abnormality

passively flex shoulder to 90deg
passively horizontally adduct fully

positive test= pain in AC joint

103
Q

Thoracic outlet syndrome special tests

A

1: hyperabduction test
2: Roos test
3: adson’s test
4: costoclavicular maneuver

104
Q

Hyperabduction test

A

indicates TOS

pt sits up straight. both arms placed at sides for PT to assess radial pulse
pt then places arms above 90 deg and and full ER and held there for 1 minute
PT re-assesses radial pulse in abducted position.

pulse recorded as no chance, diminished, or occluded.

positive test=change in radial pulse and report of paresthesia

105
Q

Roo’s test

A

indicates TOS (evaluates neural &vascular structures)

pt sits up straight with arms at sides.
pt brings arms up to 90deg abduction and ER. then rapidly opens and closes hands for a full minute

positive test=inability to maintain position, diminished motor function of hands, loss of sensation
**considered most accurate TOS test, often mistaken w/ fatigue

106
Q

Adson’s test

A

indicates scalene tightness and TOS

pt sits straight with arms abducted 15deg.
PT palpates radial pulse.
pt inhales deeply, holds breath, tilts head back and rotate head to examine side
PT records radial pulse as diminished or occluded

positive test=absent or diminished radial pulse, paresthesias

107
Q

Costoclavicular maneuver

A

indicates TOS

pt sits straight (exaggerated military position) both arms at sides
PT assesses radial pulse
pt retracts and depresses shoulders while protruding chest. holds for 1 minute
PT re-assesses radial pulse

positive test=absent or diminished radial pulse, paresthesias

108
Q

GH joint mobs

A 
GH traction: short axis, long axis
caudal humeral glide
dorsal humeral glide (in abd, or flex)
ventral humeral glide
lateral rotations
dorsal- ventral humeral oscillations
109
Q

SC joint mobs

A

craniodorsal clavicular glide
caudoventral clavicular glide

*thumbs or hypothenar eminence

110
Q

AC joint mobs

A

ventral clavicular glide

dorsal clavicular glide

111
Q

scapular mobilizations

A

not a synovial articulation, so more of a soft tissue stretch

dorsal tilt
medial/lateral
superior/inferior
up/down rotations

112
Q

rotator cuff disorders include medical diagnoses such as:

A
  • impingement syndrome
  • rotatory cuff/glenoid labral tears
  • posterior shoulder pain
  • GH hypermobility/instability
113
Q

therapeutic exercise intervention of rotator cuff disorders

A
  • secondary disorders should consider impairments related to hyper mobility and stability related to impingement
  • serratus anterior and trapezius strengthening is essential while monitoring GH movement!
  • attention to “level” (difficulty) of intervention is important for dosage and success
114
Q

treatment for primary rotator cuff disorders

A
  • early stages- meds, rest, resting position, ice
  • physical agents- for pain and inflammation
  • ROM, muscle length, joint mobility exercises, and joint mobilization
  • muscle performance exercises
  • posture and movement training
  • surgery-if conservative tx fails
  • prevention- educate early recognition
115
Q

specific therapeutic exercise intervention for rotator cuff disorder

A
  • pain and inflammation: provide exercise for impairments contributing to cause of symptoms
  • muscle length: passive manual stretch of rhomboids. self stretch to GH lateral rotators
  • muscle performance: strengthen middle/lower trap, serratus anterior in short range. strengthen rotatory cuff
  • posture and movement: ergonomic modifications. SEMG training for temporal relationships in scapular rotators. functional training
116
Q

scapular upward rotator exercises

A

upper trap:
-shoulder shrug from arm-elevated position

Middle trap:

  • prone arm lift with arm OH
  • prone horizontal extension with ER
  • *IT

Lower trap:

  • prone arm lift with arm OH
  • prone ER at 90 deg abduction
  • prone horizontal extension w/ ER
  • *ITYs
117
Q

serratus anterior progressions- levels I, II, III

A

level I:
-supine, arm OH, gently but consistently push arm backward into pillow and hold for 10s

level II:
-sidelying with pillows in front of head and shoulders. bend hips and knees. grasp theraband attached to feet. slide arm up towards head on pillows and slowly lower back down.

level III:
- standing an inch from the wall. post tilt pelvis. head lying on wall… ?

118
Q

therapeutic exercise intervention for common physiologic impairments- PAIN

A

differential dx of pain in this shoulder girdle is difficult due to interdependence of anatomy of shoulder, elbow, wrist, hand and cercivothoracic spine.

