GH hypomob

Question 1

compare involvement of OA and RA

Answer 1

OA: uni - PIP, DIP, MCP 1, lumbar, cervical, knee, hips, MTP1

RA: bilat - PIP, MCP, elbow, wrist, cervical, shoulder, MTP, talonavicular

Question 2

discuss acute phase for arthritis

Answer 2

pain c MG; may radiate to elbow and disturb sleep

tenderness in sulcus

LOM in ER and ABD

Question 3

discuss subacute phase for arthritis

Answer 3

capsular tightness - ERAbIR

pain and end of limited range

limited joint play - accessory motion testing

Question 4

discuss chronic phase for arthritis

Answer 4

progressive restriction of capsule - LOM in capsular pattern

dec jt play

loss of function of shoulder

local pain around deltoid

Question 5

discuss traumatic arthritis

Answer 5

in response to fall or high force blow to shoulder

night pain and disturbance of sleep

pain on motion and rest

dec mob and ROM

postural compensations

dec arm swing

muscle weakness of GH muscles

overuse of traps, lev scap and post cervical muscles

Question 6

discuss post-immob arthritis

Answer 6

stiff shoulder - d/t lack of movement or secondary to heart disease, stroke and DM

pain and LOM

Question 7

discuss idiopathic frozen shoulder

Answer 7

female, 40-65 yo

dense adhesions and capsular thickening on folds of capsule

primary - inflammation of rot cuff. biceps ten or capsule

secondary - from OA, RA, trauma or immob

Question 8

stage 1 - frozen shoulder

Answer 8

< 3 mo

gradual onset of pain that inc c movement

Question 9

stage 2 freezing stage

Answer 9

3-9 mo

persistent and more intense pain even at rest

night pain

severe LOM d/t pain

Question 10

stage 3 frozen stage

Answer 10

9-15 mo

pain only with movement and significant adhesions

Question 11

stage 4 thawing stage

Answer 11

15-24 mo

minimal pain and no synovitis

evident capsular restrictions - ABD and ER

Question 12

interventions in protection phase of ad caps

Answer 12

immob with sling - rest and dec pain pero wag too long

PROM - AROM in pain free range

PJM gr 1-2, codman’s

gentle muscle setting

pt educ about stages and mga acitvity mod

Question 13

interventions in controlled motion phase of ad caps

Answer 13

PJM gr 3-4 for stretch
self mob
manual stretching and self stretching

gr 1-2 to dec muscle spasm

MWM or sustained caudal glide

stretching and strengthening

Question 14

interventions in return to function phase of ad caps

Answer 14

strengthening and stretching

vigorous stretching and PJM if may capsular restrictions pa

Functional activities - heavy lifting, pushing, pulling, carrying or reaching

Question 15

discuss overuse syndromes for AC and SC jts

Answer 15

repeated stressful movement of arm at waist level - packing and construction work or diagonal add and IR

susceptible following trauma and c arthritis

Question 15

discuss subluxation or disloc for AC and SC jts

Answer 15

FOOSH - distal end of clavicle displace sup and post

ligaments may rupture - overstretched since no muscle to stab = hypermob

Question 15

discuss hypomoblity for AC and SC jts

Answer 15

dec clavicular mob and may occur c arthritis

can contribute to TOS since space narrows bet clavicle and 1st rib

Question 16

impairments in AC and SC jts pathology

Answer 16

pain local to jt or ligament

painful arc at end range shoulder elevation

pain c horizontal add/abd

hypermob if tauma or overuse

hypomob if arthritis or immob

Question 17

management for AC and SC pathology

Answer 17

minimize loading - arm sling

cross fiber massage to capsule or ligs or PJM - if hypomob

maintain ROM og GH and scap

inc strength of shoulder, trunk and legs

return to func