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Therapeutic Exercise > Exam 2: Shoulder, Wrist & Hand > Flashcards

Exam 2: Shoulder, Wrist & Hand Flashcards

1
Q

Which cervical spine segments refer pain to the shoulder

A

C3-C5

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2
Q

What are some examples of systemic origins that can be sources of shoulder pain

A

diaphragm, heart, gallbladder, and spleen

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3
Q

The shoulder itself can refer pain to the upper ____, but usually not past the ____.

A

arm; elbow

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4
Q

What joints are involved with shoulder movement that could be impacting this patient’s pain?

A

Sternoclavicular joint
acromioclavicular joint
glenohumeral joint
scapulothoracic articulation

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5
Q

What are the goals of a patient with hypomobility

A

reduce pain and impairments
restore ROM and function
improve strength throughout range

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6
Q

What types of conditions would cause a patient to have hypomobility

A

immobility after immobilization
adhesive capsulitis
rotator cuff pathologies

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7
Q

Adhesive capsulitis can be seen in patients with hypomobility. What are the general details about adhesive capsulitis

A

decreased ROM in a capsular pattern
it is idiopathic or insidious
Has four stages

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8
Q

What are the four stages of an adhesive capsulitis

A
  1. initial onset of symptoms
  2. freezing
  3. frozen
  4. thawed
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9
Q

What does idiopathic or insidious mean

A

a diagnosis where they don’t really know what causes it

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10
Q

What type of patients typically present with idiopathic adhesive capsulitis

A

diabetic patients

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11
Q

Patients with adhesive capsulitis can gain ROM back naturally after ___ years

A

two

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12
Q

What is the term used to describe a patient that just stops using their arm because of an injury/pain

A

a secondary capsulitis

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13
Q

If a patient is in the protection phase, an injury is (acute/chronic) and probably has ______.

A

acute; inflammation

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14
Q

Which stage of healing and inflammation is a patient with hypomobility in if we want to

  • control pain, edema, and muscle guarding
  • maintain soft tissue and joint integrity and mobility
  • maintain integrity and function
A

protection phase

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15
Q

What types of interventions can be done for a patient with hypomobility in the protection phase

A

gentle PROM
modalities
working the joints above and below the problematic sight

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16
Q

Which stage of healing and inflammation is a patient with hypomobility in if we want to

  • control pain, edema, and joint effusion
  • progressively increase joint and soft tissue mobility
  • inhibit muscle spasms
  • improve arthrokinematics and muscle performance
A

controlled motion

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17
Q

What types of interventions can be done for a patient with hypomobility in the controlled motion phase

A

Functional activities
ROM
Self or manual stretching
Joint mobs

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18
Q

Which stage of healing and inflammation is a patient with hypomobility in if we want to

  • progressively increase flexibility and neuromuscular strength
  • prepare for functional demands
A

Return to function phase

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19
Q

What types of interventions can be done for a patient with hypomobility in the return to function phase

A

emphasize correct mechanics, safe progressions, and exercise strategies for return to function
try to mimic possible job situations the patient may encounter

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20
Q

If the GH joint is stiff, what is going on at the other joints

A

The AC joint will be hypomobile and the scapula will do more winging instead of moving in its normal planes

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21
Q

True or False:

joints that are hypomobile typically cause joints around it to be hypermobile

A

true

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22
Q

What is the order of ROM progression in patients with hypomobility

A

PROM -> AAROM -> AROM

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23
Q

True or False:

Joint mobilizations and stretching can be added with PROM as long as you don’t risk damaging healing tissue

A

true

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24
Q

What are the indications of using isometric exercise in patients with hypomobility

A

When motion is contraindicated but activation isn’t
to facilitate neuromuscular control, proprioception, and improve circulation
in early states of rehab when restrictions still occur

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25
Q

What is the progression of DCER exercises in patients with hyomobility

A

minimal to no resistance
multiple tools to perform exercises
concentric and eccentric exercises
begin slowly during controlled motion phase

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26
Q

Which phase of healing and inflammation will a patient with hypomobility perform stabilization exercises

A

at the end of controlled motion or later

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27
Q

Which phase of healing and inflammation will a patient with hypomobility perform functional exercise

