Exam 2: Shoulder, Wrist & Hand Flashcards
Which cervical spine segments refer pain to the shoulder
C3-C5
What are some examples of systemic origins that can be sources of shoulder pain
diaphragm, heart, gallbladder, and spleen
The shoulder itself can refer pain to the upper ____, but usually not past the ____.
arm; elbow
What joints are involved with shoulder movement that could be impacting this patient’s pain?
Sternoclavicular joint
acromioclavicular joint
glenohumeral joint
scapulothoracic articulation
What are the goals of a patient with hypomobility
reduce pain and impairments
restore ROM and function
improve strength throughout range
What types of conditions would cause a patient to have hypomobility
immobility after immobilization
adhesive capsulitis
rotator cuff pathologies
Adhesive capsulitis can be seen in patients with hypomobility. What are the general details about adhesive capsulitis
decreased ROM in a capsular pattern
it is idiopathic or insidious
Has four stages
What are the four stages of an adhesive capsulitis
- initial onset of symptoms
- freezing
- frozen
- thawed
What does idiopathic or insidious mean
a diagnosis where they don’t really know what causes it
What type of patients typically present with idiopathic adhesive capsulitis
diabetic patients
Patients with adhesive capsulitis can gain ROM back naturally after ___ years
two
What is the term used to describe a patient that just stops using their arm because of an injury/pain
a secondary capsulitis
If a patient is in the protection phase, an injury is (acute/chronic) and probably has ______.
acute; inflammation
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
protection phase
What types of interventions can be done for a patient with hypomobility in the protection phase
gentle PROM
modalities
working the joints above and below the problematic sight
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
controlled motion
What types of interventions can be done for a patient with hypomobility in the controlled motion phase
Functional activities
ROM
Self or manual stretching
Joint mobs
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
Return to function phase
What types of interventions can be done for a patient with hypomobility in the return to function phase
emphasize correct mechanics, safe progressions, and exercise strategies for return to function
try to mimic possible job situations the patient may encounter
If the GH joint is stiff, what is going on at the other joints
The AC joint will be hypomobile and the scapula will do more winging instead of moving in its normal planes
True or False:
joints that are hypomobile typically cause joints around it to be hypermobile
true
What is the order of ROM progression in patients with hypomobility
PROM -> AAROM -> AROM
True or False:
Joint mobilizations and stretching can be added with PROM as long as you don’t risk damaging healing tissue
true
What are the indications of using isometric exercise in patients with hypomobility
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
What is the progression of DCER exercises in patients with hyomobility
minimal to no resistance
multiple tools to perform exercises
concentric and eccentric exercises
begin slowly during controlled motion phase
Which phase of healing and inflammation will a patient with hypomobility perform stabilization exercises
at the end of controlled motion or later
Which phase of healing and inflammation will a patient with hypomobility perform functional exercise
later controlled motion or return to function stages
Which phase of healing and inflammation will a patient with hypomobility perform plyometric and sport specific exercises
Not until ROM is fully regained and good quality muscular control achieved
What are the goals of a patient with hypermobility
reduce pain and impairments
restore function
decrease instability by improving neuromuscular control throughout range
A patient that often dislocates or subluxes has ______ joints
hypermobile
Which phase of healing and inflammation is a patient with hypermobility in if we want to protect healing tissue and promote tissue health
protection phase
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
controlled motion
Which phase of healing and inflammation is a patient with hypermobility in if we want to restore function control and return to maximum function
return to function
What is the ROM progression of a patient with hypermobility
maintain normal rage while avoiding motion that cause the humeral head glide in the direction of dislocation. NO stretching or joint mobilization
When should isometric exercises be used with patients with hypermobility
during the early stages or protection phase
which phase of healing and inflammation is DCER performed in patients with hypermobility
controlled motion
What is the biggest part of rehab with hypermobility
stabilization
which phase of healing is stabilization exercises typically started in patients with hypermobility
controlled motion
Which phase of healing and inflammation should functional exercise begin in patients with hypermobility
end of controlled motion or return to function
Which phase of healing and inflammation should plyometric and sport specific exercises begin in patients with hypermobility
Once good quality of muscular control and stabilization is achieved
What are the goals of patients with scapulothoracic or postural dysfunction
reduce pain and impairment
restore function and ROM
improve strength and motor control throughout ROM
A patient with a winging scapula with rounded shoulders and forward head posturing is an example of _______
scapulothoracic or postural dysfunction
True or False:
Scapulothoracic or postural dysfunctions typically are not in a stage of inflammation
true
What are the impairments of a patient with scapulothoracic or postural dysfunction
*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
What type of ROM can patients with scapulothoracic or postural dysfunction tolerate
AROM
What type of exercise can patients with scapulothoracic or postural dysfunction tolerate early into rehab
DCER
What are the goals of post operative patients
protect surgical repair, reduce pain and control inflammation, restore ROM, improve strength, reduce impairments and restore function
Post operative patients will have a ___ protective phase
long
post op patients look like _____ patients because they come in with decrease ROM.
