Clinical Interventions for the Shoulder

Question 1

Acromioclavicular joint Sprain (shoulder pain with movement coordination impairments): a majority were _________ grade sprains

Answer 1

low

Question 2

Acromioclavicular joint Sprain is more common in men or women

Answer 2

men

Question 3

Acromioclavicular joint Sprain occurs mostly during _______________

Answer 3

athletic events

Question 4

Acromioclavicular joint Sprain clinical MOI

Answer 4

trauma or fall on tip of shoulder

Question 5

Acromioclavicular joint Sprain: Reported findings

Answer 5

Pain with reaching across body, Pain with overhead activities, pain with weightbearing on arms or elbows, and pain with sleeping on the injured shoulder

Question 6

Acromioclavicular joint Sprain: exam findings

Answer 6

palpable and observable displacement between the clavicular and acromial articular surfaces, pain with ac joint accessory movement tests, pain with palpation/provocation of AC join/ligament, and pain with sheer testing of the AC joint

Question 7

Acromioclavicular joint Sprain: palpation

Answer 7

pt is seated and PT standing, detect side to side for step-off

Question 8

Step-off typically implies _________________; grades 1-3 can be _______, grades 4-6 are more severe and require ____________

Answer 8

ligament tearing; rehabbed; surgery

Question 9

Acromioclavicular joint Sprain: special tests

Answer 9

sulcus sign

Question 10

Acromioclavicular joint Sprain: manual therapy

Answer 10

AC joint mobs, thoracic mobilization of shoulder ROM is limited, soft tissue mobs (delts, upper traps, biceps tendon, and RTC), and PROM

Question 11

Acromioclavicular joint Sprain: capsular pattern

Answer 11

ER>ABD>IR>FLX

Question 12

Acromioclavicular joint Sprain: Mobility for high irritability

Answer 12

Codman’s or arm circles, table stretch in sitting (FLX, ABD, ER), sleeper stretch in side-lying (IR), Supine ER stretch, AAROM in supine (ER, ABD, FLX)

Question 13

Acromioclavicular joint Sprain: mobility for low to moderate irritability

Answer 13

AAROM cane in supine (can add weight then progress to standing), pec major stretching (doorway), AAROM in standing, and closed chain gentle ROM exercises (table stretches, physio ball roll outs in standing on table, wall slides)

Question 14

Acromioclavicular joint Sprain: motor control for high irritability

Answer 14

don’t do

Question 15

Acromioclavicular joint Sprain: motor control for moderate irritability

Answer 15

Scapular squeezes, quadruped push-up with camel, prone I, Y, Ts (start unilateral, can do on physioball in pt is uncomfy in prone), Standing TB rows, Standing TB extensions, and Standing TB ER in 90/90

Question 16

Acromioclavicular joint Sprain: motor control for low irritability

Answer 16

increase reps and sets, resistance, and weight of moderate exercises; body blade exercises; lawn mower pulls

Question 17

Primary adhesive capsulitis affects what percent of the general population and who is most common to have it?

Answer 17

2-5.3%; women between the age of 40-60

Question 18

Secondary adhesive capsulitis is associated with _________________ affects ___________%, and 30% of those with frozen shoulder have ______________

Answer 18

DM and thyroid disease (hypothyroidism); 4.3-38%; DM

Question 19

Primary adhesive capsulitis history

Answer 19

insidious onset or minimal event onset

Question 20

Secondary adhesive capsulitis history

Answer 20

associated with multiple different pathologies

Question 21

Adhesive capsulitis or frozen shoulder: reported findings

Answer 21

insidious onset of lateral/global shoulder pain and stiffness, progressive increased pain, gradual loss of motion, sleep disturbing night pain, positions of comfort include arm at pt’s side or in mid-range, and shoulder pain that worsens with GHJ end of range positions or functional overhead tasks

Question 22

Adhesive capsulitis or frozen shoulder: stage 1

Answer 22

Duration of symptoms 0-3 months, significant night pain, pain with AROM and PROM, and equally limited in all motions

Question 23

Adhesive capsulitis or frozen shoulder: stage 2 Freezing state

Answer 23

Duration of symptoms: 3 to 9 months, Chronic pain in addition to pain with active and passive ROM, and Significant limitations in all motions

Question 24

Adhesive capsulitis or frozen shoulder: stage 3 frozen state

Answer 24

Duration of symptoms: 9 to 15 months, Minimal pain except at end ROM, and Significant limitations of ROM with rigid end feel

Question 25

Adhesive capsulitis or frozen shoulder: stage 4 thawing stage

Answer 25

Duration of symptoms: 15 to 24 months, Minimal pain overall, and Progressive improvements in ROM

Question 26

Adhesive capsulitis or frozen shoulder: shoulder ROM deficits

Answer 26

Restricted passive motion, ER and ABD equally limited

Question 27

Adhesive capsulitis or frozen shoulder: special tests

Answer 27

RTC impingement cluster/CPR: Hawkins-Kennedy, painful arc, and infraspinatus MMT; and Neer's

Question 28

Adhesive capsulitis or frozen shoulder: Manual therapy

Answer 28

GHJ mobs, Thoracic mobilizations (CPR), Soft tissue massage, PROM (long, prolonged stretch)

Question 29

Adhesive capsulitis or frozen shoulder: mobility for high irritability

Answer 29

Codman's or arm circles, table stretch in sitting, sleeper stretch in side-lying, supine ER stretch, and AAROM in supine (ER, ABD, FLX)

