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Ortho PTA > Exam 2 > Flashcards

Exam 2 Flashcards

1
Q

How do you figure out if pelvis is aligned?

A

Look at ASIS, PSIS, and ischial tuberosities (just under each landmark)

See if all landmarks are level

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2
Q

What is muscle energy?

A

Contraction followed by relaxation in order to move bone

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3
Q

What are the ligaments of the SI joint?

A 
Anterior sacroiliac
Interosseus sacroiliac
Posterior sacroiliac
Sacrotuberous
Sacrospinous
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4
Q

Which ligament is usually the culprit of the SI joint?

A

The sacrotuberous

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5
Q

What causes Si joint dysfunction?

A

Malalignment or abnormal movement of joint

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6
Q

What is the main function of the SI joint?

A

Built for stability over mobility

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7
Q

What is treatment for SI dysfunction?

A

Soft tissue
Alignment
Core and hip stabilization
Stretching

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8
Q

What are good exercises for hip and glute stabilization for SI dysfunction?

A

Planks, hip drops, lower level lumbar

Look for tightness, asymmetry and perform shotgun technique

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9
Q

What is pain origin testing?

A

Cluster of tests

Thigh thrust, distraction, sacral thrust, and compress = 2+

Distraction, compression, thigh thrust, FABER, and Gaenslen’s = 3+

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10
Q

What are the special tests for the lumbar spine?

A

Straight leg test - Well leg test

Cross leg test

Slump sit test

Centralization

Prone instability test

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11
Q

What is a good HEP for pt with LBP?

A

Active rest - IE. walking

Do not want to sit around

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12
Q

What are the nonosseous structures of the spine?

A

Intervertebral discs

Surrounding ligaments

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13
Q

What is the direction of facets in the lumbar spine?

A

Vertical

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14
Q

What motion do lumbar facets allow?

A

Flex/ext

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15
Q

What is the direction of facets in the thoracic spine?

A

Frontal plane

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16
Q

What motion do thoracic facets allow?

A

Lateral bend

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17
Q

What is the direction of facets in the cervical spine?

A

Transverse plane

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18
Q

What motion do cerv facets allow?

A

Rotation

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19
Q

What is the role of zygapophyseal joints?

A

Guide ROM of spine

Lumbar spine = flex/ext

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20
Q

How many intervertebral discs are between vertebral bodies?

A

23

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21
Q

What is the annulus of the vertebral disc?

A

Outer wall

Composed of 12-18 consecutive rings

Contains the nucleus pulposus

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22
Q

What composes the nucleus pulposus?

A

Mucopolysaccharide gel that transmits force, equalize stress, and promote movement

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23
Q

Do intervertebral discs have vascularity and nerves?

A

Largely avascular and aneural

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24
Q

Where does the minimal vascular supply of the intervertebral disc come from?

A

Diffusion from vertebral bodies above and below the disc

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25
Q

Can a disc heal if it is injured?

A

Limited capacity to heal and repair

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26
Q

Which portion of the disc is more vascular and have more nerves?

A

Outer portion

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27
Q

What are the 3 classifications of the McKenzie method?

A

Posture Syndrome
Dysfunction syndrome
Derangement

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28
Q

What is Posture Syndrome?

A

Mechanical deformation of soft tissue intermittent in nature appears when soft tissues are placed under prolonged stress

Slouch overcorrected procedure

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29
Q

What is dysfunction syndrome?

A

Pain caused by mechanical loading of structurally impaired soft tissue

Tx to elongate adaptively shortened tissue

Take extend periods of time to allow full elongation

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30
Q

What is derangement?

A

Aimed at disc tissue

Mechanics obstruction to movement within the joint

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31
Q

What is the purpose of the McKenzie method?

A

Good for centralization

Find direction of preference and do exercises in that direction

Many reps

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32
Q

What motion do you perform if there is an anterior herniation?

A

Extension exercise

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33
Q

What motion do you perform if there is a posterior herniation?

A

Flexion exercise

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34
Q

What motion causes the most pressure on the lumbar spine?

