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DPT 730/1: MSK > E3- RTC tear-Labrum Tears > Flashcards

E3- RTC tear-Labrum Tears Flashcards

1
Q

what type of impingement is a RTC tear

A

secondary
you are tearing tissues causing instability within the jt

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2
Q

what can cause acute RTC tears

A

high UE velocity
heavy lifting
impact of FOOSH

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3
Q

how can a RTC tear be from degeneration

A

tendinosis tears from repetitive overhead activities

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4
Q

what structures are involved with RTC tear

A

supra/infraspinatus
labrum
biceps tendon

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5
Q

what is a SLAP tear

A

superior labral ant/post tear

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6
Q

how can a SLAP tear occur

A

gradual degeneration
excessive contraction of bicep tendon

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7
Q

what are the S&S with RTC tear

A

increased pain with overhead activities
painful arc around 90 deg ele

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8
Q

what can be found in a scan for RTC tear

A

RST- weak and painful (FLX, ABD, IR)
ST- possible +
Sp. Test- + for cuff and maybe labrum/bicep

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9
Q

how do we treat RTC tear

A

treat as worse case of hypermobility

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10
Q

what is the ultimate MET purpose for RTC tear

A

stabilization
tissue proliferation

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11
Q

what can be beneficial with degenerative tears of RTC

A

early ROM
accelerated recovery in most

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12
Q

what is the biggest predictor of a RTC tear going into surgery

A

pt negative perception

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13
Q

what are other factors taking into consideration for a pt to have RTC reconstruction sx

A

size of tear
retraction
fatty infiltration
age
pain

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14
Q

what is the corticosteriod injection with RTC tear

A

no evidence of effectiveness
does allow for window of opportunity to progress pt

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15
Q

what is an arthroscopic with arthroplasty

A

sewing back together and reattaching to the bone
full ROM under anesthesia

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16
Q

what are the outcomes of PT with degenerative tears

A

successful
especially for this with small, partial tears or unfit for sx

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17
Q

what are the outcomes of Sx with degenerative tears

A

good clinical outcome with pain, ROM, strength, quality of life, and sleep

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18
Q

what does radiology outcomes contradict Sx and PT outcomes for degenerative tears

A

structures doesn’t have to entirely change to have better function or symptoms

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19
Q

what are the outcomes of PT with acute small to medium tears

A

may help

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20
Q

what are the outcomes of Sx with acute small to medium tears

A

no difference from PT or slightly more beneficial
more critical for young people due to higher activity levels

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21
Q

what are the outcomes of PT with full thickness/multi-tendon tear

A

may help in low demand patients or unfit for sx
increase the likelihood of tear progression and other tissue damage

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22
Q

what are the outcomes of Sx with full thickness/multi-tendon tear

A

80% satisfaction

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23
Q

why would we do a RTSA

A

irreparable tears- tendon distance is too far apart due to shortening to pull back together

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24
Q

what are the benefits of RTSA

A

pain relief, function, and active elevation

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25
Q

what is different anatomically about the the RTSA

A

biomechanics is now concave on convex
convex portion is more lateral allowing for more leverage of deltoid of FLX/ABD

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26
Q

what is the rehab protocol of RTC tears

A

criteria + time based
bracing - depends on m
tens for pain management
get moving
supervised PT
early isometric loading improved outcomes

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27
Q

what type of impingement is FSCS

A

primary
limited motion

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28
Q

what are RF of FSCS

A

female
hypothyroidism
40-65 yrs
previous adhesive capsilitis
diabetes
family hx

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29
Q

what is the primary cause of FSCS

A

pathology- diabetes, hypothyroidism

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30
Q

what is the secondary cause of FSCS

A

concomitant injury and period of immobilization

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31
Q

what is the most often structural changes of FSCS

A

inflammation of GH capsule and lig
reduced jt volume

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32
Q

what are symptoms a pt can present with for FSCS

A

gradual and progressive pain and loss of motion
functional limitations

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33
Q

what is the capsular pattern of restriction for FSCS

A

greatest % of loss ROM
ER>ABD>FLX>IR

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34
Q

what can be found in a scan for FSCS

A

CM- consistent block
RST- possible weak and painful depending on stage
ST- + distraction depends on stage
AM- hypomobile
Sp. test- + for impingement