Question 30

Adhesive capsulitis or frozen shoulder: mobility for moderate irritability

Answer 30

Depending on irritability and availability, UBE or arm bike for active warm-up, AAROM with cane (supine first then move to standing), pulleys, cane ER stretch, wall slides with towel, and continue sleeper IR stretch

Question 31

Adhesive capsulitis or frozen shoulder: mobility for low irritability

Answer 31

continue mod exercises, add physioball table stretch, IR towel stretch, and increase time and reps and sets

Question 32

Adhesive capsulitis or frozen shoulder: Motor control for high irritability

Answer 32

quadruped rock back, supine thoracic extensions over foam roll and seated

Question 33

Adhesive capsulitis or frozen shoulder: motor control for mod irritability

Answer 33

Scap squeezes, quadruped push-up with camel, Prone IYT (unilateral first), standing TB rows, extensions, and ER in 90/90

Question 34

Adhesive capsulitis or frozen shoulder: motor control for low irritability

Answer 34

Increase reps, sets, resistance, and weight; Body blade exercises, and lawn mower pulls

Question 35

Primary shoulder dislocations peak in _______ and ________ decade

Answer 35

2nd and 6th

Question 36

In how many cases does the shoulder displace anteriorly? posteriorly?

Answer 36

98%, 2%

Question 37

95% of first-time shoulder dislocations result from either a ___________________

Answer 37

forceful collision, FOOSH, or wrenching movement

Question 38

5% of dislocations have an ___________ origin

Answer 38

atraumatic

Question 39

70% of people who have dislocated can expect ___________ within 2 years; much more prevalent in _____________ population

Answer 39

recurrence; adolescent

Question 40

26 to 92% have recurrent ___________ following first-time anterior dislocation

Answer 40

instability

Question 41

Labral tears, SLAP lesions, bankart lesions, anterior and multidirectional instability: history

Answer 41

Recurrent subluxations or dislocations with certain movements, positions, and activities, and age usually <40 years

Question 42

Labral tears, SLAP lesions, bankart lesions, anterior and multidirectional instability: reported findings

Answer 42

Shoulder pain with most activities and subjective complaints of instability

Question 43

Labral tears, SLAP lesions, bankart lesions, anterior and multidirectional instability: exam findings

Answer 43

generalized laxity, apprehension with end range motions and testing (especially elevation and ER), relocation tests, and poor motor control of GHJ/STJ during functional movements

Question 44

Labral tears, SLAP lesions, bankart lesions, anterior and multidirectional instability: special tests

Answer 44

relocation/apprehension test, jerk test, sulcus sign, and posterior apprehension test

Question 45

Labral tears, SLAP lesions, bankart lesions, anterior and multidirectional instability: manual therapy

Answer 45

Scapular mobs, thoracic mobs, and GHJ mobs (if labral tear, bankart or reverse bankart lesions, not with instability pts)

Question 46

Labral tears, SLAP lesions, bankart lesions, anterior and multidirectional instability: mobility for high irritability

Answer 46

Codman's or arm circles, table stretch in sitting, sleeper stretch in side-lying, supine ER stretch, and AAROM in supine

Question 47

Labral tears, SLAP lesions, bankart lesions, anterior and multidirectional instability: mobility for moderate instability

Answer 47

UBE or arm bike for active warm-up, AAROM with cane, pulleys, cane ER stretch, wall slides with towel, and sleeper IR stretch

Question 48

Labral tears, SLAP lesions, bankart lesions, anterior and multidirectional instability: mobility for low irritability

Answer 48

same ones from mod, add physioball table stretch, IR towel stretch, and increase time and reps and sets

Question 49

Labral tears, SLAP lesions, bankart lesions, anterior and multidirectional instability: motor control for high irritability

Answer 49

quadruped rock back, supine thoracic extensions over foam roll and seated

Question 50

Labral tears, SLAP lesions, bankart lesions, anterior and multidirectional instability: motor control for mod irritability

Answer 50

Scap squeezes, quadruped push-up with camel, Prone IYT (unilateral first), standing TB rows, extensions, and ER in 90/90

Question 51

Labral tears, SLAP lesions, bankart lesions, anterior and multidirectional instability: motor control for low irritability

Answer 51

Increase reps, sets, resistance, and weight; Body blade exercises, and lawn mower pulls

Question 52

Sub-acromial pain syndrome: _________% of all conditions that cause shoulder pain

Answer 52

44-65

Question 53

What is the most frequent cause of visits to a physician's office

Answer 53

Sub-acromial pain syndrome

Question 54

What is the most common shoulder condition?

Answer 54

Sub-acromial pain syndrome

Question 55

Sub-acromial pain syndrome prevalence is high in ________________ and _______________

Answer 55

repetitive overhead sports and manual jobs requiring prolonged overhead work

Question 56

Sub-acromial pain syndrome history

Answer 56

Symptoms developed from, or worsen with, repetitive activities, or from an acute strain

Question 57

Sub-acromial pain syndrome: reported findings

Answer 57

pain in posterior-lateral shoulder that is most noticeable with overhead activities

Question 58

Sub-acromial pain syndrome: Exam findings

Answer 58

Midrange catching sensation or painful arc of movement, symptoms reproduction with impingement signs: neers, hawkins-kennedy, and jobe tests, pain with isometric resistance to rotator cuff, weakness on strength testing, shoulder girdle muscle flexibility, strength, and coordination deficits, and atrophy

Question 59

Sub-acromial pain syndrome: Special tests

Answer 59

Impingement cluster, RTC full tear cluster, painful arch is a hallmark sign*; Neer test, hawkins-kennedy test, speed’s test, yergason test