A

Bending forward

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35
Q

What is radiculopathy?

A

Tingling
Peripheralization of pain
Numbness, burning
Indirection of loss of function

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36
Q

What is the true direction sign of radiculopathy?

A

Muscle weakness, sensation, and loss of reflex

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37
Q

What is the cause of muscle strain?

A

Sudden, violent contraction, rapid stretching, combined lumbar ext and rot, eccentric loading, and repetitive overuse resulting in microscopic damage

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38
Q

What is the treatment for a muscle strain?

A 
LB strengthening
Restore flexibility
Enhance cardioresp fitness
Restore function
Protect affected area
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39
Q

How should core stabilization progress?

A 
Start hooklying - drawing in
Add limb loading
Seated
Quadruped
Half kneel
Plank
Standing
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40
Q

What is transitional pain?

A

Those who struggle to transfer/get out bed, etc

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41
Q

What are the spinal ligaments?

A

Anterior longitudinal ligament

Posterior longitudinal ligament

Ligamentum flavum

Interspinous ligament

Supraspinous ligament

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42
Q

What is the function of the ALL?

A

Anterior SC to posterior body

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43
Q

What is the function of the PLL?

A

Back of central cord

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44
Q

What is the function of the LF?

A

Connecting lamina

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45
Q

What is the function of the ISL?

A

Between spine of each vertebrae

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46
Q

What is the cause of lumbar radiculopathy?

A

Mechanical compression or inflammation of nerve root

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47
Q

What are the symptoms of the lumbar radiculopathy?

A 
Pain
Numbness
Tingling
Weakness
Burning
Paresthesias
Change in reflexes
Strength loss
Sensory loss
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48
Q

What is another term for lumbar radiculopathies?

A

Sciatica or pinched nerve

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49
Q

Is lumbar radiculopathy unilateral or bilateral?

A

Unilateral

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50
Q

What are the tests for lumbar radiculopathies?

A

SLR/Crossed SLR

WELLS test

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51
Q

What are treatment options for lumbar radiculopathies?

A 
Centralization
Clinical prediction rule
Traction
Wait and see
Steroid pack
Surgery (laminectomy)
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52
Q

What is the clinical prediction rule?

A

Radicular pain less than two weeks and is still above the knee

PT manipulates = high success rate

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53
Q

What is lumbar protrusion?

A

Annulus protrudes outwards

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54
Q

What is lumbar extruded?

A

Nucleus extends all the way through the annulus, but confined and maintained within PLL

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55
Q

What is lumbar sequesterated?

A

Nucleus moves through annulus and PLL

Might need surgery

Severe pain

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56
Q

What are the types of disc protrusion?

A

Type I: peripheral annular bulge

Type II: localized annular bulge

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57
Q

What are the types of disc herniation?

A

Type I: prolapsed intervertebral disc

Type II: extruded disc

Type III: sequestrated disc

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58
Q

What is spondylolysis?

A

Bony defect in pars interarticularis of the posterior spine - IE. stress fracture

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59
Q

What is spondylolisthesis?

A

Anterior slippage of superior vertebra over the inferior

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60
Q

What is pars interarticularis?

A

Scotty dog fracture - side of lumbar spine

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61
Q

What are the classifications of lumbar slippage?

A

Type I: congenital or dysplastic

Type II: isthmic spondylolisthesis

Type III: degenerative spondylolisthesis

Type IV: traumatic spondylolisthesis

Type V: pathologic spondylolistesis

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62
Q

What types of people get spondylolisthesis?

A

V-ball players
Gymnasts
Football players

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63
Q

Where is pain generally found with spondylolisthesis?

A

Belt line

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64
Q

What type of motions increase pain in those with spondylolisthesis?

A

Extension

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65
Q

What are the grades of spondylolisthesis?

A

Grade I: 0-25%

Grade II: 25-50%

Grade III: 50-75%

Grade IV: 75-100%

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66
Q

How is grade I spondylolisthesis treated?

