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MSK 2 > EXAM 3 - OA and clavicle > Flashcards

EXAM 3 - OA and clavicle Flashcards

1
Q

what allows for stability in the GH joint

A

shape of the joint, the articular cartilage, the labrum, capsule and the intra-articular pressure

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2
Q

degenerative change sis seen in what percentage of adult over 65%

A

17% to 20%

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3
Q

what is the presentation of shoulder OA

A
  • 17% of patients with shoulder pain.9
  • Women
  • Previous history of shoulder injury
  • Overhead sports and occupational endeavors
  • ROM: External rotation appears to be significantly affected
  • Sleep issues
  • Night pain
  • Anxiety / Depression
  • Pain perception
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4
Q

is MRI helpful for the differential diagnosis for OA

A

yes

helpful to confirm the diagnosis and less helpful to rule out the diagnosis

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5
Q

what is indicated in post op management - total shoulder arthorscopy

A

sling and progressive exercise for ROM and strengthing

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6
Q

what position should the shoulder be when placed in a sling

A

neutral position

for those who have undergone a TSA

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7
Q

when should shoulder ROM exercises be implemented in therapy

A

delayed up to 4 weeks

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8
Q

what is the evidence behind pre-op PT before TSA

A

based on clinical expertise

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9
Q

what is the evidence for no surgery but PT

A

absence of evidence

clinical expertise say that PT may help pt who have not undergone TSA

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10
Q

fro conservative management is there any particular intervention that is recommend

A

no

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11
Q

evidence of post op PT outcomes and edema

A

absence of evidence

clinical expertise say that PT may help

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12
Q

what are examples of non-surgical repair of shoulder OA

A

PT

activity modification

Intra-articular Injections

meds

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13
Q

what are Lifestyle modifications for OA

A

ROM restriction – going to need to find different ways to perfrom ADLs

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14
Q

Physical Therapy intervention

A

Modalities
Joint Mobilization
Range of Motion
Strengthening

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15
Q

Intra-articular Injections typically are what

A

Corticosteroids

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16
Q

Medication used for shoulder OA

A

NSAIDS, aspirin, acetaminophen

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17
Q

3 types of shoulder replacement

A

hemi-arthroplasty
total arthroplasty
reverse arthroplasty

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18
Q

Indications for shoulder arthroscopy

A

Rotator cuff tear arthropathy
Degenerative Joint Disease
AVN failed pasts replacement

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19
Q

Degenerative Joint Disease

A

OA

RA

Post Traumatic RA

Proximal Humeral fractures

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20
Q

Rotator cuff tear arthropathy

A

There is RC issue because of the change in the osteokinematics

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21
Q

total shoulder arthroplasty provided better functional outcome than hemiarthroplasty for pt with OA

A

yes is a two year follow up

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22
Q

what happens if the center mech of the shoulder is distrupted

A

subacromial structures can be impinged

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23
Q

During upper extremity elevation, the rotator cuff is responsible for what

A

keeping the humeral head centered in the glenoid

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24
Q

In the presence of a rotator cuff failure what happens to the biomechnics of the shoulder and what does this cause

A

biomechanical alterations and abnormal motions predispose the joint to abnormal wear.

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25
Q

where do we see abnormal wear in the shoulder with RC failure

A

superior portion of the glenoid and the underside of the acromion

followed by degeneration of the articular cartilage in the area.

26
Q

why have total shoulder replacments become the norm

A

the continued degeneration of the glenoid or humeral head.

27
Q

when is the total shoudler artho indicated

A

degenerative conditions where the RC is still intact.