A

later controlled motion or return to function stages

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28
Q

Which phase of healing and inflammation will a patient with hypomobility perform plyometric and sport specific exercises

A

Not until ROM is fully regained and good quality muscular control achieved

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29
Q

What are the goals of a patient with hypermobility

A

reduce pain and impairments
restore function
decrease instability by improving neuromuscular control throughout range

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30
Q

A patient that often dislocates or subluxes has ______ joints

A

hypermobile

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31
Q

Which phase of healing and inflammation is a patient with hypermobility in if we want to protect healing tissue and promote tissue health

A

protection phase

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32
Q

Which phase of healing and inflammation is a patient with hypermobility in if we want to provide protection as needed due to fatigue and increase stability and strength of RC and scapular muscules

A

controlled motion

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33
Q

Which phase of healing and inflammation is a patient with hypermobility in if we want to restore function control and return to maximum function

A

return to function

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34
Q

What is the ROM progression of a patient with hypermobility

A

maintain normal rage while avoiding motion that cause the humeral head glide in the direction of dislocation. NO stretching or joint mobilization

35
Q

When should isometric exercises be used with patients with hypermobility

A

during the early stages or protection phase

36
Q

which phase of healing and inflammation is DCER performed in patients with hypermobility

A

controlled motion

37
Q

What is the biggest part of rehab with hypermobility

A

stabilization

38
Q

which phase of healing is stabilization exercises typically started in patients with hypermobility

A

controlled motion

39
Q

Which phase of healing and inflammation should functional exercise begin in patients with hypermobility

A

end of controlled motion or return to function

40
Q

Which phase of healing and inflammation should plyometric and sport specific exercises begin in patients with hypermobility

A

Once good quality of muscular control and stabilization is achieved

41
Q

What are the goals of patients with scapulothoracic or postural dysfunction

A

reduce pain and impairment
restore function and ROM
improve strength and motor control throughout ROM

42
Q

A patient with a winging scapula with rounded shoulders and forward head posturing is an example of _______

A

scapulothoracic or postural dysfunction

43
Q

True or False:

Scapulothoracic or postural dysfunctions typically are not in a stage of inflammation

A

true

44
Q

What are the impairments of a patient with scapulothoracic or postural dysfunction

A

*pain, decrease *ROM, poor motor control of scapula

**when treating these patients, start with pain and ROM since it is most likely reduced secondary to poor postural alignment

45
Q

What type of ROM can patients with scapulothoracic or postural dysfunction tolerate

A

AROM

46
Q

What type of exercise can patients with scapulothoracic or postural dysfunction tolerate early into rehab

A

DCER

47
Q

What are the goals of post operative patients

A

protect surgical repair, reduce pain and control inflammation, restore ROM, improve strength, reduce impairments and restore function

48
Q

Post operative patients will have a ___ protective phase

A

long

49
Q

post op patients look like _____ patients because they come in with decrease ROM.

A

hypomobile

50
Q

control of _____ is key for reducing a post-op patient’s pain

A

inflammation

51
Q

True or false:

Power training comes before endurance and strength training

A

false, endurance and strength come before power

52
Q

Which nerve roots refer symptoms to the elbow, but are usually not isolated to the elbow

A

C5, C6, T1, and T2

53
Q

Which nerves can get entrapped at or near the elbow causing pain to an individual

A

ulnar, median, and radial

54
Q

The hand is the terminal point for which nerve roots? via which nerves?

A

C6, C7, and C8 via median ulnar and radial nerves

55
Q

The hand is the ____ ____ for C6, C7, C8 nerve roots via median, ulnar, and radial nerves

A

terminal points

56
Q

Injury or entrapment of the median, ulnar, or radial nerve anywhere along their course can cause symptoms in the ____ and ____

A

wrist and hand

57
Q

True or False:

Treatment of the symptoms alone will result in lasting outcomes

A

false, need to treat the source of the pain

58
Q

Which joints are involved at the elbow

A

humeroradial
humeroulnar
proximal radioulnar
distal radioulnar

59
Q

Which joints are involved in the wrist/hand

A

radiocarpal
midcarpal
carpometacarpal joints
metacarpophalangeal joints

60
Q

Which muscles make up the elbow flexors

A

brachialis
biceps brachii
brachioradialis

61
Q

Which muscles make up the elbow extensors

A

triceps brachii

anconeus

62
Q

Which muscle make up the supinators

A

supinator
biceps brachii
brachioradialis

63
Q

Which muscles make up the pronators

A

pronator teres

pronator quadratus

64
Q

Which muscles make up the wrist flexors that attach to the medial epicondyle

A 
FCR
FCU
palmaris longus
FDS
profundus
65
Q

Which muscles make up the wrist extensors that attach to the lateral epicondyle

A

ECR longus and brevis
ECU
Extensor Digitorum

66
Q

The function of the hand is a result of a balance and control of forces of the _____ and _____ muscles of the wrist and hand

A

extrinsic and intrinsic

67
Q

What are some possible pathologies and etiologies that could cause a patient to be hypomobile in their elbow and hand

A 
Rheumatoid arthritis
osteoarthritis
degenerative joint disease
acute reactions from trauma, dislocations, or fractures
post-immobilization
68
Q

Should you stretch a patient with Rheumatoid arthritis? why or why not

A

Not too much because during a flare up, they will present to be hypomobile, but as soon as the flare up goes away they could actually be hypermobile

69
Q

What are some possible causes of pain in patients with osteoarthritis or degenerative joints disease

A

they will probably have joints spurs, inflammation, or bony blocks that limit ROM. Do not push them through further ROM

70
Q

Why is stretching limited in patients with acute reactions from trauma, dislocations, or fractures?

A

The pain and swelling will occur within a joint and make them hypomobile, but as soon as the swelling goes away they might be hypermobile

71
Q

Patients who are post-immobilized may have a ___ shortening of muscles and hypomobility and need to be stretched

A

true

72
Q

What are common functional/activity limitations at the elbow in patients who present with hypomobility

A

turning the doorknob, pushing and pulling doors, pushing up from a chair, carrying objects and reaching

73
Q

What are common functional/activity limitations at the wrist in patients who present with hypomobility

A

difficulties with ADL’s and gripping and finger dexterity for writing and typing

74
Q

Which phase of healing and inflammation is a hypomobile patient in if we want to maintain soft tissue and joint mobility, improve joint tracking of the elbow, improve muscle performance for functional abilities, control pain and protect joints and maintain joint/tendon mobility and muscle integrity

A

protection phase

75
Q

Which phase of healing and inflammation can the PT do a lot of education and tell the patient about what we are doing and why we are doing it

A

protection phase

76
Q

Which phase of healing and inflammation is a hypomobile patient in if we want to improve muscle performance for functional abilities, increase joint play and accessory motions, improve joint tracking and pain-free motion, and restore functional mobility of joints and soft tissue

A

controlled motion and return to function

77
Q

Regaining full ROM of the elbow/hand after surgery should be on of your main goals in the (early/late) stages of rehab

A

early

78
Q

It is important to remember that with surgical procedures on the wrist and hand, some tendons are very ____ and by moving surrounding joints you may be putting tension through a tendon that shouldn’t be

A

long

79
Q

What are some examples of overuse/repetitive trauma syndromes of the elbow/hand

A 
lateral epicondylitis
medial epicondylitis
carpal tunnel
trigger finger
de Quervain's disease
Tendonitis/tenosynovitis
80
Q

What is another term for lateral epicondylitis

A

tennis elbow

81
Q

What is another term for medial epicondylitis

A

golfers elbow

82
Q

Which phase of healing and inflammation is a overuse/repetitive trauma of the elbow/hand patient in if we want to

  • decrease pain, edema, or spasm
  • develop soft tissue and joint mobility
  • maintain upper extremity function
A

protection phase

83
Q

Which phase of healing and inflammation is a overuse/repetitive trauma of the elbow/hand patient in if we want to

  • increase muscle flexibility and scar mobility
  • restore joint tracking of the radioulnar joint
  • improve muscle performance and function
  • patient education
A

controlled motion and return to function phase

Therapeutic Exercise (9 decks)

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