A

Analgesics, muscle relaxants, NSAIDs, modalities to alleviate acute pain

Avoid extension and strengthen core, avoid vertical loading, work on controlled lumbar extension with deep abdominal stabilizers

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67
Q

Is surgery required for spondylolisthesis patients?

A

Rarely

More for high-grade slippage

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68
Q

What do you expect in post op PT for spondylolisthesis?

A

Immobilization
Pt can amb as tolerated
Perform ROM and strengthening exercise of UE and LE

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69
Q

What is lumbar spondylosis?

A

Lumbar OA

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70
Q

What are the interventions of lumbar spondylosis?

A 
Traction
Functional WB activities
Stretching
Strengthening
Breathing
Educate on posture
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71
Q

What are the symptoms of spinal stenosis?

A

Radicular ache in thigh and less frequently calf

Paresthesis of LE

Disturbances in motor function

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72
Q

What are the spinal stenosis tests?

A

Ext of the lumbar spine compresses and increases symptoms

More forward flexed gait

Leg pain while walking

Treadmill test

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73
Q

What is the treadmill test?

A

Walking on an inclined t-mill and see if symptoms increase

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74
Q

What are important positions for spinal stenosis?

A

More flexion and activity

Work on gait/posture/positions

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75
Q

What is the role of PTA in spinal stenosis?

A

Posture, body mechanics, lifting techniques

Address sitting and sleeping changes

General conditioning

Manual intervention followed by a specific exercise and walking programs

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76
Q

What is a teardrop lumbar fracture?

A

Little fractures or bone chips

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77
Q

What is important to remember with lumbar compression fractures?

A

Get out of flexed position

Teach them to lean forward with a long spine and hip hinge

WB to stimulate bone growth

Balance

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78
Q

What are symptoms of vertebral compression fractures?

A

Acute local pain with essentially no signs

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79
Q

What are treatments for vertebral compression fractures?

A

Relief of pain

Activity modification

Analgesics, NSAIDs, heat, ice, massage

E-stim

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80
Q

What are more invasive treatments to vertebral compression fractures?

A

Epidural steroid injection to relieve pain and inflammation

Surgery in presence of disc herniation

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81
Q

What is the protocol post-op spine surgery?

A

For the first 3 days limit sitting for no more than 1 hr at a time and maintain proper position with no flexion

Caution forward bend and rotation

Encourage proper posture

Strengthening begins when initial wound healing is complete and pain is decreased

ROM exercise when tolerated

Gentle active ext exercise and pelvic tilts

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82
Q

What is the goal of rehab after spinal surgery?

A

Increase motion, control pain, improve endurance, and sufficient strength before beginning general conditioning

3-5 weeks post-op
- restore lumbar motion, normalize UE and LE strength, improve aerobic fitness, and decrease pain and swelling

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83
Q

What are the 3 categories of rehab classification of spinal surgery?

A

Symptoms modulation approach (early)

Movement control approach (pain comes and goes - not quite chronic - movement patterns)

Functional optimization approach

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84
Q

What are the 5 L’s of lifting

A 
Legs
Lever
Load
Lordosis
Lung

Look - 6th

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85
Q

What is the Back School Model?

A

Designed to provide an understanding of anatomy, causes of LBP, lifting mechanics, posture, self-care for LBP, exercise, nutrition, ergonomics, and stress reduction for high-risk patients

Involves 1-2 hr weekly classes for 4-6 weeks

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86
Q

What is an FCE?

A

Screening tool to acquire data related to pre-employment risk assessment and management of back injuries

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87
Q

What kind of injuries occur to the thoracic muscles?

A

Direct contact or indirect overstretching/contraction of muscles

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88
Q

What population does thoracic muscle injury typically occur?

A

Younger, active patients

Heal well because of increased blood flow

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89
Q

How do you manage thoracic spine muscle injuries?

A

Control pain and swelling

Once pain is controlled, pt should participate in ROM and strengthening

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90
Q

What are the muscles of the thoracic region?