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35
Q

describe stage 1 of FSCS

A

initial
gradual onset, achy pain, sharp with use, night pain, unable to lie on side
high irritablility
AROM sig <PROM
empty and painful end feel

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36
Q

describe stage 2 of FSCS

A

freezing
constant pain at night
high irritability
mod-severe limitations, AROM<PROM
empty and painful end feel

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37
Q

describe stage 3 of FSCS

A

frozen
stiffness> Pain, intermittent pain
mod irritability
mod-sev limitations, pain at end range, AROM=PROM
firm end feel

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38
Q

describe stage 4 of FSCS

A

thawing
minimal to no pain
low irritability
gradually ROM improvement
firm end feels

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39
Q

how do we dx FSCS and what is our best dx tool

A

by exclusion
clinical presentation most common tool

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40
Q

what is our Rx for FSCS

A

POLICED
Pt edu
modalities
JM
STM
MET

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41
Q

what do we need to educate the pt on with FSCS

A

the stages
promote pain free activity
matching stretching with symptoms

42
Q

why do we need to match stretching/JM with symptoms for FSCS

A

can create more fibrotic tissue if we stretch or do JM too aggressivly

43
Q

what grade of JM do we do for FSCS

A

grade 3-4

44
Q

what is our primary focus of MET with FSCS

A

elasticity and mobility
particularly with inhibited m

45
Q

what is the benefit of oral steroids/corticosteriod injection for FSCS

A

gives window of opportunity for increase in PT

46
Q

what is the evidence for manipulation with FSCS

A

questionable
causes scarring of capsular lig which can lead to more inflammation or fibrotic tissue

47
Q

what happens if FSCS is left untreated

A

may resolve after 12-42 months
50% with pain out to 4-7 yrs

48
Q

how long does stage 1 of FSCS last

A

1-2 months roughly due to prolong inflammatory phase

49
Q

how long does FSCS last

A

12-18 months is the course of pain and mobility deficits

50
Q

what type of impingement is dislocation

A

secondary

51
Q

what jt is most likely to dislocate

A

GH jt

52
Q

what type of dislocation is most common at the GH jt

A

anterior inferior direction
ER and ABD with FOOSH

53
Q

what is a post dislocation of GH jt

A

less common
90 deg flexion with FOOSH

54
Q

what structures are involved with dislocation of GH jt

A

labrum
tendons
capsule

55
Q

What is a bankart lesion

A

anterior inferior labral tear

56
Q

describe fibrocartilage

A

thick and concave
outer portion is thick
inner portion is thin
deepens and widens jt surface

57
Q

describe the outer portion of fibrocartilage

A

type 1 collagen
resist tension for stability
vascular and neural tissue

58
Q

describe the inner portion of fibrocartilage

A

type 2 collagen
resist compression for shock absorption
hypo - vascular/neural/lymphatic

59
Q

how can the fibrocartilage be damaged

A

tears possibly with RTC/dislocation
gradual with repetitive stress including impingement

60
Q

why is the outer portion of fibrocartilage hyperneural

A

proprioception
ligament like
annulus for stabilization

61
Q

describe fibrocartilage healing

A

better at periphery due to vascularity
tensile strength improves at 3-5 wks
dense fibrous tissue fills in at 8-12 wks

62
Q

what is the MET focus for fibrocartilage

A

tissue integrity/proliferation
stabilization

63
Q

what is hill-sachs lesion

A

compression fx of humeral head

64
Q

what are symptoms of dislocation

A

trauma in characteristic position- FOOSH
acute presentation

65
Q

what can you find in your scan for dislocation

A

ROM- limited and painful most directions
RST- weak and painful most direction
ST- + depending on tissue

66
Q

what is the Rx for dislocation

A

immobilization
POLICED
MET

67
Q

what is the protocol for immobilization with dislocation

A

6 weeks
improve RTC - contralateral use, ipsilateral squeezing

68
Q

what can shorter periods of immobilization favor

A

muscle integrity
proprioception
peripheral and central neural activity
dynamic stability

69
Q

what is the primary MET focus for dislocation

A

stabilization
tissue integrity and proliferation

70
Q

for an anterior dislocation what MET can we start them out with to combat the acuity

