EOS Theory Flashcards
Key subjective findings for RCRSP
Pain is load dependent
Pain in deltoid region → will be deep
Pain and weakness with elevation
Sleep disturbances
Prolonged and frequent overhead tasks
Can be acute or insidous
Objective findings for RCRSP
AROM < PROM
Painful arc in abduction (70-120)
Pain and weakness with resisted movements → mainly abd, IR and ER
Pain on MMTs for RC muscles
Key tests
Positive ER lag test
Positive Gerbers lift off → Subscap. Lot of strain on shoulder
Can also do the belly press test for subscap
Full can and empty can → integrity of supraspinatus
SMPs for RCRSP
RC facilitation
Reduce level length of arm → superman
Basic treatment plan for RCRSP
Advice and education
Sleeping posture
Some pain during prescribed exercise is ok
Manual therapy
Based on symptom relieving SMPs
MWM of GHJ to assist with elevation
Exercise
Start with motor control exercise and progress to more strengthening
Motor control:
- Short lever arm, RC facilitation
Aiming to progressively load the rotator cuff
Moving to more whole body movements and functional movements
Subjective for LH biceps pathology
- Pain in the anterior shoulder
- Pain is load dependent
- Pain and weakness on over head movement
- Patient may feel flicking of tendon
- Repeated overhead movement
- If relating to tendinopathy then abnormal loading patterns may be seen
Objective for biceps pathology
- AROM < PROM
- LHB tendon painful on palpation
- Pain and weakness with resisted movements
Special tests
- Speeds test
- Patient flexes arm to 90 in supination and therapist resists further flexion
- Yergasion’s test (looking at LHB and transvers ligament)
- Patient arm flexed to 90 by side in pronation
- Therapists palpated LHB with one hand and actively resists supination with the other
- Can add active ER while resisting supination to look for sublux
- Upper cut
- Patient flex to 90 with full supination and makes a fist
- Therapist resits patient quickly moving fist to opposite shoulder
Frozen shoulder pathology overiview
- Inflammation, fibrosis and contracture of the capsule
- Follows a progression over 4 phases
- Pre freezing → present very similar to RCRSP with pain at EOR, sleep disturbances and ache
- Freezing → severe pain and some loss of ER
- Frozen → Painful (less than freezing) but severe loss of ROM
- Thawing → Resolving pain and persistence stiffness
Subjective for frozen shoulder
Incidence = around 50 years and more common in females
Key take away from the subjective is looking for the symptom progression and sleep disturbances
Comorbidities → obesity, thyroid, family history
Objective for frozen shoulder
AROM = PROM but will be restricted (especially ER)
Accessory glides and capsular length tests are also all restricted
Treatment overview for frozen shoulder
Advice and education
- Diagnosis → natural course of progression pain>stiff, stiff>pain
- Prognosis → don’t need to give full 2 year max at start
- Proposed management plan → self management strategies for pain relief, activity modification and posture
Manual therapy
This is matched the course of progression but more importantly the patients level of irritability
Low grade GHJ glides in pain free range → high grade GHJ at EOR for increased duration
Exercise
This is also linked to progression
- Pain > stiffness
- Pain free passive ROM, active assist in pain free
- Gentle stretches
- Stiffness > pain
- Progression of stretching
- Neuromuscular re-education → normal scapulohumeral movement
5 aspects of conservative carpal tunnel management
Night splinting
Activity modifications → avoid aggravating activities
Oedema management through massage
Median nerve gliding exercises
Finger tendon gliding
Conservative treatment for ACJ
Conservative
- Sling for 3 weeks
- Passive circumduction exercises outside sling
- AROM exercises after sling removal
- Strengthening exercises
- Non competitive contact sport till 3 months
- Maintain mobility in other joints
Prognosis
- G1 → 2-4 wk
- G2 → 4-8 wk
- G3 → 8-12 wk
Discuss treatment plans, especially around G1-3 trying at least 4-6 weeks of conservative first
Can explain criteria for RTS → pain free full ROM and strength requirements
SLAP lesion management
Need to trial conservative management first:
- Progression of RC exercises, scap exercises and posterior capsular stretching
- Goal to reduce shearing of GHJ meaning reduced work for LHB
Ensure care is taken when tensioning LHB
Adolescence injuries at the elbow
Prevalent in 9-10 yrs and pitchers
- ME apophysitisRepetitive tensile stress of medial epicondyle
- Progressive medial elbow pain during late cocking
- Focal tenderness
- Eventually decreased throwing ability
- Avulsion fracturesMedial traction from acute valgus stress
- Acute onset medial elbow pain
- Crack or pop during throw +/-
- Limited elbow extension from pain
TFCC management
Conservative management
- Often rest and immobilise in splint for 2-3 weeks if acute → this is just the wrist widget. Don’t actually immobilise in a full splint unless patient is very irritable.
- Wrist widget may be useful → can replicate with tape
- Progressive pain free ROM and avoidance of aggs → UD, WB, EOR forearm rotation
- Need to consider strengthening of pronator quad and ECU (makes up dorsal part of TFCC). These strengthening exercises are only started once pain free
- Start isometrics on day one
- Wall push ups on first are a good late stage exercise