A 
Intercostals
Diaphragm
Lats
Erector spinae
Paraspinals
Rhomboids
Middle and lower trap
Serratus ant/post
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91
Q

What is upper crossed syndrome related to?

A

Stretch weakness

Post mm are stretched
Strengthen these muscles to bring up posture

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92
Q

What muscles are part of the anterior thoracic?

A

Pecs
Rectus abdominis
Scalenes

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93
Q

What exercises strengthen the posterior thoracic?

A

Important to turn off UT - rows and scap depression

Press ups
Press up with push up
Rows - lats

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94
Q

What is kyphosis?

A

Increase thoracic posterior convexity

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95
Q

What causes kyphosis?

A

Congenital
Neuromuscular
Poor posture
Osteoporosis

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96
Q

What is the main symptom someone has with kyphosis?

A

Pain due to extra stress on PLL

Continuous eccentric contraction

Lots of trigger points

97
Q

What are tx options for kypohsis?

A

Depends on degree of curvature

Supportive bracing (minimize compression)

PTA - pt education, postural awareness, and apply exercise and stretch

If it gets really bad there are surgical interventions (replace discs, add rods, etc)

98
Q

What PT is involved for someone with kyphosis?

A

Strengthen scap retractors, rhomboids, middle trap, and erector spinae

Stretch anterior shoulder mm

99
Q

What should be avoided with someone who has osteoporosis and kyphosis?

A

Repetitive flexion

100
Q

What is involved in back breathing for kyphosis?

A

Childs pose or squat holding on to something and breath

101
Q

What should be avoided in someone with a rigid thoracic spine?

A

Do not start large movements because you could increase soreness

Start small and progress

102
Q

How is scoliosis named?

A

Named for the side of curvature

103
Q

What is the cause of scoliosis?

A

Often idiopathic

104
Q

What are some sx/sx of scoliosis?

A

Pain
Trouble breathing
Can cause stenosis

105
Q

What is structural scoliosis?

A

Irreversible

106
Q

What is nonstructural scoliosis?

A

Can be reversed

Rib hump - rotate thoracic spine. If it goes away it is considered nonstructural

107
Q

What interventions are included in non-op scoliosis

A

Strengthen and stretch to improve motion, increase mm length, and reduce pain

Bracing can also be done

108
Q

What is 1 dimensional scoliosis treatment?

A

Strengthen convex
Stretch concave

Add breathing

109
Q

How can you tell if someone has scoliosis?

A

Supine observation

Lumbar flexion to see if there is rib hump

Pure observation

Scoliometer

110
Q

What degree is seen on a positive scoliometer test?

A

5-10 degree curve

111
Q

How do you use a scoliometer?

A

Have pt bend forward like diving into pool. Scoliometer should be at a right angle and go down thoracic and/or lumbar spine.. It sits just at the top of the skin

112
Q

What are the muscles of inspirataion?

A

Primary - diaphragm and intercostals

Accessory - scalenes, SCM, levator costarum, and serratus

113
Q

What are the muscles of expiration?

A

Primary - relaxation of inspiratory mm (passive)

Accessory - QL, intercostals, obliques, rectus abdominis

114
Q

How does the diaphragm move in inspiration and expiration?

A 
Inhale = move down
Exhale = move up
115
Q

How to assess bucket handle breathing?

A

Place hands on ribs

Should see inspiration and expiration be even

Look in both supine and sitting

116
Q

What is the process of diaphragmatic breathing?

A

One hand on chest and the other on belly

Should only see hand on belly move up and down

Hand on chest should not move

117
Q

What is the process of pursed lip breathing?

A

“In with the roses, blowing out candles”

Big inhale

Slowly exhale through pursed lips

118
Q

T/F men are affected more by neck pain than women?

119
Q

What are cues to cervical spine posture?

A

Start at thoracic - lift ribs off your stomach or lift your chest up

Tell pt to balance head over shoulders

120
Q

What is the cause of neck pain?

A

Not identifiable for a lot of pt

121
Q

What are common ways someone may sprain or strain their cerv mm?

