E3 - Shoulder Complex 3 -5 Flashcards

1
Q

how do you treat tendinitis and tendinosis

A

pt education - load management
POLICED

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2
Q

how can NSAIDS affect healing of tendinitis and tendinosis

A

shout term pain relief if acute
delays healing if injury at insertion
poor response and no support in persistent presentation

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3
Q

why do NSAIDS not aid in healing during a persistent condition

A

tendon is structurally changing
the issue is not inflammation

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4
Q

how does bracing/taping/straps aid in treatment of tendinitis and tendinosis

A

decreases resistance arm
decreases stress on tendon

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5
Q

what is the soreness rule with ADLs and exercise

A

activities as long as the quality of movement is good and no symptoms during/after 24 hours

keep with the activity to give tendon load to maintain tendon response

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6
Q

what are the primary purposes of MET with tendinosis

A

tendon proliferation

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7
Q

what are the primary parameters of MET with tendinosis

A

implement after any acuity settles
heavy loads
slower eccentrics/3 sec muscle actions

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8
Q

what is the general rx of MET for tendinosis

A

2-3 sets of 10-15 reps to fatigue
2-3 exercises with involved tendon
8-12 weeks

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9
Q

what is the expected activity response of MET with tendinosis

A

mild-moderate increase in pain (5/10)

pain should ease to baseline levels before repeating exercises (24-48 hours)

my soreness rule

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10
Q

what are some complications that could delay healing in tendinosis

A

predisposition/prevalence of “failed healing response”
obesity
diabites
low grade inflammation

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11
Q

how does obesity affect tendinosis healing

A

excessive fat absorbes inflammaoryt cells away from tendon

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12
Q

how does diabetes affect tendinosis healing

A

excessive glucose impairs collagen production/remodeling

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13
Q

how does low grade inflammation affect healing with tendinosis

A

associated with systemic disease/poor diet

persistent inflammation limits proliferation/remodeling

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14
Q

what are MD rx’s for patients with tendinopathy

what is the rare intervention

A

cortisone injections for short-term benefits
glycerin trinitrate patches to increase circulation
surgical debridement

sclerosing injections - stiffens tendon for pain relief

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15
Q

t/f
MET is just/more beneficial than surgical debridement

A

true

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16
Q

what is surgical debridement and how is it intended to aid in tendon healing

A

surgeon scrapes tendon which increases blood flow leading to inflammatory response

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17
Q

how does scapular taping aid in impingement syndrome

A

improved short term pain

may provide an earlier “window” for MET and limit ADL provocation

no difference at 6 weeks

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18
Q

are modalities beneficial for patients with impingment syndrome

A

mostly not beneficial

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19
Q

are JM recommended for impingment syndrome

A

strong recommendation
GH joint
aids in regional interdependence

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20
Q

how does joint mobilities aid in the thoracic spine

A

accelerated recovery and reduced pain and disability immediately when compared to usual care

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21
Q

t/f
JMs added to exercise are more effective than exercise alone

A

true

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22
Q

is high-dose MET more beneficial than conventional low-dose exercise

what is low-dose exercise

A

yes

4-5 exercises for 3x10 reps

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23
Q

what time frame is MET beneficial for tendinosis

A

> 6 months of symptoms

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24
Q

what muscles in the shoulder are targeted with MET with tendinosis

A

cuff (SITS)
scapular exercises (MT/LT/Rhom/SA)

