E3- RTC tear-Labrum Tears Flashcards
what type of impingement is a RTC tear
secondary
you are tearing tissues causing instability within the jt
what can cause acute RTC tears
high UE velocity
heavy lifting
impact of FOOSH
how can a RTC tear be from degeneration
tendinosis tears from repetitive overhead activities
what structures are involved with RTC tear
supra/infraspinatus
labrum
biceps tendon
what is a SLAP tear
superior labral ant/post tear
how can a SLAP tear occur
gradual degeneration
excessive contraction of bicep tendon
what are the S&S with RTC tear
increased pain with overhead activities
painful arc around 90 deg ele
what can be found in a scan for RTC tear
RST- weak and painful (FLX, ABD, IR)
ST- possible +
Sp. Test- + for cuff and maybe labrum/bicep
how do we treat RTC tear
treat as worse case of hypermobility
what is the ultimate MET purpose for RTC tear
stabilization
tissue proliferation
what can be beneficial with degenerative tears of RTC
early ROM
accelerated recovery in most
what is the biggest predictor of a RTC tear going into surgery
pt negative perception
what are other factors taking into consideration for a pt to have RTC reconstruction sx
size of tear
retraction
fatty infiltration
age
pain
what is the corticosteriod injection with RTC tear
no evidence of effectiveness
does allow for window of opportunity to progress pt
what is an arthroscopic with arthroplasty
sewing back together and reattaching to the bone
full ROM under anesthesia
what are the outcomes of PT with degenerative tears
successful
especially for this with small, partial tears or unfit for sx
what are the outcomes of Sx with degenerative tears
good clinical outcome with pain, ROM, strength, quality of life, and sleep
what does radiology outcomes contradict Sx and PT outcomes for degenerative tears
structures doesn’t have to entirely change to have better function or symptoms
what are the outcomes of PT with acute small to medium tears
may help
what are the outcomes of Sx with acute small to medium tears
no difference from PT or slightly more beneficial
more critical for young people due to higher activity levels
what are the outcomes of PT with full thickness/multi-tendon tear
may help in low demand patients or unfit for sx
increase the likelihood of tear progression and other tissue damage
what are the outcomes of Sx with full thickness/multi-tendon tear
80% satisfaction
why would we do a RTSA
irreparable tears- tendon distance is too far apart due to shortening to pull back together
what are the benefits of RTSA
pain relief, function, and active elevation
what is different anatomically about the the RTSA
biomechanics is now concave on convex
convex portion is more lateral allowing for more leverage of deltoid of FLX/ABD
what is the rehab protocol of RTC tears
criteria + time based
bracing - depends on m
tens for pain management
get moving
supervised PT
early isometric loading improved outcomes
what type of impingement is FSCS
primary
limited motion
what are RF of FSCS
female
hypothyroidism
40-65 yrs
previous adhesive capsilitis
diabetes
family hx
what is the primary cause of FSCS
pathology- diabetes, hypothyroidism
what is the secondary cause of FSCS
concomitant injury and period of immobilization
what is the most often structural changes of FSCS
inflammation of GH capsule and lig
reduced jt volume
what are symptoms a pt can present with for FSCS
gradual and progressive pain and loss of motion
functional limitations
what is the capsular pattern of restriction for FSCS
greatest % of loss ROM
ER>ABD>FLX>IR
what can be found in a scan for FSCS
CM- consistent block
RST- possible weak and painful depending on stage
ST- + distraction depends on stage
AM- hypomobile
Sp. test- + for impingement
describe stage 1 of FSCS
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
describe stage 2 of FSCS
freezing
constant pain at night
high irritability
mod-severe limitations, AROM<PROM
empty and painful end feel
describe stage 3 of FSCS
frozen
stiffness> Pain, intermittent pain
mod irritability
mod-sev limitations, pain at end range, AROM=PROM
firm end feel
describe stage 4 of FSCS
thawing
minimal to no pain
low irritability
gradually ROM improvement
firm end feels
how do we dx FSCS and what is our best dx tool
by exclusion
clinical presentation most common tool
what is our Rx for FSCS
POLICED
Pt edu
modalities
JM
STM
MET
what do we need to educate the pt on with FSCS
the stages
promote pain free activity
matching stretching with symptoms
why do we need to match stretching/JM with symptoms for FSCS
can create more fibrotic tissue if we stretch or do JM too aggressivly
what grade of JM do we do for FSCS
grade 3-4
what is our primary focus of MET with FSCS
elasticity and mobility
particularly with inhibited m
what is the benefit of oral steroids/corticosteriod injection for FSCS
gives window of opportunity for increase in PT
what is the evidence for manipulation with FSCS
questionable
causes scarring of capsular lig which can lead to more inflammation or fibrotic tissue
what happens if FSCS is left untreated
may resolve after 12-42 months
50% with pain out to 4-7 yrs
how long does stage 1 of FSCS last
1-2 months roughly due to prolong inflammatory phase
how long does FSCS last
12-18 months is the course of pain and mobility deficits
what type of impingement is dislocation
secondary
what jt is most likely to dislocate
GH jt
what type of dislocation is most common at the GH jt
anterior inferior direction
ER and ABD with FOOSH
what is a post dislocation of GH jt