A

Young athletes
MVA
Whiplash injuries

122
Q

What is whiplash?

A

Reflexive mechanism to protect the carotid arteries

Mm spindles and GTO respond to speed and force

123
Q

What is the goal for whiplash treatment?

A

Reduce pain early on - typically use modalities, relaxation techniques, breathing, etc. DO NOT use traction

Find a pain free postural position

124
Q

What are some signs in pt with whiplash?

A

Unable to lift head off table in supine

125
Q

What is cerv radiculopathy?

A

Mechanical compression or inflammation of nerve root causing neurologic symptoms in UE

126
Q

What are some common causes of cerv radiculopathy?

A

Spondylosis
Bone fragments
Stenosis

127
Q

What are the treatment goals for cerv radiculopathy?

A

Get out of compressive positioning

128
Q

What is cerv spondylosis?

A

Chronic degenerative disc disease

129
Q

What population experiences cerv spondylosis the most?

A

Women more than men between 40-50 y/o

130
Q

What are causative factors of cerv spondylosis?

A

Repetitive microtrauma

Sustained impact loading

131
Q

What are tx options for cerv spondylosis?

A

PT intervention

Surgery - anterior discectomy and fusion or posterior foraminotomy or multilevel laminectomy

132
Q

What is cerv facet syndrome?

A

Degenerative changes to cerv facets and surrounding soft tissue

133
Q

What are symptoms of cerv facet syndrome?

A

Post neck stiffness

Pain in cerv ext/rot

Cervicogenic HA

Possible pain referral into shoulder and scap

134
Q

What are PT interventions for cerv facet syndrome?

A

ROM
Strengthening
General conditioning

135
Q

What is another name for thoracic inlet syndrome?

A

Thoracic outlet syndrome

136
Q

What is the cause of thoracic inlet syndrome?

A

Probably neurovascular - proximal compression of subclavian Aa/Vn and brachial plexus

Could be compressed by clavicle, first rib, or short/hypertrophied ant scalene

137
Q

What are symptoms of thoracic inlet syndrome?

A

Radicular signs (because of compressed brachial plexus) - pain, numbness, tingling, weakness, skin and temp change

138
Q

What are tx options for someone with thoracic inlet syndrome?

A

Postural adjustments

Movement/thoracic mobility

STM

Jt mobs

UE Nn flossing

Stretching

Strengthening

Ergonomics

139
Q

What are special tests of thoracic spine?

A

Adson’s test

Costoclavicular maneuver

Roos test

140
Q

How is tx classified for cerv spine?

A

Subgroups

  • Mobility
  • Centralization
  • Exercise and conditioning
  • Pain control
  • HA
141
Q

What are the special tests for the cerv spine?

A

Spurlings compression

Cerv compression

Cerv distraction

Upper limb tension test

Shoulder ABD test

Neck flexor Mm endurance

142
Q

What is the function of the RTC?

A

Pull humerus back into glenoid fossa

143
Q

Which RTC is most commonly torn?

A

Supraspinatus

144
Q

What are the mm of the shoulder?

A 
Rhomboids major and minor
Lats
Biceps
Teres major and minor
Pec major and minor
Serratus ant and post
Levator scap
Deltoids x 3
Traps x 3
Subclavicular
Supraspinatus
Infraspinatus
Subscapularis
Coracobrachialis
145
Q

What mm are involved in scap stabilization?

A

Middle and lower traps
Serratus
Rhomboids

146
Q

What are the passive scap stabilizers?

A

GH ligaments

Labrum

147
Q

What are the 3 main components of the shoulder?

A

Osteology
Arthrology
Passive stabilizers

148
Q

Does the sternoclavicular jt move?

149
Q

What is scapular rhythm?

A

After first 30-degrees of shoulder flexion, there is 2 degrees of humeral motion for every 1 degree of scapular motion

150
Q

What is a subacromial RTC impingement?

A

Tendons of RTC are compressed under the coracoacromial arch due to mechanical wear, stress, and friction

151
Q

What might be the cause of a subacromial RTC impingement?