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25
what is the PT rx regarding the HEP
HEP with supporting PT visits not PT with supporting HEP
26
How many times per day should MET for tendinosis be performed
1-2x/day
27
what is the effect of MET after 3 months with tendinosis patients
70% improved pain/function
28
t/f MET does not provide long-term benefits for impingement syndrome
fals
29
what are the results of subacromial decompression when compared to exercise alone
equally or no more effective and more expensive than exercise alone
30
what is the recommendation of subacromial decompression
should not be performed if atraumatic and present for more than 3 months (tendinosis)
31
what is regional interdependence
theory that impairment in one area of the body will contribute to an impairment in another particularly persistent
32
what muscles act concentrically with overhead reaching
flexors abductors external rotators
33
what muscles act eccentrically with overhead reaching
extensors adductors internal rotators
34
what segment is most common cause of shoulder pain in regards to regional interdependence
C5-6
35
dysfunctional overhead reaching is due to what muscle group
excessively recruited internal rotators that share innervation from C6 inhibition and protective hypertonicity of external rotators
36
how does excessively recruited IRs by C5-6 affect GH movement
humeral head pulled anterior of coracoid process creates excess tension and compression underneath LHB tendon that can lead to tendinopathy
37
how does inhibition and protective hypertonicity of external rotation affect GH motion
greater tubercle won't efficiently move fully out from acromion impingement of supraspinatus and LHB tendons that can lead to tendinopathy
38
how does C2-3 dysfunction affect overhead reaching
scapula elevated or elevation compensation creates excess tension and compression on supraspinatus
39
what will occur if scapular depressors are inhibited
scapula won't depress impingement especially >150 degrees supraspinatus and lHB tendons will impinge and can lead to tendinopathy
40
t/f GH and AC joint will not compensate with hypermobility/instability to reach higher with overhead reaching
False the GH and AC joints will compensate with hypermobility/instability with overhead reaching
41
in regard to the muscle, what can limit optimal motion
imbalances of position muscle activity
42
can treating one area of the body (the spine) influence outcomes at another area that may seem unrelated
yes
43
what are the risk factors of rotator cuff tear
gradual/degernative (tendinosis) repetitive overhead activities
44
what are the risk factors of acute rotator cuff tears
high UE velocity heavy lifting impact with fall on outstretched hand (FOOSH)
45
what structure is most commonly torn in rotator cuff tear
supraspinatus or infraspinatus
46
how are rotator cuff tears graded
size (S,M,L) partial/full thickness tear
47
what is a SLAP tear
superior labral anterior/posterior tear long head of biceps excessively contracts and tears labrum
48
what are common traumas that can cause rotator cuff tears
SLAP tear compression onto labrum with FOOSH
49
what are the S&S of rotator cuff tears
worse impingement increased pain with repetitive overhead activities painful arc around 90 degrees elevation resisted test - weak and painful stress test - possibly positive positive special test
50
what motions will most likely be weak and painful with rotator cuff
flexion ABD/ER (supraspinatus) IR (subscapularis)
51
if patient experiences pain with compression, what structures in the shoulder are most likely involved after a rotator cuff tear
labrum
52
What S&S indicate a rotator cuff tear
>65 y.o. weak ER night pain
53
what S&S indicates a full-thickness tear
>/=60 y.o. painful arc drop arm ER MMT
54
high/low specificity: drop arm
high specificity indicates supraspinatus tear
55
what kind of tests are lift off, belly press, and bear hug
high specificity tests subscapularis tears
56
what is the general PT Rx for rotator cuff tears
treat as worse case of hypermobility with tissue damage that has occurred
57
how does early ROM with degenerative tears affect RC recovery
accelerated recovery limited tendon healing with large tears
58
what are the MET ultimate purposes for RC tear
stabilization tissue proliferation of muscle, tendon, labrum
59
what is the biggest predictor of if a tear will go to surgery
patient's negative perception
60
what is the prognosis of corticosteroid injections for RC tears
no evidence of effectiveness only provides transient relief
61
what are primary arthroscopic procedures with arthroplasty
sewing fibers back together and reattaching to bone full ROM under anesthesia
62
what is the prognosis of PT with degenerative tears
successful outcomes especially for those unfit for surgery or with small/partial tears
63
what is the prognosis of surgery for those with degenerative tears
good clinical outcome with pain, ROM, strength, quality of life, sleep
64
are radiological outcomes as good as clinical outcomes? why or why not?
no clinical outcomes are better than imaging structure does have to change to get better function imaging can find things that have no symptoms
65
what is the impact of PT for acute small-medium tears
possibly can help if not progressing well, delays associated with poor surgical outcomes
66
is surgery or PT more beneficial with small-medium tears?
