Hyper, Hypomobility & Adhesive Capsulitis

Question 1

hypermobility and compensatory weakness can be created in the body by….

Answer 1

soft tissue tightness and HYPOmobility in another place

ex. hypermobile spinal joint found next to a hypomobile spinal joint

Question 2

list and describe the 3 body types:

Answer 2

ectomorph: linear, delicate, slightly developed and has hypermobile joints
mesomorph: tend to be more HYPOmobile
endomorph:

Question 3

what does the hormone relaxin do during pregnancy to help facilitate labour and delivery?

Answer 3

allows joint capsule and ligaments to become hypermobile - joints in pelvis, ankles and feet remain hypermobile for up to 6 months post partum

Question 4

hypermobility syndrome occurs in what % of those with hypermobility?

Answer 4

5%

Question 5

what are 5 SSx someone could experience with hypermobility syndrome?

Answer 5

muscles surrounding joint pain
overuse syndromes - tendinitis
abdominal weakness
hyper-extensible skin 
mitral valve prolapse

Question 6

what inflammatory condition can predispose someone to hypermobility?

Answer 6

RA (systemic autoimmune disorder characterized by the inflammation and destruction of CT = hyper mobility of affected joints

Question 7

what part of Marfan’s syndrome leads to joint hypermobility?

Answer 7

fragmentation of elastin

Question 8

What are some cardiac outcomes seen with Marfan’s syndrome?

Answer 8

aortal widdening and mitral valve prolapse

Question 9

from a medical take, if damage to a joint is sufficient enough, a hypermobile joint maybe treated in one of 3 ways:

Answer 9

injection - sclerose the joint capsule or vertebral discs
Surgical shortening of ligaments or mm crossing the joint
Fixation with pins, plates and other appliances

Question 10

when symptomatic, hypermobility maybe painful if…

Answer 10

the ligament crossing the joint are intact but over stretched (painless when ligaments rupture)

Question 11

why might mm crossing the affected hypermobile joint be hypertonic (abnormally increased or excessive mm tone)?

Answer 11

attempting to support the joint

Question 12

what test is used to measure hypermobility in the spine, fingers, thumbs, elbows and knees?

Answer 12

nine point scoring system (higher score = more hyper mobility; 4-6 poiunts indicating hypermobility syndrome)

Question 13

what is the criteria for points on the nine point scoring system for hypermobility?

Answer 13

1. passive DF of little finger past 90 degrees (x1/finger)
2. passive opposition of thumbs to forearms (x1/thumb)
3. hyper ext of elbows beyond 10 degrees (x1/elbow)
4. forward flexion of the trunk with knees extended and palms flat on floor
5. hyper ext of knees past 10 degrees
6. spine and rib cage = manipulation of SP’s, palpation of spine and rib cage

Question 14

what is a minor intervertebral derangement in the spine?

Answer 14

an isolated, painful, hypomobile vertebra due to a mechanical, postural or traumatic cause
- x-rays will show nothing, but palpation and vertebral mobility tests will rteveal painful, hypomobile segment

Question 15

what are 5 causes of hypomobility?

Answer 15

compensations
decreased flexibility due to body type or occupation
intra or extra-articular adhesions
post immobilization
surgical fixations
pathologies/conditions causing contractures

Question 16

what are 5 pathologies/conditions that cause contractures, leading to hypomobility of an area?

Answer 16

dupuytrens - localized formation of scar tissue around the tendosn that flex the fingers beneath the skin of the palm of the hand - scaring accumulates in palmar fascia that normally covers the tendons that pull the fingers to grip
AD CAP
AS
Peripheral nerve lesion
CNS lesion

Question 17

frozen shoulder involves painful limitations of movement (commonly in ABD and ER - capsular patten of restriction ER>ABD>IR>FLEX) and fibrosis of the GH capsule which can result in what?

Answer 17

shortened, thickened and adhered capsule

Question 18

what may frozen shoulder be precipitated by?

Answer 18

scapulo-humeral aligment problems

Question 19

what are 5 conditions that can predispose someone to AC?

Answer 19

DJD of the AC joint
RA
MI
#/dislocations/immobilization
reflex sympathetic dystrophy

Question 20

fibrosis and degeneration of the shortened CT of the GH joint maybe related to what intrinsic collagen disorder in regards to Ad Cap?

Answer 20

RA

Question 21

when will patients typically seek help for Ad Cap?

Answer 21

shoulder has already lost 90 ABD, 60 FLEX and ER
pain restricts ADL’s
increased scapulo-thoracic motion with decreased GH joint ROM (humero-scapular ratio down to 1:1).

Question 22

what is the expected humero-sacapular ratio in a non pathology shoulder?

Answer 22

after 60 degrees ABD - 2:1; GH:ST

with AD Cap = 1:1

Question 23

list the communicating layers of tissue of the GH joint that will develop adhesions with Ad Cap?

Answer 23

scapula and GH joint
fold of jt capsule and between joint capsule and glenoid fossa/labrum and humerus
between layers of subdeltoid bursa

Question 24

what are pathological changes that can occur with the rotator cuff when it comes to AC?

Answer 24

mm spasm/guarding in RC
atrophy of RC and deltoid
contracture of subscap and biceps tendon
- overall possible tendonitis, bursitis, capsulitis and fibrosis

Question 25

what are the 3 stages of AC?

Answer 25

stage 1: localized pain of brachial/deltoid area not below elbow - can still lay on side and elastic end feel, no pain with mvmt
stage 2: pain w movement - cant sleep on affected side- end feel changing/mm spams is more abrupt
stage 3: severe pain from shoulder to wrist, woken up by pain, ed feel is abrupt

Question 26

what are the other terms for acute, sub acute and chronic AC?

Answer 26

acute: “freezing, first stage, painful stage”
subacute: “ frozen, second stage, stiffening phase”
chronic: “thawing, third stage, resolution phase”

Question 27

what is the possible nerve referral of AC pain?

Answer 27

lateral brachial region, possible C5-6 referred distally

Question 28

what is the expected time frame for spontaneous resolution of AC in 60% of cases?

Answer 28

12-16 months - with therapy=3-4 months (improvements occur in spurts and plateaus)