A

Hooked acromion
High riding humerus
Degeneration
Mechanical wear, stress, and friction

152
Q

What is a primary shoulder impingement?

A

Mechanical depression

Involves acromion and coracoid process

153
Q

What is a secondary shoulder impingement?

A

GH instability - reduces space and mm imbalance

154
Q

What is an age-related degenerative impingement?

A

Bony osteophyte - anatomic crowding

155
Q

What nerve innervates the supraspinatus?

A

Suprascapular nerve (C5-6)

156
Q

What is the action of the supraspinatus?

A

ABD and stabilization

157
Q

What is stage I of a RTC impingement?

A

Younger pt

Edema/hemorrhage - reversible lesion

Conservative PT less than 90-degrees

158
Q

What is stage II of a RTC impingement?

A

Fibrosis and tendinitis stage (25-40 y/o)

Irreversible

Daily pain and difficulty sleeping

159
Q

What do you work on in stage I RTC impingement?

A

Scap stabilizers and scapulohumeral rhythm

160
Q

What is stage III of RTC impingement?

A

Affect pt over 40 y/o

Tendon degeneration, RTC tears, and RTC ruptures

161
Q

What do you see in stage III RTC impingement?

A

Significant mm weakness and atrophy (above scap spine and top of clavicular area)

162
Q

What is the tx for primary and secondary RTC impingements?

A

Scap stabilization exercise

Modification of activities

Local and systemic methods to control pain and swelling

Corticosteroid injections

Ice, US, ionto, phonophoresis

Stretching and strengthening exercise

163
Q

What is considered a modifying activity for someone with primary or secondary RTC impingment?

A

Limit OH activities (80-90 degrees)

Limit long lever of OH activities

164
Q

Why should someone limit corticosteroid injections?

A

Cause degeneration

No more than 3x/year

165
Q

Where is a corticosteroid injected?

A

Subacromial space and into tendon

166
Q

What type of stretches are done for someone with a primary or secondary RTC impingement?

A

Posterior capsule stretch

Pec stretch below 90

167
Q

What type of strengthening exercises are done for someone with a primary or secondary RTC injection?

A

Scap stabilization first

Then RTC

Then primary movers

168
Q

What are clinical tests for RTC impingements?

A

Neer painful arc test

Hawkins-Kennedy test

Yergeson’s test

169
Q

What is the Neer painful arc test?

A

Pain when shoulder goes into elevation with IR

170
Q

What is Hawkin’s-Kennedy test?

A

Elevate shoulder to 90-degrees in scap plane with IR and over pressure

171
Q

How do you fully palpate the greater tubercle?

A

Fully ADD, IR, and ext

172
Q

What is part of phase I (prefunctional) of non-op tx of impingement and symptomatic RTC tears?

A

Relief of symptoms

Protective positions

Stretches and pain free motion

Posterior capsule

Scap stabilization, CKC

173
Q

What is part of phase II (return to function) of non-op tx of impingement and symptomatic RTC tears?

A

Comprehensive GH and scapulothoracic strengthening

OKC

174
Q

What is part of phase III (return to activity) of non-op tx of impingement and symptomatic RTC tears?

A

More dynamic

I, Y, and T’s - prone
Rowing
Scaption
Push up with scap retraction

175
Q

What are examples of exercises to do in phase I (prefunctional)?

A

4-way isometrics

Pendulum

Ice

S/L scap clock

AAROM

Pec stretch below 90-degrees

176
Q

What are examples of exercises to do in phase II (return to function)?

A

Short arc, eccentrics

Shelf reach 90/below in flex/scap

Prone rows

Rolling ball on wall at or below 90-degrees (add rhythmic stabilization)

Body blade

S/L ER to midrange (put towel roll underneath)

177
Q

What are examples of exercises to do in phase III (return to activity)?

A

Upright row

Pushup with retraction

Wall slides with no pain in flex/scap

Lat pulldown

3-way shoulder motion

Wall swim

Rebounder

Bosu rhythmic stabilization - walk over

D1/D2 flex/ext

178
Q

What is the middle trap special test?

