Evidence Based Management of the Shoulder Joint Complex Flashcards
how much AC jt motion makes up 120 deg of GH abd?
35 deg upward rot
how much ST jt motion makes up 120 deg of GH abd?
60 deg upward rot
how much GH jt ER makes up 120 deg of GH abd?
45 deg
how much SC jt motion makes up 120 deg of GH abd?
25 deg upward rot
25 deg elevation
what kind of jt is the SC jt?
a saddle jt
what is the articulation of the SC jt?
the clavicle articulates with a disc on the manubrium
t/f: the clavicle moves in an oblique plane that tilts into the sag plane when going into protraction/retraction
true
what are the benefits of the disc articulation in the SC jt?
increased mobility, stability, and load acceptance in the SC jt
elevation and depression of the clavicle is restricted by what lig?
the costoclavicular lig
protraction at the SC jt is accompanied by what other motion?
depression
retraction at the SC jt is accompanied by what other motion?
elevation
when the SC jt protracts and depresses, what is the direction of the glide?
anterior
when the SC jt retracts and elevates, what is the direction for the glide?
posterior
when the SC jt protracts/retracts, is it convex on concave motion or concave on convex motion?
concave on convex motion
what plane is rotation of the clavicle?
sagittal plane
what ligament stops elevation of the clavicle at about 90 deg, then rotates the clavicle to allow for the scap to continue moving?
the coracoclavicular lig
what is the roll and glide of elevation at the SC jt?
roll sup
glide inf
what is the roll and glide of depression at the SC jt?
roll inf
glide sup
what motions does the interclavicular lig restrict?
sup and lat motions
what motion does the costoclavicular lig restrict?
elevation
what plane does protraction/retraction occur in?
transverse plane
t/f: the AC jt is a pseudoarticulation
true
what kind of jt is that AC jt?
planar jt
what part of the scap defines upward/downward rotation?
the inf angle of the scap
when the inf angle of the scap moves medially, what motion is occurring?
downward rotation
how much downward rotation occurs at the scap?
20 deg
when the inf angle of the scap moves laterally, what motion is occurring?
upward rotation
how much upward rotation is there at the scap?
60 deg
t/f: the scap does upward/downward rotation, tilting, and IR/ER
true
when the scap tilts anteriorly, what muscle is working a lot?
pec minor
when the scap tilts posteriorly, what muscle is working a lot?
LT
what is the most mobile jt in the body?
the GH jt
why is the GH jt prone to instability?
bc only 25% of the humeral head is covered by the glenoid fossa
what provides dynamic stability at the shoulder?
SITS muscles (supraspinatus, infraspinatus, teres minor, subscapularis)
describe the setting phase of the shoulder
during the first 30 deg of shoulder and, there is very little scap motion
what the scapulohumeral rhythm?
2:1 GH to ST
what is the exception to the roll/glide rules at the shoulder?
IR/ER
when the GH jt ERs, what is the glide?
posterior
what is a theory as to why the humeral head glides posteriorly during ER?
the anterior lig complex catches the humeral head and pushes it back as it becomes tight
ER muscles are posterior and therefore pull the humeral head back
when the GH jt IRs, what is the glide?
anterior
what is the theory as to why the humeral head glides anteriorly during IR?
the posterior lig complex catches the humeral head and pushes it forward as it becomes taught
what is the roll and glide of shoulder flexion?
roll sup
glide inf/ant
what is the roll and glide of shoulder abduction?
roll sup
glide inf/post
what is the roll and glide of shoulder IR?
roll/spine post
glide ant
what is the roll and glide of shoulder ER?
roll/spine ant
glide post
what is the roll and glide of shoulder horizontal adduction?
roll med
glide lat
what is the roll and glide of shoulder horizontal abduction?
roll lat
glide med
what is the roll and glide of shoulder POS elevation?
roll sup
glide inf
what is the roll and glide of shoulder extension?
