Exam 3 Flashcards by Katie Carrico

Hypomobility pathologies of elbow and forearm

Rheumatoid arthritis 
Juvenile rheumatoid arthritis 
Degenerate joint disease 
Acute joint reactions after trauma
Post-immobilization

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Definition of Myositis ossificans

formation of bone in muscle tendon unit, capsule, or ligamentous structure

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Most common site for myositis ossificans

Thigh and elbow

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Cause of myositis ossificans

trauma (fracture or tear of brachialis tendon)

Aggressive stretching of the elbow flexors after injury and immobilization

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Differences between myositis ossificans and arthritis

Passive extension more limited than flexion
Resisted elbow flexion causes pain
Resisted flexion in mid-range causes pain in brachialis
Palpation of distal brachialis muscle is tender

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Contraindications of myositis ossificans

Massage
Passive stretching
Resistive exercises

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Symptoms of tennis elbow

pain in common wrist extensors along with lateral epicondyle and HR joint with gripping activities

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Tendons affected in tennis elbow

ECRB and extensor communis

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Positive tests for tennis elbow

Palpation tenderness on lateral epicondyle
Pain with resisted wrist extension
Pain with resisted middle finger extension
Pain with passive wrist flexion with elbow extended and forearm pronated

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Pathology of golfer’s elbow

Involvement of flexor/pronator tendon near medial epicondyle

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Symptoms of golfer’s elbow

Pain with palpation of medial epicondyle
Pain with resisted wrist flexion
Pain with wrist extension and forearm supinated

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Etiology of golfer’s elbow

Repetitive movement into wrist flexion

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Pathologies that can lead to wrist and hand hypomobility

Rheumatoid arthritis
Degenerative joint disease
Immobilization

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Structural and functional impairments post immobilization of hand

Decreased ROM and decreased joint play with firm end feel
Tendon adhesions
Decreased muscle performance and weakness

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Causes of tendonoapthies of the wrist and hand

Continued or repetitive use of involved muscles beyond its ability to adapt
Effects of RA
Stress overload to contracting muscle
Roughening of the surface of the tendon or its sheath

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Common reasons for restricted mobility of GH joint

Pathology (OA or RA)
Immobilization
Idiopathic frozen shoulder

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Acute signs of GH arthritis

Pain and muscle guarding
Pain radiating below elbow and may disturb sleep
Tenderness immediately below the edge of the acromion process

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Subacute signs of GH arthritis

Capsular tightness
Limited motion consistent with capsular pattern
Pain at the end of limited range
Limited joint play

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Chronic signs of GH arthritis

Progressive limited motion in a capsular pattern and decreased joint play
Loss of function with an inability to reach overhead
Aching to deltoid region

Stage 1 of frozen shoulder

Gradual onset of pain that increases with movement and is present at night
Loss of ER with intact rotator cuff strength
Less than 3 months

Stage 2 of frozen shoulder

Freezing stage
Persistent and more intense pain even at rest
Motion limited in all directions
Typically between 3-9 months

Stage 3 of frozen shoulder

Frozen stage
Pain only with movement, significant adhesions, and limited GH motions
Atrophy of deltoid, rotator cuff, biceps, and triceps
9-15 months

Stage 4 of frozen shoulder

Thawing stage 
Minimal pain an no synovitis
Significant capsular restrictions 
Motion may gradually improve 
15-24 months

Pathologies associated with OA

Overuse syndromes - stressful movements with arm at waist
Subluxation/disloction - common with falls
Hypomobility

Common impairments associated with AC

``` Pain localized to involved joint or ligaments Painful arc toward the end range Pain with shoulder HAdd & HAbd Hypermobility Hypomobility ```

Intrinsic impingement

Compromise integrity of musculotendinous structure by vascular changes, tissue tendon overload, and collagen disorientation and degeneration

Extrinsic impingement

Mechanical wear of RC against acromion in the suprahumeral space during elevation activities of the humerus

Primary impingement

Can be anatomical or biomechanical factors

Anatomical factors

Structural variations in acromion, humeral head, hypertrophic changes of AC or humeral head which decrease suprahumeral space

Biomechanical factors

Altered orientation of the clavicle or scapula during movement or increase anterosuperior humeral head associated with tight posterior GH capsule

Secondary impingement

Compression of suprahumeral tissues due to hypermobility or instability of GH joint and increased translation of humeral head

Internal impingement

Occurs in the position of elevation, horizontal abduction, and maximum ER Entrapment of posterior supraspinatus tendon between humeral head and labrum

Stage I impingement

Hemorrhage and edema (less than 25 yo)

Stage II impingement

Tendonitis/bursitis (25-40 yo)

Stage III impingement

Bone spurs and tendon rupture (greater than 40 yo)

Tissues that are impaired with impingement

``` Supraspinatus Infraspinatus Biceps tendon Superior labrum Subacromial bursa ```

Criteria to progress to final stage of rehab in impingement patients

Negative impingement test Full, pain-free AROM of shoulder without substitution 75% or more strength of shoulder compared to other shoulder

Cause of anterior instability of shoulder

Occurs with forces against arm in an abducted and ER position

Cause of posterior instability of shoulder

Repetitive forces against a forward flexed humerus

Cause of inferior instability of shoulder

RC weakness; in patients with hemiplegia and repetitive reaching overhead

Causes of multidirectional instability

Increased extensibility of CT | Frequently overhead athletes

Cause of anterior shoulder dislocation

Posteriorly directed forced to arm while humerus is in a position of elevation, ER, HAbd

Stability provided by what in elevation, HAbd, ER

Subscapularis, GH ligaments, long head of biceps

Common complications with anterior dislocation

Rupture of RC fracture of posterolateral humeral head (hill-saks lesion) Vascular or nerve damage (axillary nerve)

Causes of posterior shoulder dislocation

Force applied to humerus in position of flexion, adduction, and IR (FOOSH)

Rate of recurrence following first time traumatic dislocation

Highest in younger populations (less than 30) because they are more active and place greater demands on shoulder

Immobilization times following traumatic dislocation

6-8 weeks in young patients | 2 weeks for older patients