Hyper, Hypomobility & Adhesive Capsulitis Flashcards
hypermobility and compensatory weakness can be created in the body by….
soft tissue tightness and HYPOmobility in another place
ex. hypermobile spinal joint found next to a hypomobile spinal joint
list and describe the 3 body types:
ectomorph: linear, delicate, slightly developed and has hypermobile joints
mesomorph: tend to be more HYPOmobile
endomorph:
what does the hormone relaxin do during pregnancy to help facilitate labour and delivery?
allows joint capsule and ligaments to become hypermobile - joints in pelvis, ankles and feet remain hypermobile for up to 6 months post partum
hypermobility syndrome occurs in what % of those with hypermobility?
5%
what are 5 SSx someone could experience with hypermobility syndrome?
muscles surrounding joint pain overuse syndromes - tendinitis abdominal weakness hyper-extensible skin mitral valve prolapse
what inflammatory condition can predispose someone to hypermobility?
RA (systemic autoimmune disorder characterized by the inflammation and destruction of CT = hyper mobility of affected joints
what part of Marfan’s syndrome leads to joint hypermobility?
fragmentation of elastin
What are some cardiac outcomes seen with Marfan’s syndrome?
aortal widdening and mitral valve prolapse
from a medical take, if damage to a joint is sufficient enough, a hypermobile joint maybe treated in one of 3 ways:
injection - sclerose the joint capsule or vertebral discs
Surgical shortening of ligaments or mm crossing the joint
Fixation with pins, plates and other appliances
when symptomatic, hypermobility maybe painful if…
the ligament crossing the joint are intact but over stretched (painless when ligaments rupture)
why might mm crossing the affected hypermobile joint be hypertonic (abnormally increased or excessive mm tone)?
attempting to support the joint
what test is used to measure hypermobility in the spine, fingers, thumbs, elbows and knees?
nine point scoring system (higher score = more hyper mobility; 4-6 poiunts indicating hypermobility syndrome)
what is the criteria for points on the nine point scoring system for hypermobility?
- passive DF of little finger past 90 degrees (x1/finger)
- passive opposition of thumbs to forearms (x1/thumb)
- hyper ext of elbows beyond 10 degrees (x1/elbow)
- forward flexion of the trunk with knees extended and palms flat on floor
- hyper ext of knees past 10 degrees
- spine and rib cage = manipulation of SP’s, palpation of spine and rib cage
what is a minor intervertebral derangement in the spine?
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
what are 5 causes of hypomobility?
compensations
decreased flexibility due to body type or occupation
intra or extra-articular adhesions
post immobilization
surgical fixations
pathologies/conditions causing contractures
what are 5 pathologies/conditions that cause contractures, leading to hypomobility of an area?
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
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?
shortened, thickened and adhered capsule
what may frozen shoulder be precipitated by?
scapulo-humeral aligment problems
what are 5 conditions that can predispose someone to AC?
DJD of the AC joint RA MI #/dislocations/immobilization reflex sympathetic dystrophy
fibrosis and degeneration of the shortened CT of the GH joint maybe related to what intrinsic collagen disorder in regards to Ad Cap?
RA
when will patients typically seek help for Ad Cap?
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).
what is the expected humero-sacapular ratio in a non pathology shoulder?
after 60 degrees ABD - 2:1; GH:ST
with AD Cap = 1:1
list the communicating layers of tissue of the GH joint that will develop adhesions with Ad Cap?
scapula and GH joint
fold of jt capsule and between joint capsule and glenoid fossa/labrum and humerus
between layers of subdeltoid bursa
what are pathological changes that can occur with the rotator cuff when it comes to AC?
mm spasm/guarding in RC
atrophy of RC and deltoid
contracture of subscap and biceps tendon
- overall possible tendonitis, bursitis, capsulitis and fibrosis
what are the 3 stages of AC?
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
what are the other terms for acute, sub acute and chronic AC?
acute: “freezing, first stage, painful stage”
subacute: “ frozen, second stage, stiffening phase”
chronic: “thawing, third stage, resolution phase”
what is the possible nerve referral of AC pain?
lateral brachial region, possible C5-6 referred distally
what is the expected time frame for spontaneous resolution of AC in 60% of cases?
12-16 months - with therapy=3-4 months (improvements occur in spurts and plateaus)