roll/spin ant
glide ant
what are the restraints to ER at 0 deg abd?
subscap
sup GH lig
coracohumeral lig
what are the restraints to ER at 45 deg abd?
subscap
mid GH lig
what are the restraints to ER at 90 deg abd?
inf GH lig
when the arm is higher up, where do the restraints come from?
further down
when the arm is lower down, where do the restraints come from?
further up
what is the shape of the inf GH lig?
pouch-like (axillary pouch)
what is the benefit of the shape of the inf GH lig?
the puhc allows for more flexibility in arm elevation
when the inf GH lig becomes inflammed and sticks to itself, what condition may be present?
adhesive capsulitis
what are the restraints to IR at 0 deg abd?
ing GH lig
teres minor
post capsule
what are the restraints to IR at 45 deg abd?
inf GH lig
what are the restraints to IR at 90 deg abd?
inf GH lig
post capsule
the inf GH lig and coracohumeral lig resist what motions?
ER and ext
the sup GH lig resists what?
inf translation of the humeral head
the middle GH lig resists what motions?
anterior translation from 0-45 deg in ER
how can we try to loosen ligs?
heat, stretching, US, cross/transverse friction massage
the inf GH lig restricts ____ and ____ in 90 deg abd?
IR, ER
when is the inf GH lig most taught?
at 90 abduction with full ER
t/f: the higher the arm gets, the more slack the mid and sup GH ligs get
true
what is the rotator interval?
a critical zone in the shoulder bw the subscap and supraspinatus where impingement frequently occurs
what structures run through the rotator interval?
the biceps tendon
subacromial bursa
suprascapularis tendon
t/f: the shape of the acromion can cause impingement at the rotator interval
true
the rotator interval space is typically _______mm
4-11
what can cause decreased acromial space in the rotator interval?
inflammation of the structures running through it, acromial shape differences
what questions should we ask about the chief complaint at the shoulder?
reproducible motions/positions
pain levels and location
what is a macrotrauma?
a single event causing the injury
what is a microtrauma?
cumulative events causing the injury
t/f: we can use US for feedback on muscle use
true
what diagnostic imaging can be used at the shoulder?
plain film radiograph
arthrography
CT scan
MRI
what are possible adjacent contributors to shoulder pain?
cervical spine
thoracic spine
how may the thoracic spine contribute to shoulder pain?
if someone lack motion at the thoracic spine, they may compensate for the lack of motion by overusing the shoulder
what are typical views used in radiographs of the shoulder?
AP in IR or ER
lat/scapular (Y view)
what shoulder pathology can be diagnosed with an MRI?
rotator cuff tears, Bankart lesions, SLAP lesions
what is a Bankart lesion?
a labral tear at 3-6 o clock
what is a SLAP tear?
a labral tear at 10-2 o clock
what does SLAP stand for?
sup labrum anterior or posterior to the biceps
a tight biceps could cause what at the shoulder?
SLAP tear
what disability questionnaires may be used for shoulder pathology?
SPADI
DASH/quick-DASH
UCLA Shoulder Rating Scale
Penn Shoulder Score
what are medical red flags in the shoulder?
R shoulder-lung, GB
L shoulder-heart, spleen, diaphragm
cardiac (MI)
Pancost’s tumor (superior sulcus0
gall bladder
liver
spleen
peripheral nerve entrapment
what organs can refer pain to the R shoulder?
lung
gall bladder
what organs can refer pain to the L shoulder?
heart
spleen
diaphragm
a peripheral nerve entrapment of what nerves could cause shoulder pathology?
spinal accessory
axillary
long thoracic
suprascpaular
a peripheral nerve entrapment of the spinal accessory nerve could cause weakness of what muscle?
traps
a peripheral nerve entrapment of the axillary nerve could cause weakness of what muscle?
delts
a peripheral nerve entrapment of the long thoracic nerve could cause weakness of what muscle?
serratus anterior
a peripheral nerve entrapment of the suprascapular nerve could cause weakness of what muscles?
supraspinatus
infraspinatus
what should we observe at the shoulder during an exam?
head, neck position
thoracic kyphosis
scap position
shoulder position
muscles contours
upper crossed
what is normal thoracic kyphosis?