A

Prone, ABD to 90, and ER

179
Q

What is the low trap special test?

A

120-degrees ABD

180
Q

How to avoid painful area of the arc of motion?

A

ABD
Walk to scap and flex
Go back to ABD to get to full range

181
Q

What is biceps tendinitis?

A

When RTC is injured and the long-head of the biceps has to work harder

182
Q

What are the common symptoms of shoulder impingement?

A

Worse with OH activities

Have to modify ADLs to at or below 90-degrees

183
Q

What are the surgical managements for shoulder impingements and RTC tears?

A

Subacromial decompression (SAD)

Acromioplasty - DCE (distal clavicular excision)

Open arthrotomy or arthroscopic procedure

184
Q

What is considered a small RTC tear?

A

Less than 1 cm

185
Q

What is considered a medium RTC tear?

A

Less than 2-3 cm

186
Q

What is considered a large RTC tear?

A

Greater than 4-5 cm

187
Q

What type of surgery is done with a small tear?

A

Decompression

188
Q

What type of shoulder injury do you not do a lot of contraction exercise and why?

A

Musculotendinous injuries

Need to scar over

189
Q

What are the phases of post-op rehab?

A

Phase I: 3-4 weeks
Phase II: 5-12 weeks
Phase III: > 12 weeks

190
Q

What is a GH jt instability and dislocation injury?

A

Indirect trauma with arm ABD, elevated, and IR

Anterior most common

191
Q

What is a Bankart lesion?

A

Avulsion of capsule and glenoid labrum off the anterior rim of glenoid resulting in anterior dislocation

192
Q

What is a Hill-Sachs lesion?

A

Compression or impaction fracture of posterolateral aspect of humeral head resulting from anterior instability

193
Q

What is the articular capsule of the shoulder?

A

Encloses jt cavity from margin of glenoid cavity to neck of humerus

194
Q

What ligament has the strongest reinforcement of the shoulder capsule?

A

Anterior coracohumeral ligament

195
Q

How many ligaments strengthen the front of the capsule?

196
Q

What are the muscular tendons that help stabilize the capsule?

A

Long head of biceps

RTC mm

197
Q

What are the GH ligaments?

A

Superior, middle, inferior, and coracohumeral

198
Q

What is part of the non-op management for shoulder instability and dislocation?

A

Protection period = 4-6 weeks

Immobilization may be needed for healing

Manage pain and swelling

Prefunctional phase: PROM, AAROM elevation

AVOID ABD and ER (return to function_

Can do isometrics in neutral because there is no tendon interruption

Be careful not to stretch or tear other tissue

CKC

199
Q

What is the process of recovery of someone with shoulder dislocation and instability?

A

Full function is not always possible

Sometimes even minor stress can cause dislocation after an acute traumatic dislocation

200
Q

What are the surgical treatments for dislocations and shoulder instability?

A

Open or arthroscopic techniques

Anterior capsulolabral reconstruction procuedure

SLAP

201
Q

What interventions are used in those who have surgery for dislocations and shoulder instability?

A

Prefunctional phase is required

Slow and protected ER up until 12 weeks post-op

Meds for pain and swelling

Ice 20 min, 3-5 x/day

Pt can perform finger, hand, wrist, and elbow ROM

Progressive motion and strengthening (~6-8 weeks post-op)

Return to function phase

202
Q

What is adhesive capsulitis?

A

Decreased ROM, pain, inflammation, fibrotic synovial adhesions, and reduction of jt cavity

203
Q

What population is more likely to get adhesive capsulitis?

A

Women more than men between 40-60 y/o

204
Q

What are the causes of adhesive capsulitis?

A

Primary - idiopathic

Secondary - post trauma/immobilization

205
Q

What is the best outcome for adhesive capsulitis?

A

Caught early and get corticosteroid injections

206
Q

What are the sx/sx of adhesive capsulitis?

