Exam 2: Shoulder, Wrist & Hand

Question 1

Which cervical spine segments refer pain to the shoulder

Answer 1

C3-C5

Question 2

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

Answer 2

diaphragm, heart, gallbladder, and spleen

Question 3

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

Answer 3

arm; elbow

Question 4

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

Answer 4

Sternoclavicular joint
acromioclavicular joint
glenohumeral joint
scapulothoracic articulation

Question 5

What are the goals of a patient with hypomobility

Answer 5

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

Question 6

What types of conditions would cause a patient to have hypomobility

Answer 6

immobility after immobilization
adhesive capsulitis
rotator cuff pathologies

Question 7

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

Answer 7

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

Question 8

What are the four stages of an adhesive capsulitis

Answer 8

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

Question 9

What does idiopathic or insidious mean

Answer 9

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

Question 10

What type of patients typically present with idiopathic adhesive capsulitis

Answer 10

diabetic patients

Question 11

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

Answer 11

two

Question 12

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

Answer 12

a secondary capsulitis

Question 13

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

Answer 13

acute; inflammation

Question 14

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

Answer 14

protection phase

Question 15

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

Answer 15

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

Question 16

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

Answer 16

controlled motion

Question 17

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

Answer 17

Functional activities
ROM
Self or manual stretching
Joint mobs

Question 18

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

Answer 18

Return to function phase

Question 19

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

Answer 19

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

Question 20

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

Answer 20

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

Question 21

True or False:

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

Answer 21

true

Question 22

What is the order of ROM progression in patients with hypomobility

Answer 22

PROM -> AAROM -> AROM

Question 23

True or False:

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

Answer 23

true

Question 24

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

Answer 24

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

Question 25

What is the progression of DCER exercises in patients with hyomobility

Answer 25

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

Question 26

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

Answer 26

at the end of controlled motion or later

Question 27

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

Answer 27

later controlled motion or return to function stages

Question 28

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

Answer 28

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

Question 29

What are the goals of a patient with hypermobility

Answer 29

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

Question 30

A patient that often dislocates or subluxes has ______ joints

Answer 30

hypermobile

Question 31

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

Answer 31

protection phase

Question 32

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

Answer 32

controlled motion

Question 33

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

Answer 33

return to function

Question 34

What is the ROM progression of a patient with hypermobility

Answer 34

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

Question 35

When should isometric exercises be used with patients with hypermobility

Answer 35

during the early stages or protection phase

Question 36

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

Answer 36

controlled motion

Question 37

What is the biggest part of rehab with hypermobility

Answer 37

stabilization

Question 38

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

Answer 38

controlled motion

Question 39

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

Answer 39

end of controlled motion or return to function

Question 40

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

Answer 40

Once good quality of muscular control and stabilization is achieved

Question 41

What are the goals of patients with scapulothoracic or postural dysfunction

Answer 41

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

Question 42

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

Answer 42

scapulothoracic or postural dysfunction

Question 43

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

Answer 43

true

Question 44

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

Answer 44

*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

Question 45

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

Answer 45

AROM

Question 46

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

Answer 46

DCER

Question 47

What are the goals of post operative patients

Answer 47

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

Question 48

Post operative patients will have a ___ protective phase

Answer 48

long

Question 49

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

Answer 49

hypomobile

Question 50

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

Answer 50

inflammation

Question 51

True or false: Power training comes before endurance and strength training

Answer 51

false, endurance and strength come before power

Question 52

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

Answer 52

C5, C6, T1, and T2

Question 53

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

Answer 53

ulnar, median, and radial

Question 54

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

Answer 54

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

Question 55

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

Answer 55

terminal points

Question 56

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

Answer 56

wrist and hand

Question 57

True or False: Treatment of the symptoms alone will result in lasting outcomes

Answer 57

false, need to treat the source of the pain

Question 58

Which joints are involved at the elbow

Answer 58

humeroradial humeroulnar proximal radioulnar distal radioulnar

Question 59

Which joints are involved in the wrist/hand

Answer 59

radiocarpal midcarpal carpometacarpal joints metacarpophalangeal joints

Question 60

Which muscles make up the elbow flexors

Answer 60

brachialis biceps brachii brachioradialis

Question 61

Which muscles make up the elbow extensors

Answer 61

triceps brachii | anconeus

Question 62

Which muscle make up the supinators

Answer 62

supinator biceps brachii brachioradialis

Question 63

Which muscles make up the pronators

Answer 63

pronator teres | pronator quadratus

Question 64

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

Answer 64

``` FCR FCU palmaris longus FDS profundus ```

Question 65

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

Answer 65

ECR longus and brevis ECU Extensor Digitorum

Question 66

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

Answer 66

extrinsic and intrinsic

Question 67

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

Answer 67

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

Question 68

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

Answer 68

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

Question 69

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

Answer 69

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

Question 70

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

Answer 70

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

Question 71

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

Answer 71

true

Question 72

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

Answer 72

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

Question 73

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

Answer 73

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

Question 74

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

Answer 74

protection phase

Question 75

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

Answer 75

protection phase

Question 76

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

Answer 76

controlled motion and return to function

Question 77

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

Answer 77

early

Question 78

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

Answer 78

long

Question 79

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

Answer 79

``` lateral epicondylitis medial epicondylitis carpal tunnel trigger finger de Quervain's disease Tendonitis/tenosynovitis ```

Question 80

What is another term for lateral epicondylitis

Answer 80

tennis elbow

Question 81

What is another term for medial epicondylitis

Answer 81

golfers elbow

Question 82

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

Answer 82

protection phase

Question 83

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

Answer 83

controlled motion and return to function phase