40 deg
what is normal scap position?
2 in from spine
sup angle at T2
inf angle at T7
what spinal level should the sup angle of the scap be at?
T2
what spinal level should the inf angle of the scap be at?
T7
what is weak in upper crossed syndrome?
deep cervical flexors
scap stabilizers (rhomboids, MT, LT, SA)
what is tight in upper crossed syndrome?
suboccipital
UT
LS
pecs
how do we know if the head is properly aligned?
the tragus should be in line with the acromion
if we observe scapular winging, what muscle should we MMT?
the SA
what is the purpose of observation?
to help us dial in on the specific things we want to check in the exam
what may cause one shoulder to be more elevated than the other?
UT tightness
scoliosis
spinal accessory nerve injury on the dropped side
poor ergononics
higher pelvis on one side
what does QQR mean when testing ROM?
assess for Quality, Quantity, and Reproduction of symptoms
where might we note pain in ROM?
at end range
through range
in a painful arc
why is the time to baseline pain important to us?
bc it tells us the reactivity of the problem
t/f: we should assess just uniplanar motions when testing ROM?
false, we should be test uni and multiplanar motions
why should we test motions single and multiple times?
to see if pain is reproduced after one time or multiple times and how many times if multiple
where is the painful range for the AC jt?
170-180 deg shoulder abd
where is the painful range for the GH jt?
45/60 deg to 120 deg shoulder abd
what does it mean when a pt has to lean over to flexion their shoulder?
possible RC weakness, so they try to get a better advantage for the delts
during the first 30 deg shoulder flexion, what is the RC doing?
stabilizing and depressing the humeral head to prevent it jamming into the acromion
why is it a problem if the delts work unopposed?
bc it jams the humeral head straight up into the acromion
what motions make up functional ER?
abduction
ER
overpressure
what motions make up function IR?
extension
adduction
IR
overpressure
how do we measure functional ER and IR?
by how far up or down the thumb can go
in normal functional IR range, where should the thumb get to?
about T7 at the inferior angle of the scap
what muscles are involved in resisted abduction?
delts
supraspinatus
if resisted abduction causes pain with horizontal abduction, what muscle may be involved?
posterior delts
if resisted abduction causes pain with horizontal adduction, what muscle may be involved?
anterior delts
if resisted abduction causes pain, but there is no pain with resisted horizontal adb or add, what muscle may be involved?
supraspinatus
what muscles are involved in resisted adduction?
pec major
teres minor
lats
teres major
if resisted adduction and flexion causes pain, what muscle may be involved?
pec major
if resisted adduction and ER causes pain, what muscle may be involved?
teres minor
if resisted adduction and extension cause pain, what muscle may be involved?
lats (or could be teres major)
if resisted adduction and IR cause pain, what muscle may be involved?
teres major (or could be lats)
what muscles are involved with resisted ER?
teres minor
infraspinatus
supraspinatus
if resisted ER and adduction causes pain, what muscle may be involved?
teres minor
if resisted ER and abduction causes pain, what muscle may be involved?
supraspinatus
if resisted ER causes pain, but not adduction or abduction, what muscle may be involved?
infraspinatus
what muscles are involved in resisted IR?
subscap
pec major, lats, and teres major
if resisted IR and adduction causes pain, what muscles may be involved?
pec major
lats
teres major
if resisted IR causes pain but not adduction, what muscle may be involved?
subscap
what muscle is involved in resisted flexion?
corocobrachialis
if there is pain with flexion and horizontal abduction and adduction, what muscle may be involved?
delts
how do we perform scapulothoracic and scapulohumeral resistance testing (flip sign)?
have pt perform scapular adduction w/ER resistance
what would result in a positive flip sign?
weak MT/UT
why would weak MT/UT result in a positive flip sign?
bc the tension of the supra, infra, and teres minor without the tension of the MT/UT holding the scap down against the chest wall will cause the scap to flip
how do we perform lats testing?
have PT in ext, IR, and add
resist pt arm going towards the ceiling in prone
how do we perform rhomboid resistance testing?
in prone, have the pt put their hand behind their back and lift their hand off their back while you push on their scap
how do we perform UT resistance testing?
in sitting or supine, try to bend ear to shoulder or elevate shoulders with resistance down
how do we perform MT resistance testing?
in prone with elbow bent to 90 deg and shoulder abducted 90 deg, resist the pt pushing up towards the ceiling at the elbow
how do we perform LT resistance testing?
in prone with the arm over the head, resist the arm going up to the ceiling
how do we perform SA resistance testing?
in sitting or standing with the arm overhead to 130 deg, push down and back into retraction while feeling the medial border of the scap
if the pt can’t hold the SA resistance test and there is scap winging, what may this indicate?
SA weakness or long thoracic nerve injury
what are the special tests for impingement syndromes?
Hawkins Kennedy
Neer
Yergason
if you do all contractile tissue tests and they are negative, but all impingement tests are positive, what is likely going on?
bursitis
how do we perform the Hawkins Kennedy test?
have PT in flex, IR, add (can increase add) and push down at their wrist and up at their elbow
what is the sensitivity and specificity of the Hawkins Kennedy test?
sn=72-92%
sp=25-66%
is the HK better to rule in or out?
out
what is the crossover test?
test for impingement or AC jt like HW
bring arm across body
how do we perform the Neer test?
have PT flex, IR as you stabilize the scap
t/f: the Neer and HK test will test us that something is wrong, but not what is wrong
true
what is the sensitivity and specificity of the Neer test?
sn=68-95%
sp=25-68%
is the Neer test better to rule in or out?
out
how do we perform the Yergason test?
have the pt’s elbow at 90 deg flexion and pronated
resist supination and/or elbow flexion while palpating the bicipital groove
what can the Yergason test test for?
impingement and biceps
t/f: in the Yergason test, we may also bring them out into ER to see if it will flip out the bicipital groove
true
what is the sensitivity and specificity of the Yergason test?
sn=9-37%
sp=86-96%
is the Yergason test better to rule in or out?
in
what are the special tests for the RC?
ER Lag (dropping) sign
Hornblower sign
drop arm test
lift off test
full/empty can test
what are the indications for the ER Lag (dropoff) sign?
R/O infraspinatus tear
how do we perform the ER Lag (dropoff) sign?
put the pt’s arm into 90 deg elbow flexion and have them hold it then apply resistance to ER
if a pt can hold their arm in a position (strong), but it’s painful, what may we suspect?
tendinopathy
if a pt cant hold the position, what may we suspect?
a full tear
if a pt has pain with active motion and resistance, what may we suspect?
partial tear
what is the sensitivity/specificity and +/- LR of the ER Lag (dropoff) sign?
sn=20-100%
sp=69-100%
(-) LR=0-.64
(+)LR=NA
is the ER Lag (dropoff) sign better to rule in or out?
in
what are the indications for Hornblower test?
R/O teres minor tears
how do we perform the Hornblower sign?
bring the shoulder into elevation and ER with slight elbow flexion
what will we see with a teres minor tear in the Hornblower test?
the arm will drop
what is the sensitivity/specificity and +/- LR of the Hornblower test?
sn=92-100%
sp=30-93%
(+)LR=14.3
(-)LR=0
in the Hornblower test better to rule in or out?
out
what are the indications for the drop arm test?