A

isometrics and isotonics into opposite directions initially- ADD,EXT, IR - sensitize m spindle for proprioception for after acuity settles
FLX,ABD,ER- contraindicated

71
Q

describe the MD rx arthroscopic procedure for dislocation

A

3-6 months prognosis
full ROM under anesthesia
follow protocol

72
Q

what is a coracoid transfer

A

reposition coracoid process and coracobrachialis and short head of bicep to GH neck

73
Q

what is a capsular shift

A

most common
overlap torn portions of capsular folds

74
Q

who is most commonly susceptible to proximal humeral fx and how

A

elderly
FOOSH
surgical humeral neck

75
Q

what complications could arise with proximal humeral fx

A

axillary artery damage- coldness/blanching, avascular necrosis, emergency
adhesive capsulitis- prolong immobilization

76
Q

how can a clavicular fx happen

A

compression mechanism thru long axis of clavicle
weak spot at S curve

77
Q

what complications arise from clavicular fx

A

large displacement may require sx

78
Q

what are S&S of a fx

A

ROM- painful and limited most directions
RST- painful and weak in most directions
pain with compression, tuning fork, palpation

79
Q

when can PT start with a fx

A

after clinical union
after 4-8 wks- modeling phase

80
Q

what population can proximal humeral apophysitis affect

A

male adolescents
mostly overhead throwers

81
Q

what is proximal humeral apophysitis

A

bone growth exceeding RTC lengthening
increase tendon tension
growth plate is weak spot
most often just inflammation

82
Q

what are complications of proximal humeral apophysitis

A

avulsion and or premature closure

83
Q

what are symptoms of proximal humeral apophysitis

A

gradual onset of sh pain with overuse

84
Q

what is in our scan for proximal humeral apophysitis

A

impingement
RST- ER weakness, GIRD impingement
TTP over antero and posterolateral aspect of proximal humerus (most common)

85
Q

what is the Rx for proximal humeral apophysitis

A

pt edu
POLICED
Throwing mechanics

86
Q

how do we edu the pt with proximal humeral apophysitis

A

soreness rule
load management - pitch count, active rest , rest days
movement cues

87
Q

what is our MET for proximal humeral apophysitis

A

cuff but also trunk, scapular, and LE impairments
RTP- throwing progression

88
Q

is stretching indicated for GIRD with proximal humeral apophysitis

A

yes, but be careful due to vulnerable growth plate
make sure stretching is stretching the muscle and not reproducing the same symptoms

89
Q

what is the prognosis for proximal humeral apophysitis

A

most return to preinjury levels and as early as 2 months but could be as long as 8 months
can be recurrent

90
Q

what is the prognosis for an avulsion of proximal humeral apophysitis

A

4.5 months to competition

91
Q

when does the proximal humeral growth plate close

A

16-20 years

92
Q

scapular m lengthen: levator scapulae/rhomboids

A

depression and protraction
vertical clavicle

93
Q

scapular m lengthen: lat dorsi

A

elevation and protraction
acromion ahead of ear lobe

94
Q

scapular m lengthen: lower serratus

A

retraction and elevation
acromion behind ear lobe

95
Q

scapular m lengthen: pec minor

A

retraction and depression
vertical clavicle

96
Q

what is the postinf labrum test

A

jerk
block scapula, 90 deg ABD/IR with compression moving into H ADD
pain with or without clunk

97
Q

what is ant labrum test

A
  1. apprehension - supine, 90 deg ABD/ER and ant glide (pain or apprehension)
  2. relocation- supine, 120 deg ABD with post glide (relief of pain and apprehension)

speeds- resist shd flx from 0-60 deg with FA supination

98
Q

describe SLAP: biceps load II

A

120 deg ABD/ER
resist elbow FLX
pain

99
Q

describe SLAP: pain provocation

A

90 deg ABD/ER with elbow flx
pro and sup the FA
pain with pro>sup

100
Q

describe SLAP: passive compression

A

ER then 30 deg ABD
long axis compression and move shd into EXT
stabilize scapula
pain with or without click

101
Q

describe SLAP: yergasons

A

90 deg elbow FLX with FA pro
resist supination
ant shd pain

DPT 730/1: MSK (11 decks)

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