A

Early stage - pain at rest and during activity

As it progresses pain gradually subsides and spontaneously disappears

Severely restricted ROM and loss of function

207
Q

What is treatment for acute phase of adhesive capsulitis?

A

Treat pain and inflammation

208
Q

What are other tx options for adhesive capsulitis?

A

Ice, heat, US, phonophresis, and infrared

Pain free motion and relaxation of mm guarding

Exercise with wand and pulleys for controlled pain-free ROM

PT may ask for specific jt mobs to reduce pain

209
Q

What is the goal of treatment for late stage adhesive capsulitis?

A

Complete restoration of GH jt mobility

210
Q

What are AC sprains and dislocations?

A

Usually result from direct force on acromion or FOOSH

211
Q

How are AC sprains and dislocations graded?

A

Degree of injury to specific ligamentous structures

212
Q

What is a first-degree AC sprain?

A

Grade I: AC jt sprain

Minimal loss of function

213
Q

What is second-degree AC sprain?

A

Grade II: Moderate pain

Some dysfunction

214
Q

What is a third-degree AC sprain?

A

Grade III

Ligament injury

May need surgical intervention (open surgical repair, closed reduction, immobilization, and progressive rehab)

Initial PT is to reduce pain and swelling. Educate for compliance of immobilizer

215
Q

When does prefunction phase for AC sprain occur?

216
Q

When does return to function occur with AC sprain?

A

Follows pt level of motion and strength

217
Q

What causes a scapular fracture?

A

Direct, severe trauma

218
Q

What part of scapula is most commonly fractured?

219
Q

What is the tx for scapular fractures?

A

Conservative if associated injuries have not occurred

Ice and immobilization for 2-3 weeks

Can be as painful as pelvic fractures

Don’t start AROM and strengthening until there is evidence of healing

220
Q

What causes a clavicular fracture?

A

Direct or indirect trauma

221
Q

Who is most likely to obtain a clavicular fracture?

A

Men under 25 y/o

222
Q

What is involved in tx for clavicular fracture?

A

Focus on reducing fracture fragments

Maintain reduction

Minimize immobilization of GH jt

Figure 8 brace (~4-6 weeks)

223
Q

What is a proximal humerus fracture?

A

Four-part classification - humeral head, lesser tuberosity, greater tuberosity, and humeral shaft

224
Q

What is a nondisplaced humeral fracture?

A

Most common - one part fractures

Affect arm is placed in immobilizer

225
Q

What tx occurs if the humeral fracture is more complex?

A

ORIF with screws and plates

Longer periods of immobilization

226
Q

What are complications of humeral fractures?

A

Avascular necrosis

227
Q

What is avascular necrosis?

A

Found in older population with advancing osteoporosis

Four part humeral fracture

228
Q

What is the role of the PTA in a humeral fracture?

A

Protected limited ROM early on

Submax isometrics for scap stabilizers, RTC, and upper arm mm

Provide continued protection to injured site

229
Q

What is a TSA?

A

Proximal humerus may be replaced with prosthesis

230
Q

What are indications for a TSA?

A

Severe four-part fractures

Osteoporosis

RA and advanced OA

RTC repair plus shoulder arthroplasty guides dictates need for protective limited ROM and longer rehab program

231
Q

What type of procedure may someone have with a total RCT rupture?

A

Reverse TSA

232
Q

What is the special test for shoulder instability?

A

Apprehension test

233
Q

What are the special tests for biceps tendon pathology?

A

Speed’s test

Yergason’s test

234
Q

What are the special tests for RTC tear?

A

Drop Arm test

Supraspinatus test: empty can

235
Q

What are the special tests for shoulder impingement?

A

Neer impingement test

Hawkin’s-Kennedy impingement test

236
Q

What is closed packed position for shoulder?

A

90-degrees ABD

Full ER

237
Q

What is loose packed position for shoulder?

A

50-degrees ABD

30ish-degrees Horiz ADD

238
Q

What is the shoulder capsular pattern?

A

ER > ABD > IR

Ortho PTA (4 decks)

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