  • tx can be directed toward the source of the pain (rotator cuff tendinopathy)
  • tx must be directed toward the cause of the pain (scapula downward syndome)

**have to think “WHY is there pain there?”

119
Q

Hypomobility

A

often coexists with hypermobility

tx:
-manual stretching with concurrent strengthening of weakened antagonist
-ex: stretch rhomboids while strengthening scapular upward rotators
(stretch rhomboids sidelying. strengthen lower trap and serratus anterior by facing wall and sliding ulnar side of hands in sagittal or scapular plane)

120
Q

Hypermobility

A

to treat effectively- Hypomobility segments must be identified

  • improve muscle performance, length-tension relationships, motor control of dynamic stabilizers
  • Ex: anterior GH hypermobility due to inefficient properties of medial rotators (subscap)
  • Goal- train subs cap to limit anterior GH movement. include functional activities

to strengthen subscap in short range- supine 90/90 with elbow hanging off. IR

121
Q

impaired muscle performance

A
  • neurologic patholoy
  • muscle strain
  • disuse, deconditioning, and reduced conditioning
122
Q

muscle strain tx

A

can result from sudden and excessive tension or from gradual and continuous tension imposed on muscle

  • initially- isometric contractions in pain free shortened range
  • concentric-eccentric dynamic exercise can be slowly introduced
  • low load muscle contractions in regeneration phase
  • final phase of healing should include activity-specific exercises
123
Q

disuse, deconditioning and reduced conditioning tx

A
  • combined program aimed at restoring muscle force, endurance and coordination
  • conditioning program should include exercises for all major muscle groups
  • posture and movement technique should be closely monitored
  • training depends on performance level (high level athletes, strenuous workers)
124
Q

4 core scapular stabilization

A
  • focus on movement CONTROL
  • easy to overload/underload
  • watch for substitutions!
  • end at form fatigue

1: seated rows - post delt
2: push up with a plus (serratus)
3: press ups, with a plus
4: empty can (supraspinatus)- 90 deg max. only to point of pain, in scapular plane

125
Q

shoulder girdle conditioning program

A
  • bench press (flat, incline, decline)
  • prone middle and lower trapezius
  • lat pulldown
  • lateral deltoid raise-frontal or scapular plane (through full ROM)
  • front deltoid raise (through full ROM)
  • biceps curl
  • triceps extension
126
Q

posture treatment

A
  • education of habitual postures (cervical, thoracic, lumbar, and pelvic) standing, sitting and sleeping
  • ergonomic/workstation education and modification
  • support via bracing, taping, etc to reduce strain on lengthened muscles
127
Q

movement treatment

A
  • restore “normal” scapulohumeral rhythm during active motion
  • use of SEMG and cinematography can be helpful
128
Q

treatment of GH instability/hypermobility

A
  • specific joint mobilization (post capsule)
  • immobilization (max 3 wks) if subluxation is diagnosed
  • AROM against gravity as pt regains strength and motor control
  • main target muscle tends to be subscap as well as gradually resisted exercises for pectoralis major, lats, teres major
  • infraspinatous and teres minor are also often targeted

**must have stable scapula for rotator cuff function to be effective!

129
Q

tx principles for post-op rotator cuff disorders- four phases

A

**educate pt- tendinous repair may take 1 year

1: protective phase
2: early intermediate phase
3: later intermediate phase
4: advanced rehabilitation

130
Q

protective phase

A

1-6 wks

  • sling protection
  • pendelum exercises
  • self assisted ROM
131
Q

early intermediate phase

A

6 wks-3 months

  • additional self assisted ROM
  • PROM
132
Q

later intermediate phase

A

3-5 months

  • isometrics and progress to dynamics if possible
  • swimming at 5 months
133
Q

advanced rehabilitation

A

5 months-1 year

  • submax activity-specific training
  • progress to max training by end of year
134
Q

tx of stage 1 adhesive capsulitis

A
  • type and intensity dependon pt’s specific strength, ROM, joint mobility, motor control, and level or irritability
  • NSAIDS, steroid, and local analgesics can be helpful
  • postural training to discourage FHP and kyphosis
  • therapeutic modalities to control pain, inflammation and promote relaxation (pendulums, scap mobs, protect GH jt but everything else can move!)
  • grade 1 &2 jt mobs and movements within pain free range
  • closed chain exercises to promote GH stabilization
  • scapular exercises in pain free position
  • taping can be used to augment stability
135
Q

tx of stage 2 adhesive capsulitis

A
  • continue to decrease pain and inflammation
  • passive stretching of post capsule (in pain free range)
  • active exercises against gravity MAY be introduced
  • careful isolated strengthening of rotator cuff, serratus anterior, middle and lower trap
  • taping of ST jt for stabilization
136
Q

tx of stage 3& 4 adhesive capsulitis

A
  • improve GH mobility
  • restore SH rhythm
  • aggressive stretching and jt mobilization
  • heat may be used for relaxation of tissues
  • strengthening of rotator cuff and SH muscles
137
Q

adjunctive interventions: taping

A

scapular taping can improve resting alignment of the scapula on the thorax

138
Q

goals &benefits of taping

A
  • improve initial alignment
  • alter length0tension properties
  • provide support and reduce stress to myofascial tissues
  • provides kinesthetic awareness of scapular position during rest and movement
139
Q

taping scapula into elevation

A

slide 46

140
Q

tapin scapula into upward rotation

A

slide 47

141
Q

scap re-education exercise

A
  • make a fist and reach up, supine
  • grab inf/med scap border
  • pt squeezes down and back “hold it there” try to pull and check to make sure not upper trap
  • try to pull arm up “don’t let me move you”
  • push up into me
  • try to move arm back and forth
  • hold a shoe/kettle bell and try to rotate IR/ER
  • or rotate head back and forth
  • knees up-trunk rotation

Ortho 1-first half (10 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions