exam questions Flashcards
- What are the stages of Impingement Syndrome?
Neer’s stages of impingement syndrome
- edema and hemorrhage
- fibrosis and tendinitis
- bone spurs
- What is the difference between a client with shoulder tendonitis versus Calcific tendonitis versus bursitis? Where would they feel pain?
refer to individual cards
- What is the typical picture of a client with shoulder tendonitis? What are the symptoms and physiology?
posture: forward shoulder, forward head.
symptoms: painful arch of motion seen with PROM and AROM. diffuse weakness, edema, spasms in scapular muscles.
***4. Name some common interventions for Tendonitis in the acute and subacute. Know why you would use them.
acute phase- conservative therapy
subacute- HEP, periodic eval and progression, 2x/week until sx begin to resolve, patient education to adapt activities, environment is critical, sleep and work positions (body pillows put under shoulder, hug like a teddy bear).
acute- active rest- arm 30 degrees abduction arm up on couch. Use w/o increasing pain and no resistance, not above 90. Out hand in pocket while walk. Ice, sleep supinebody pillow under arm 30 degrees hug like bear.
AAROM pendelum
subacute- do a little bit more start isometrics, massage, cardio, isotonics later
- After Rotator Cuff Repair surgery, what is the usual progression of interventions? When do you start a HEP of pendulums (Codmans)? What begins at 4-6 weeks post op as directed by the MD? 6- 8 weeks?
Conservative-nonoperative
- Modalities
- ultrasound
- TENS
- Hot/cold (short term pain relief)
- Exercise- not one protocol
- includes PROM, AAROM, AROM, strengthening, manual therapy.
- Describe the pathology that occurs with adhesive capsulitis.
Frozen shoulder
- onset usually 50-70 years of age
- women>men
- more seen in sedentary workers, diabetics
- develops slowly with pain and tenderness over deltoid insertion
- motion aggravates pain
- decreased P/AROM of shoulder
- Decreased ADLs and sleep
- shrugging shoulder motion
- progresses to very decreased ROM and increased pain
PATHOLOGY:
- many tissues are involved- such as bursa, glenohumeral capsule, biceps tendon, rotator cuff tendon
- capsular thickening
- repair of tissues is delayed or impaired by frequent irritation
- muscles atrophy
- 3 phases: freezing, frozen, and thawing phases.
- What are the evidence based practice interventions for Adhesive Capsulitis/Rotator Cuff?
- Exercise was demonstrated to be effective in terms of short term recovery in rotator cuff disease and longer term benefit with respect to function.
- Combining mobilisation with exercise resulted in additional benefit when compared to exercise alone for rotator cuff disease.
- Laser therapy was demonstrated to be more effective than placebo for adhesive capsulitis but not for supraspinatus tendinitis.
- Both ultrasound and pulsed electromagnetic field therapy resulted in improvement compared to placebo in pain in calcific tendinitis.
-There is no evidence of the effect of ultrasound in shoulder pain (mixed diagnosis), adhesive capsulitis or rotator cuff tendinitis. When compared to exercises, ultrasound is of no additional benefit over and above exercise alone.
-There is some evidence that for rotator cuff disease, corticosteroid injections are
superior to physiotherapy
***8. What are the classifications for fractures and relationship of fragments? Can you label them if given a picture?
-origin
-stress, traumatic, pathological
-anatomical location
-base, midshaft, neck or articular
***ON TEST
fx line
-transverse, oblique, spiral, comminuted (BAD-more than 2 pieces)
relationship of fragments
-closed, open, complete, incomplete, dorsa(not good)l and volar(not good)
- What are the various methods of reduction for fracture? Can you label them if given a picture?
-closed, open or distraction techniques (cast, immobilized)
-ORIF (open reduction internal fixation)- when closed techniques wont work, use Kirschner wires, interosseus screws, plates with screws
-external fixators- distraction
casting, splinting
- What is the normal range for fracture healing in infants, adolescents and adults?
a. normal bone is regenerated (fx. bone heals)
rate depends on age, fx characteristics, presence of disease, vascularity of bone segment.
*infants- 4-6 wks
*adolescence- 6-10 wks
adults- 8 weeks and on
(AROM: means you can move safely- wait 2-4 more wks for strengthening).
- Examine the progression of intervention for clients with a humeral fracture. Know the general progression so that if an intervention is described, you would know if it was indicated for a client or not.
a. Acute
- Pendulum, edema control- wrap it, don’t apply to much pressure (don’t let sh. get stiff, do it soon according to MD).
- Cold to heat modalities- switch quickly to heat
- One handed ADL’s- assistive dressing
- Distal AROM- take arm out of sling 3x a day- move sh., elbow, and wrist- NO ER or IR
3-4 wks
- gentle AAROM sh, not > than 60 degrees of elevation- pt. is healing based on MD eval.
