EXAM 3 - hypomobile shoulder Flashcards
two types of shoulder pain
primary and secondary
primary shoulder pain often know as
Often referred to as idiopathic adhesive capsulitis
presentation of primary shoulder pain
Painful loss of shoulder motion of unknown origin
Females >40
primary shoulder pain seen in what population
Females >40
40 -65
secondary shoulder pain often occurs secondary to what
Soft tissue injury
Fracture
Arthritis
Neurologic issue
Post surgically
4 Stages of Adhesive Capsulitis
Stage I – Pre-Freezing phase
Stage II – Freezing phase
Stage III – Frozen phase
Stage IV – Thawing phase, pain is decreasing
what is another name for Adhesive Capsulitis (AC)
hypomobile shoulder
is AC issue associated with calcified deposists
not associated with calcifies deposits in the RC, RC tears
AC issue may be linked to what
thyroid disorders, diabetes and autoimmune diseases
Contralateral involvement of AC issue
20-30%
If you have it one you can have it in the other
how much does the chance of getting AC issue increase with thyroid issue
10-38%
what do we see during the freezing phase
Reactive synovitis
what do we see during the frozen phase
Adhesions between the joint surfaces
what is An adhesion
a band of scar tissue that joins two internal body surfaces that are not usually connected
what is Synovial angiogenesis
increased c growth
insidious
comes on slowly
how does AC issues develop
insidious
what is the predominant initial feature in AC
pain followed by loss of ROM
patient starts to sleep through the night what is this a indicator of
transition from stage II to III
o Range of Motion Limitations ER
<30
ROM limits - elevation
<120
ROM limits - IR
leat limited
Capsular pattern - AC issue
ER > ABD/FLEX > IR
what is Scapular substitution
Pt try to increase their ROM with the scapula when the GH is not working well
stage 2 II – Loss of ROM reflects what
a decrease in the capsular volume
Stage I - pain
Achy @ rest, sharp with motion, night and rest, a/p capsule and deltoid insertion
Stage I - ROM
Global loss with ER being most restricted Capsular pattern
Stage II - pain
Still rest and night pain. Significant sleep disturbances
Stage II - ROM
Progressive loss in the capsular pattern.
Stage III - pain
Significant decrease in pain. Usually only at end range
Stage III - ROM
Marked loss in capsular pattern with no changes after injection of anesthesia.
Stage IV - pain
Minimal pain. Subj. report of longstanding hx of rest and night pain w/ spontaneous resolution
STAGE IV - ROM
Progressive improvement 2° to capsular remodeling. Loss is still in capsular pattern
things that could have lead to AC issue
Trauma
Diabetes
Prolonged immobilization
Thyroid disease
Psychiatric Disease
Stroke / MI
Auto Immune
Abduction - actionn
Combination of superior roll & inferior translation
what are the restraits to inferior translation
0 - SGHL & C-H
90 - IGHLC
External Rotation - action
Combination of posterior roll & anterior glide
what restricts ER - 0
SGHL, C-H & subscapularis
what restricts ER - 45
SGHL & MGHL
what restricts ER - 90
anterior band IGHLC
Internal Rotation - action
Combination of anterior roll & posterior glide
Restraints to IR - 0
posterior band IGHLC
Restraints to IR - 45
anterior & posterior band IGHLC
Restraints to IR - 90
anterior & posterior band IGHLC
Flexion action
anterior/superior roll & posterior/inferior glide
restriction to flex
posterior and inferior capsule
what is reactive synovitis
A type of synovitis causing an increase in the volume of fluid in the joint
this often causes limited mobility in the join
what is Synovitis
when the synovial membrane of a joint becomes inflamed (swollen)