surgery has no difference from PT more critical in younger patients bc of high activity levels
67
what patients with multi-tendon/massive full-thickness tears would benefit from PT
low demand patients or those unfit for surgery increased likelihood of tear progresssion and arthropathy
68
why is there an increased likelihood of tear progression and arthropathy with supra/infraspinatus tear
multitendon involvement increased stress on surrounding tissues
69
__% satisfaction rate is consistent with surgery for multi-tendon/massive full-thickness tears
80%
70
joint replacement is mostly used for ____ tears
irreparable
71
what would classify an irreparable tear
2 ends of the tendon with full thickness tear has no blood supply = dries and pulls apart
72
what is the new joint arthroplasty for a reverse total shoulder arthroplasty
concave on convex
73
describe the results of a reverse total shoulder arthroplasty
90% able to participate in sports without significant restriction good-excellent results
74
what individuals have the best prognosis after surgery
younger male high bone density no diabetes/obesity small/single tear
75
what type of impingement is frozen shoulder contraction syndrome
primary (hypomobile)
76
what are 3 examples of functional questionnaires for frozen shoulder contraction syndrome
DASH ASES SPADI
77
what are 2 other names for frozen shoulder contraction syndrome
adhesive capsulitis frozen shoulder
78
t/f frozen shoulder contraction syndrome is frequently misdiagnosed with any multi-directional limitation in ROM
true
79
what are the risk factors for frozen shoulder contraction syndrome
female hypothyroidism 40-65 previous adhesive capsulitis diabetes family history
80
what are the primary causes of frozen shoulder contraction syndrome
pathology, autoimmune disease
81
what are the secondary causes of frozen shoulder contraction syndrome
concomitant injury period of immobilization
82
what are the common structural changes of frozen shoulder contraction syndrome
inflammation of GH capsule and ligaments reduced joint volume
83
what causes reduced joint volume
fluid loss cause structures to bunch up and capsule shrinks around it
84
what structures are involved with frozen shoulder contraction syndrome
GH capsule and ligaments joint space
85
what symptoms are to be expected with frozen shoulder contraction syndrome
gradual and progressive pain loss of motion functional limitations with reaching, sleeping, basic ADLs
86
what is the capsular pattern of restriction with frozen shoulder contraction syndrome
ER > ABD > FLX > IR
87
what are the signs of frozen shoulder contraction syndrome
CM - consistent block RST/MMT - possibly weak or painful depending on stage Stress test - dstx possibly + depending on stage Accessory motion - hypomobil e Special tests - + for impingement
88
can you skip/avoid a stage with frozen shoulder contraction syndrome
no, each stage lasts an undetermined amount of time
89
describe stage 1/inital of frozen shoulder contraction syndrome
gradual onset achy/sharp with use unable to lie on side high irritability PROM > AROM empty/painful end feel
90
describe stage 2/freezing frozen shoulder contraction syndrome
constant pain - worse at night high irritability moderate-severe limitations PROM > AROM empty and painful endfeel
91
describe stage 3/frozen of frozen shoulder contraction syndrome
stiffness is worse than pain intermittent pain moderate irritability moderate-severe limitations with pain at end rage PROM = AROM firm end feel
92
describe stage 4/thawing of frozen shoulder contraction syndrome
minimal-no pain low irritability ROM gradually improves firm end feel
93
t/f early dx of frozen shoulder contraction syndrome is very difficult due to irritability
true
94
what are the PT rx for frozen shoulder contraction syndrome
POLICED pt education of 4 courses promote pain-free functional activity match intensity of stretching/JM with S&S
95
what modalities are beneficial for frozen shoulder contraction syndrome
cryotherapy - additional benefit to JM, improved pain, ROM, function LASER
96
what grade JM shows mixed benefits for pain/ROM in frozen shoulder contraction syndrome
grade 3-5
97
what is the focus of MET for frozen shoulder contraction syndrome
elasticity and mobility increases offset disuse of inhibited muscles
98
____ approach is effective for most patients
multimodal
99
t/f cortisone injections show short term benefits when added to therex and JMs with FSCS
true
100
t/f capsular release is supported by RCTs
false capsular release is not supported by RCTs
101
how long does stage 1 of FSCS last
~1-2 months course of pain and mobility deficits may last 12-18 months
102
if left untreated, how long does FSCS take to resolve
12-42 months
103
what joint is the most commonly dislocated joint
GH
104
what direction is the GH joint most commonly dislocated
anterior
105
what is the mechanism of anterior GH dislocation
ER (anterior glide), ABD (inferior glide) with FOOSH
106
what type of shoulder impingement is dislocation considered
primary
107
what is the mechanism of posterior GH dislocation
90 degree flexion with FOOSH
108
why is shoulder dislocation recurrent
once tissue is stretched/torn it is most likely left laxed (mechanical instability) typically younger people that use arm frequently most likely results in surgery
109
what structures are involved with dislocation
stretch/tear capsule/ligament anterior labrum tear SLAP
110
describe fibrocartilage