R/O RC tears (supra, infra)
how do we perform the drop arm test?
bring the patient’s arm into about 90 deg abduction and add resistance if they can hold the position
what is the sensitivity/specificity and +/- LR of the drop arm test?
sn=15%
sp=100%
(+)LR=NA
(-)LR=NA
is the drop arm test better to rule in or out?
in
what are the indications for the lift off test?
R/O subscap tear
how do we perform the lift off test?
have the pt put their arm behind their back into functional IR and lift their arm off their back
if they can’t put their arm behind their back, have them push their arm into their belly and if they can do that, try to pull their arm away from their belly
what is the sensitivity/specificity of the lift off test?
sn=62-89%
sp=98-100%
what are the indications for the full/empty can test?
R/O supraspinatus tear
how do we perform the full/empty can test?
resist shoulder flexion in ER (thumbs up, full can) then in IR (thumbs down, empty can) in scaption
if the pt can’t do the full can test, should we do the empty can test?
no!
what is the sensitivity/specificity of the full/empty can test?
sn=62-89%
sp=98-100%
is the lift off test better to rule in or out?
in
is the full/empty can test better to rule in or out?
in
what are the special tests for instability in the shoulder?
apprehension and relocation test
Jerk test
sulcus sign
what are the indications for the apprehension and relocation test?
R/O anterior instability of the shoulder
how do we perform the apprehension and relocation test?
put the pt in abd and bring them into ER in supine
for relocation provide anterior pressure at the humeral head
what is a key consideration with the apprehension and relocation test?
BE VERY CAREFUL AND LOOK AT THE PT’S FACE
what is the sensitivity/specificity and +/- LR of the apprehension and relocation test?
sn=30-63%
sp=61-99%
(+)LR=.53-3.08
(-)LR=.47-1.11
is the apprehension and relocation test better to rule in or out?
in
what are the indications for the Jerk test?
R/O posterior instability
how do we perform the Jerk test?
have the pt in shoulder flexion to about 90 deg and IR and horizontal adduction with their elbow bent
in sitting, give posterior pressure to push the humeral head back to check the integrity of the posterior capsule
what a common mechanism of injury where the Jerk test would be positive?
FOOSH
what is a common population we see positive Jerk tests in?
football linesmen
what is the sensitivity/specificity and +/- LR of the Jerk test?
sn, sp, LR=NA
what are the indications for the sulcus sign?
R/O inferior instability
how do we perform the sulcus sign?
inferiorly glide the humeral head while palpating the subacromial area and gripping the epicondyles
if there is more than __ finger space with the sulcus sign, it is indicative of instability in the GH jt
1
what is the sensitivity/specificity and +/- LR of the sulcus sign?
sn=17%
sp=93%
(+)LR=2.43
(-)LR=.89
is the sulcus sign better to rule in or out?
in
what are the special tests for glenoid labrum dysfunction?
speed test
biceps load test
O’Brian test
Crank test
Kim test
SLAP prehension test
anterior slide test (Kibler)
t/f: a SLAP lesion is often a dx of exclusion from ruling out everything else
true
where is a SLAP lesion?
10-2 o’clock
if a pt describes the pain as achey, clicks sometimes, doesn’t other times, and is a vague pain, what are we suspecting?
a labrum problem
how do we perform the speeds test?
flex the shoulder to 90 deg, extend the elbow, and supinate the forearm
resist shoulder flexion at the forearm
what is a positive speeds test?
pain
pain with the speeds test indicates what?
biceps tendinopathy or labral tear
what is the sensitivity/specificity and +/- LR of the speeds test?
sn=17%
sp=93%
(+)LR=2.43
(-)LR=.89
is the speeds test better to rule in or out?
in
how do we perform the biceps load test?
abduct the shoulder to 90 deg, ER, and supinate with the palm facing the head in supine
resist elbow flexion
bc of the relationship bw the biceps and the labrum, the biceps load test may also indicate what?
the labrum
what is the sensitivity/specificity and +/- LR of the biceps load test?
sn=78-91%
sp=97%
(+)LR=26.38-30
(-)LR=.11
how do we perform the O’Brian test?
flex 90 deg and IR the arm then flex 90 deg and ER the arm with 10 deg hor add
resist shoulder flexion
what is a positive O’Brian test?