less common
90 deg flexion with FOOSH
what structures are involved with dislocation of GH jt
labrum
tendons
capsule
What is a bankart lesion
anterior inferior labral tear
describe fibrocartilage
thick and concave
outer portion is thick
inner portion is thin
deepens and widens jt surface
describe the outer portion of fibrocartilage
type 1 collagen
resist tension for stability
vascular and neural tissue
describe the inner portion of fibrocartilage
type 2 collagen
resist compression for shock absorption
hypo - vascular/neural/lymphatic
how can the fibrocartilage be damaged
tears possibly with RTC/dislocation
gradual with repetitive stress including impingement
why is the outer portion of fibrocartilage hyperneural
proprioception
ligament like
annulus for stabilization
describe fibrocartilage healing
better at periphery due to vascularity
tensile strength improves at 3-5 wks
dense fibrous tissue fills in at 8-12 wks
what is the MET focus for fibrocartilage
tissue integrity/proliferation
stabilization
what is hill-sachs lesion
compression fx of humeral head
what are symptoms of dislocation
trauma in characteristic position- FOOSH
acute presentation
what can you find in your scan for dislocation
ROM- limited and painful most directions
RST- weak and painful most direction
ST- + depending on tissue
what is the Rx for dislocation
immobilization
POLICED
MET
what is the protocol for immobilization with dislocation
6 weeks
improve RTC - contralateral use, ipsilateral squeezing
what can shorter periods of immobilization favor
muscle integrity
proprioception
peripheral and central neural activity
dynamic stability
what is the primary MET focus for dislocation
stabilization
tissue integrity and proliferation
for an anterior dislocation what MET can we start them out with to combat the acuity
isometrics and isotonics into opposite directions initially- ADD,EXT, IR - sensitize m spindle for proprioception for after acuity settles
FLX,ABD,ER- contraindicated
describe the MD rx arthroscopic procedure for dislocation
3-6 months prognosis
full ROM under anesthesia
follow protocol
what is a coracoid transfer
reposition coracoid process and coracobrachialis and short head of bicep to GH neck
what is a capsular shift
most common
overlap torn portions of capsular folds
who is most commonly susceptible to proximal humeral fx and how
elderly
FOOSH
surgical humeral neck
what complications could arise with proximal humeral fx
axillary artery damage- coldness/blanching, avascular necrosis, emergency
adhesive capsulitis- prolong immobilization
how can a clavicular fx happen
compression mechanism thru long axis of clavicle
weak spot at S curve
what complications arise from clavicular fx
large displacement may require sx
what are S&S of a fx
ROM- painful and limited most directions
RST- painful and weak in most directions
pain with compression, tuning fork, palpation
when can PT start with a fx
after clinical union
after 4-8 wks- modeling phase
what population can proximal humeral apophysitis affect
male adolescents
mostly overhead throwers
what is proximal humeral apophysitis
bone growth exceeding RTC lengthening
increase tendon tension
growth plate is weak spot
most often just inflammation
what are complications of proximal humeral apophysitis
avulsion and or premature closure
what are symptoms of proximal humeral apophysitis
gradual onset of sh pain with overuse
what is in our scan for proximal humeral apophysitis
impingement
RST- ER weakness, GIRD impingement
TTP over antero and posterolateral aspect of proximal humerus (most common)
what is the Rx for proximal humeral apophysitis
pt edu
POLICED
Throwing mechanics
how do we edu the pt with proximal humeral apophysitis
soreness rule
load management - pitch count, active rest , rest days
movement cues
what is our MET for proximal humeral apophysitis
cuff but also trunk, scapular, and LE impairments
RTP- throwing progression
is stretching indicated for GIRD with proximal humeral apophysitis
yes, but be careful due to vulnerable growth plate
make sure stretching is stretching the muscle and not reproducing the same symptoms
what is the prognosis for proximal humeral apophysitis
most return to preinjury levels and as early as 2 months but could be as long as 8 months
can be recurrent
what is the prognosis for an avulsion of proximal humeral apophysitis
4.5 months to competition
when does the proximal humeral growth plate close
16-20 years
scapular m lengthen: levator scapulae/rhomboids
depression and protraction
vertical clavicle
scapular m lengthen: lat dorsi
elevation and protraction
acromion ahead of ear lobe
scapular m lengthen: lower serratus
retraction and elevation
acromion behind ear lobe
scapular m lengthen: pec minor
retraction and depression
vertical clavicle
what is the postinf labrum test
jerk
block scapula, 90 deg ABD/IR with compression moving into H ADD
pain with or without clunk
what is ant labrum test
- apprehension - supine, 90 deg ABD/ER and ant glide (pain or apprehension)
- relocation- supine, 120 deg ABD with post glide (relief of pain and apprehension)
speeds- resist shd flx from 0-60 deg with FA supination
describe SLAP: biceps load II
120 deg ABD/ER
resist elbow FLX
pain
describe SLAP: pain provocation
90 deg ABD/ER with elbow flx
pro and sup the FA
pain with pro>sup
describe SLAP: passive compression
ER then 30 deg ABD
long axis compression and move shd into EXT
stabilize scapula
pain with or without click
describe SLAP: yergasons
90 deg elbow FLX with FA pro
resist supination
ant shd pain