thicker and concave than articular cartilage outer portion is thick/inner portion is thin widens and deepens joint surface
111
where is fibrocartilage located
shoulder and hip labrum SC/AC tibiofemoral, ulnotriquetral, intervertebral, pubic symphysis
112
describe the outer portion of collagen
primarily type 1 collagen resists tension for stabilization majority type in all fibrocartilage
113
describe the inner portion of collagen
secondarily and less type 2, 3, and 4 collagen resistes compression for shock absorption
114
t/f stabilized structures are highly neural
true allows for proprioception/kinesthesia like ligament/annulus for stabilization
115
describe the outer portion of fibrocartilage
vascular and neural tissue
116
describe the inner portion of fibrocartilage
hypo or avascular aneural alymphatic
117
describe fibrocartilage healing
better at periphery d/t greater vascularity
118
when does tensile strength initially impove
3-5 weeks greater strength when dense fibrous tissue fills in @ 8-12 weeks
119
what are the MET focus for fibrocartilage
tissue integrity/proliferation with vascularity issues stabilization
120
what other structures could possibly be injured during GH dislocation
RC tear neurovasular structures
121
what symptoms are common with GH dislocation
trauma in characteristic position acute presentation
122
what signs are common with GH dislocation
ROM - limited/painful most directions RST/MMT - weak/painful in most directions ST - likely + depending on structures involved
123
what is hill sachs lesion
compression fracture of humeral head
124
what is the PT rx for immobilization after dislocation
up to 6 weeks improve rotator cuff activation with contralateral UE use (uninjured side) and ipsilateral hand squeezing activities (injured side)
125
immobilization for shorter periods after dislocation favors
muscle integrity proprioception peripheral and central neural activity dynamic stability
126
what are the MET focuses for dislocation
stabilization tissue integrity and proliferation
127
with anterior dislocation, what motions are initially contraindicated for MET what motions are beneficial to exercise
ER, FLX, ABD ROM are initially contra-indicated IR, EXT, ADD initially beneficial
128
what MET exercises are initially beneficial with dislocation
isometrics and isotonics
129
recurrent dislocations highly likely if < ___ years of age
30
130
what is a coracoid transfer
reposition coracoid process and coracobrachialis and short biceps head to GH neck
131
what is capsular shift/capsuloraphy
most common overlap of torn portions of capsular folds
132
what age group most commonly experience proximal humeral fractures
elderly
133
what is the cause of most proximal humeral fractures
FOOSH
134
what structures are involved with proximal humeral fractures
surgical humeral neck
135
what are complications of proximal humeral fracture
axillary artery damage adhesive capsulitis from prolonged immobilization
136
what are the symptoms of axillary artery damage
coldness and blanching emergency referral possible avascular necrosis
137
what is the cause of clavicular fracture
compression mechanism through long axis of clavicle fall on lateral side of shoulder
138
where is the clavicular fracture located
weak spot at S curve most likely snaps in middle
139
what complications can occur with clavicular fracture
large displacement may require surgery epiphyseal plate injury - last bone to ossify @ 18-25 years
140
what test can be used to determine if there is a fracture in the shoulder
olecranon-manubrium percussion test
141
when does PT begin after a fracture
clinical union occurs between 4-8 weeks pain is not typically from bone
142
What is the focus of PT following a fracture
consequences of prolonged immobilization where every tissue is negatively influenced
143
what is proximal humeral apophysitis
little league shoulder most common in male adolescents mostly overhead throwers/racquet sports
144
what is the cause of proximal humeral apophysitis or little league shoulder
growth with high activity high activity on changing structure (growth plate)
145
what are the structural changes that are common with PHA
bone growth exceeds rotator cuff lengthening increased tendon tension growth plate is weak spot most often inflammation
146
what are complications associated with PHA
avulsion (pulling/tearing away) premature closure - very rare
147
what are the symptoms associated with proximal humeral apophysitis
gradual onset of shoulder pain with oversue "pop" can indicate trauma/avulsion
148
what signs indicate PHA
impingment like asymmetry ER weakness compared to IR special tests - + impingement test
149
what is the most common sign of PHA
Palpation - TTP over antero-/posterolateral aspect of proximal humerus
150
what is included with pt education with PHA
soreness rule load management movement cues
151
what is the treatment of PHA
pt education POLICED throwing mechanics
152
what should be avoided with treatment of PHA
prolonged stretching d/t vulnerability of growth plate
153
what is the treatment of PHA
normalize motion MET return to play
154
what is the focus of MET for PHA
cuff, trunk, LE impairments caution with muscle/tendons attached to growth plate
155
what is the prognosis of PHA
most return to preinjury levels at 2 months, possibly 2-8 months ~4-5 months to return to competition with an avulsion can become recurrent/persistent problem
156
at what age does the growth plate typically close
16-20 years