Revision after hemiarthroplasty

28
Q

goals of a Shoulder Arthroplasty

A

Restore Function, decrease pain, sleep

29
Q

what is occuring when we do a Hemi Arthroplasty

A

Only half the articular surfaces are replaced

30
Q

Rehabilitation for a hemi-arthroplasty may be slightly accelerated with what intervention

A

immediate motion allowed if the rotator cuff is still relatively intact and there was no need for repair

31
Q

which surface is replaced in a Hemi Arthroplasty

A

glenoid or the humeral head

32
Q

Phase I - goals

A

Reduce pain and inflammation and

Reduce muscular inhibition

33
Q

Phase II

A

Full PROM
Increase AROM
Do not overstress healing tissue
Initiate dynamic shoulder stability

Scapular rhythm
Active elevation against gravity
Normal swing in gait
34
Q

Phase III

A

AROM/Strengthening phase

35
Q

Phase IV

A

functional return

36
Q

general rehab guidelines - sling day and night

A

day 1-2 weeks

nigh 4-6 weeks

37
Q

general rehab guidelines - gerneal ROM

A

for first 4 -6 weeks

38
Q

general rehab guidelines - when do we add strength in

A

4 weeks

isometrics

39
Q

phase 1- what do we do

A

Increase PROM, initiate AAROM late in phase

40
Q

pahse 2 - goals

A

Control pain and inflammation and continued healing of soft tissue

41
Q

phase 2 sling

A

sling is gradually removed

42
Q

Phase III - part2

A

Gradual restoration of shoulder strength, power, and endurance

Optimize neuromuscular control

Gradual return to functional activities with involved upper extremity

43
Q

Phase IV - rom

A

Nonpainful AROM

44
Q

phase 4 - goals

A

Functional use of upper extremity

Maximize strength, and endurance

Gradual return to more advanced functional activities

45
Q

what are the indication for Reverse Total Shoulder Arthroplasty

A

GH Joint Arthritis
Irreparable RC tear
Complex fractures
Failed TSA with the rotator cuff tendons deficient/absent

46
Q

what is an arthropathy

A

a joint disease, of which arthritis is a type

47
Q

what is a Cuff tear arthropathy

A

characterized by a severe humeral head collapse following massive tearing of the RC.

48
Q

what are proposed about inactivity following a massive tear of the RC

A

results in instability of the humeral head and leakage of the GH joint synovial fluid.

49
Q

what does the loss of synovial fluid do to art cart

A

predisposes the articular cartilage to degeneration due to poor nutritional status.

articular cartilage is worn away and the surfaces are exposed, this lead to painful shoulder motion and learned non-use.

50
Q

what does rTSA do to the biomechanics of the shoulder

A

Reversal of biomechanics

Increased moment arm of the deltoid
Increased overhead elevation
Decreased pain

51
Q

intervention for AC joint dysfunction

A

activity modification

pain modulation

restroation of function - ROM and strength

return to sport or occupation

51
Q

phase 1- what do we do

A

Increase PROM, initiate AAROM late in phase

Full distal extremity (elbow, wrist, hand) AROM

Independence with modified ADL’s

51
Q

pahse 2 - goals

A

Control pain and inflammation and continued healing of soft tissue

52
Q

Reverse Total Shoulder Arthroplasty indications

A

GH Joint Arthritis
Irreparable RC tear
Complex fractures
Failed TSA with the rotator cuff tendons deficient/absent

53
Q

what is a arthropathy

A

joint disease, of which arthritis is a type

54
Q

Cuff tear arthropathy

A

characterized by a severe humeral head collapse following massive tearing of the RC.

55
Q

it was proposed that inactivity following a massive tear of the RC results in what

A

instability of the humeral head and leakage of the GH joint synovial fluid.

56
Q

what does leakage of the synovial fluid lead to

A

The loss of synovial fluid predisposes the articular cartilage to degeneration due to poor nutritional status.

articular cartilage is worn away and the surfaces are exposed, this lead to painful shoulder motion and learned non-use.

57
Q

outcome of Cuff tear arthropathy

A

destruction of the GH joint articular cartilage, osteoporosis, and ultimately collapse of the humeral head

58
Q

loss of the RC lead to what change in biomechanics

A

the centering forces on the glenoid are lost, altering GH joint biomechanics.

leading to superior migration of the humeral head,

59
Q

what happens if we have superior migration of the humeral head

A

which, over time, erodes the coracoacromial ligament and the acromioclavicular joint and the glenohumeral joint

60
Q

what happens to the shoulder biomechanics with rTSA

A

Reversal of biomechanics

Increased moment arm of the deltoid - more relient on the deltoid
Increased overhead elevation
Decreased pain

MSK 2 (15 decks)

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