hypomobile
control of _____ is key for reducing a post-op patient’s pain
inflammation
True or false:
Power training comes before endurance and strength training
false, endurance and strength come before power
Which nerve roots refer symptoms to the elbow, but are usually not isolated to the elbow
C5, C6, T1, and T2
Which nerves can get entrapped at or near the elbow causing pain to an individual
ulnar, median, and radial
The hand is the terminal point for which nerve roots? via which nerves?
C6, C7, and C8 via median ulnar and radial nerves
The hand is the ____ ____ for C6, C7, C8 nerve roots via median, ulnar, and radial nerves
terminal points
Injury or entrapment of the median, ulnar, or radial nerve anywhere along their course can cause symptoms in the ____ and ____
wrist and hand
True or False:
Treatment of the symptoms alone will result in lasting outcomes
false, need to treat the source of the pain
Which joints are involved at the elbow
humeroradial
humeroulnar
proximal radioulnar
distal radioulnar
Which joints are involved in the wrist/hand
radiocarpal
midcarpal
carpometacarpal joints
metacarpophalangeal joints
Which muscles make up the elbow flexors
brachialis
biceps brachii
brachioradialis
Which muscles make up the elbow extensors
triceps brachii
anconeus
Which muscle make up the supinators
supinator
biceps brachii
brachioradialis
Which muscles make up the pronators
pronator teres
pronator quadratus
Which muscles make up the wrist flexors that attach to the medial epicondyle
FCR FCU palmaris longus FDS profundus
Which muscles make up the wrist extensors that attach to the lateral epicondyle
ECR longus and brevis
ECU
Extensor Digitorum
The function of the hand is a result of a balance and control of forces of the _____ and _____ muscles of the wrist and hand
extrinsic and intrinsic
What are some possible pathologies and etiologies that could cause a patient to be hypomobile in their elbow and hand
Rheumatoid arthritis osteoarthritis degenerative joint disease acute reactions from trauma, dislocations, or fractures post-immobilization
Should you stretch a patient with Rheumatoid arthritis? why or why not
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
What are some possible causes of pain in patients with osteoarthritis or degenerative joints disease
they will probably have joints spurs, inflammation, or bony blocks that limit ROM. Do not push them through further ROM
Why is stretching limited in patients with acute reactions from trauma, dislocations, or fractures?
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
Patients who are post-immobilized may have a ___ shortening of muscles and hypomobility and need to be stretched
true
What are common functional/activity limitations at the elbow in patients who present with hypomobility
turning the doorknob, pushing and pulling doors, pushing up from a chair, carrying objects and reaching
What are common functional/activity limitations at the wrist in patients who present with hypomobility
difficulties with ADL’s and gripping and finger dexterity for writing and typing
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
protection phase
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
protection phase
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
controlled motion and return to function
Regaining full ROM of the elbow/hand after surgery should be on of your main goals in the (early/late) stages of rehab
early
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
long
What are some examples of overuse/repetitive trauma syndromes of the elbow/hand
lateral epicondylitis medial epicondylitis carpal tunnel trigger finger de Quervain's disease Tendonitis/tenosynovitis
What is another term for lateral epicondylitis
tennis elbow
What is another term for medial epicondylitis
golfers elbow
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
protection phase
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
controlled motion and return to function phase