- cane, towel on table, pulleys
4-6 wks
- sh. AAROM, isometric scapular protraction/retraction
(lay in bed or chair and push against bed or chair)
8-10 wks
-stretching (bone healing well)
10-12 wks
-sh. isotonics
- Describe the pathology that occurs with anterior shoulder dislocation AKA traumatic unidirectional instability (TUBS). What are the clinical signs? What are the usual conservative interventions?
Traumatic Unidirectional instability (TUBS)- lax connective tissue usually result of trauma in one direction (anterior, posterior, or inferior)- may damage to RC tendons and glenoid labrum ( anterior are weaker; athletes)
TUBS- (numbness and tingling)
-anterior- usually with a force against the abducted, ER sh. - labrum a problem also.
-posterior instability- forward flexed humerus or FOOSH
-inferior instability- RC weakness
Medical tx- may need surgery- Bankhart repair- use subscpularis to support the anterior capsule- (gives xtra strength)
clinical picture/ func. limitations
-inability to reach or lift at sh. level
-restricted ability in many ADL’s, leisure
-pain when sleeping
(NO AB or ER- avoid lifting arm over 90 degrees.
Interventions (4-8 wks)
- immobilized in sling for 3 wks, elbow distally needs ex., strike zone mvnts.
- precautions- no PROM, EX with AB or hyper/
- do ex rot with arm at side only to 50 degrees
- strengthening
- int/ext rotators, int roators and adductors need to be strong to support ant capsule
- ext rotators strong to cause humeral depression
- begin with isometric ex with joint at side pain free
- progress to isotonic ex still limiting
- Describe the difference between Rheumatoid Arthritis and Osteoarthritis in the shoulder. List some typical interventions.
a. OA- a slowly progressive uniarthicular disorder of unknown cause, occurring late in life, principally affecting the hands and large weightbearing joints and characterized by pain, deformity and limitation of motion and pathologically by focal erosive lesions, cartilage destruction, subchondral sclerosis, cyst formation and large osteophytes at the margins of the joint. very common in adults, 60% of ppl age 60 and over. women> men (breakdown of cartilage, localized to 1 joint, not usually bilateral but can be) inflammation pain at rest and w use potential for deformity stiffness
INTERVENTIONS: calm pain and inflammation 1st always! bed positioning active rest enegery conservation joint protection using sh. in pain free zone @ home modalities AAROM- pendulums, scapular clock, scapular mobility, isometric in pain free range
RA- systemic connective tissue disease whose onset and progression vary from mild joint symptoms with aching and stiffness to abrupt swelling, stiffness and progressive deformities periods of exacerbation and remissions (don’t get back to where they were before the exacerbations, usually bilateral, visually swollen).
edema at joints
pain w motion
can detect increased temperature at joints
muscle atrophy due to disuse
fatigues easily
INTERVENTION:
joint protection
energy conservation
medications - can take up to 6 months ( help adapt to therapy)
same interventions as OA but need to be MORE CAREFUL w strengthening
have to work on inflammation 1st and ADAPT & MODIFTY ACT. 1st
no repetitive motions
MODAILITES - heat, neutral gentle
adapting daily tasks!!!!
start off cold if pt. joints are hot - move to neutral warmth
- Review the general considerations for joint protection on page 459 in Cooper for Arthritis management.
a.
- Describe the pathology that occurs with Thoracic Outlet Syndrome. What are the clinical signs? What are the usual interventions?
a. symptoms are due to compression of blood vessels and nerves by structures in TOS region
COMPRESSION sites- scalenes, first rib, pec minor
contributing factors: laxity in sh., postural variations, respiratory patterns –musicians
CLINCAL SIGNS AND SYMPTOMS
largely neurologica cases- more females
intermittent BP and vascular sx of pain; parathesia, numbness (ring and little finger), weakness, discoloration, and swellings
muscle length imbalances with tightness in anterior and weakness in posterior
faulty postures
poor endurance os postural muscles
shallow respiratory pattern
pt. complains of diff sleeping, inability to hold weight objects on affect side-heaviness
inability to maintain overhead work position or desk work
INTERVENTIONS
increae mobility of tight structures- massage, cardio, stretch (anterior muscles)
increase strength and endurance of weak ms
nerve gliding (flossing)
respiration training
adapt act- driving, purse on sh., bra strap
no excessive breathing –running
modalities for spasm– heat irriated nerves, ultrasound estim
watch pt. at work
safe sleeping positions that avoid stress on nerves/ cx ( on back pillows under arms )
(massage trigger pt/spasms, adapt posture, cardio/ walking, avoid overhead act., stretch muscles and stegthen back muscles, adaptions to take stress off of sh)
TOS exercises
scapular retraction - door way or noodle stretch- sh. need to be hiked to decrease sx
stretch scalenes- chin tuck, straighten neck, side bend away and rotate forward
suboccipital stretch - supine- tuck chin in-gentle turn to side- back to center- isometic -other side
pec stretch
scapular clock- get scap muscles working
modified superman