IR>ER pain and weakness
pain “inside” the shoulder with an O’Brian test indicates what?
SLAP
pain on “top” of the shoulder with the O’Brian test indicates what?
AC jt
what test looks like a speeds test with hor add?
O’Brian test
how do we perform the Crank test?
160 deg elevation w/elbow flexion
some deg of shoulder stabilization w/other hand
compression with ER/IR
what is the Crank test for?
biceps or labrum (SLAP)
t/f: the Crank test is a good test to trust on its own
false
what is the sensitivity/specificity and +/- LR of the crank test?
sn=9-91%
sp=56-100%
(+)LR=1.04-13
(-)LR=.10-2
how do we perform the Kim test?
130 deg in POS (plane of scap) with elbow flexion
apply compression
what does a (+) Kim test indicate?
SLAP lesion
what is the sensitivity/specificity of the Kim test?
sn=80-82%
sp=86-94%
is the biceps load test better to rule in or out?
in
is the O’Brian test better to rule in or out?
out
what is the sensitivity/specificity and +/- LR of the O’Brian test?
sn=47-100%
sp=11-98%
(+)LR=.78-2.33
(-)LR=.51-1.48
is the crank test better to rule in or out?
in
is the Kim test better to rule in or out?
in
how do we perform the SLAP prehension test?
hor add w/the arm in IR then ER with no resistance
what is a (+) SLAP prehension test?
pain with IR that diminishes with ER
what is the sensitivity of the SLAP prehension test?
50-87.5%
how do we perform the anterior slide test (Kibler)?
have PT put hand on hip
provide ant/sup force through the elbow w/ one hand and other hand stabilizing the shoulder stressing the ant capsule
what does the anterior slide test (Kibler) sniff out?
Bankart lesion
where is a Bankhart lesion?
3-6 o’clock
what is the sensitivity/specificity and +/- LR of the anterior slide test (Kibler)?
sn=8-78%
sp=84-92%
(+)LR=.56-9.75
(-)LR=.24-1.1
is the anterior slide test (Kibler) better to rule in or out?
in
is the shoulder more mobile or more stable?
mobile
why does the shoulder lean towards more mobility than stability?
bc there is not a lot of coverage of the humeral head (gold ball on golf tee)
what is the association bw labral tears and GH instability?
mobc the jt is more unstable it is more prone to injury
what are some factors that contribute to GH instability?
ligament laxity (EDS), age, gender, hypermobile athletes, Marphan’s
what is a common MOI of a SLAP lesion?
winding up to throw a ball
why does shoulder ER and abd cause SLAP lesion?
it winds up the biceps tendon and it pulls on the labrum
what are the special tests for AC jt dysfunction?
AC shear test
cross body adduction test
how do we perform the AC shear test?
compression over the AC jt w/ant and post shearing forces
what is the sensitivity/specificity of the AC shear test?
sn=100%
sp=97%
is the AC shear test better to rule in or out?
out
if the HK test is positive which of these other tests may also be positive: Speeds, apprehension, Kim, AC shear tests?
Speeds bc it also create subacromial irritation and is the only resistive test
how do we perform the cross body adduction test?
flex the shoulder to 90 deg and horizontally adduct the arm across the chest
the cross body adduction test is similar to what test, except without the IR?
HK
there is likely more ____ pain with the cross body adduction test
superior
what are the special tests for thoracic outlet syndrome?
Adson test
Allen test
ROOS test
Wright test
Military press test
what kinds of s/s are we looking for with the special tests for thoracic outlet syndrome?
nerve and vascular symptoms (skin discoloration, occluded pulses, paresthesias, pain)
what causes compression in thoracic outlet syndrome?
compression of the nerve or vessel through the clavicle and 1st rib/accessory rib
how do we perform the Adson test?
stabilize the scap
palpate the radial pulse
move the arm into abd, ER, ext
have PT look at the arm and hold their breath
feel if pulse changes
what is the sensitivity/specificity of the Adson test?
sn=32-87%
sp=74-100%
is the Adson test better to rule in or out?
out
how do we perform the Allen test?
palpate the radial pulse
bring the arm into 90 deg abd, elbow flex
tell pt to look away from the arm and hold their breath
feel for changes in pulse
what is the specificity of the Allen test?
sp=18-43%
how do we perform the ROOS test?
raise the BL shoulder to 90 deg abduction, ER, and flex the elbows
open and close hands for 3 minutes
what is the sensitivity/specificity of the ROOS test?
sn=82-84%
sp=30-100%
is the ROOS test better to rule in or out?
in
how do we perform the Wright test?
palpate the radial pulse and bring the arm into 180 deg ER and take a deep breath
hold the position for 20-30 sec to see if there’s change to the pulse
what is the sensitivity/specificity of the Wright test?
sn=70-90%
sp=29-53%
is the Wright test better to rule in or out?
in
how do we perform the Military press test?
palpate the radial pulse and retract the shoulders in exaggerated military posture with palms facing out
what is the specificity of the military press test?
53-100%
what are the key (+) findings that rule in RC/impingement?
impingement sign
painful arc
pain with isometric resistance
weakness
atrophy
what are key (-) findings that rule out RC/impingement?
significant loss of motion
instability sign
what are key (+) findings to rule in adhesive capsulitis?
spontaneous progressive pain
loss of motion in multiple planes
pain at end range
what are key (-) findings to rule out adhesive capsulitis?
normal motion
age >40 y/o
what are key (+) findings to rule in GH instability?
age <40 y/o
hx of dislocation/subluxation
apprehension
generalized laxity
what are key (-) findings to rule out GH instability?
no hx of dislocation
no apprehension
what level of tissue irritability is 7/10 or greater pain
high
what level of tissue irritability is 4-6/10 pain?
moderate
what level of tissue irritability is 3/10 pain or less?
low
what level of tissue irritability has night/resting pain (constant)?
high
what level of tissue irritability has intermittent pain?
moderate
what level of tissue irritability has no night or rest pain?
low
if there is pain b4 end range, what level of tissue irritability is it?
high
if there is pain at end range, what level of tissue irritability is it?
moderate
if there is minimal pain with overpressure, what level of tissue irritability is it?
low
if AROM is less than PROM, what level of tissue irritability is it?
high
if AROM and PROM are about equal, what level of tissue irritability is it?
moderate
if AROM=PROM, what level of tissue irritability is it?
low
what are the intervention guidelines for high tissue irritability?
minimize physical stress through activity modification
monitor impairments
what are the intervention guidelines for moderate tissue irritability?
mild to moderate physical stress
restore impairments
basic level fxnal activity restoration
what are the intervention guidelines for low tissue irritability?
restore impairments
high demand for fxnal activity restoration
mod to high physical stress
if there are no active mobility impairments, what should we do?
medical screening
if there are active mobility impairments, passive mobility impairments, and passive accessory mobility impairments, what are we thinking the issue is?
GH capsular issue of some kind
if there are active mobility impairments, but no passive mobility impairments or muscle weakness, what are we thinking the issue is?
NM coordination
if there are active mobility impairments, passive mobility impairments, muscle weakness <2/5 and atrophy, what are we thinking the issue is?
peripheral neuropathy
if there is active mobility impairments, passive mobility impairments, and muscle weakness not <2/5 or atrophy, what are we thinking the issue is?
NM coordination issue, pain dominant, or force production issue
if there are active mobility impairments and passive mobility impairments, but no passive accessory impairments, what are we thinking the issue is?
myofascial restriction
