lecture 5 Flashcards
What is SINSS?
Sensitivity:
* Intensity of pain provoking activities
* Is caution necessary during examination
Irritability:
* How easy is it for symptoms to be provoked
* How long does it take for symptoms to resolve
Nature:
* Where is the source of this pain
* Musculoskeleta, neural cardiovascular
Stage:
* Acute, subacute, chronic
Stability:
* Worsening, improving, stable
KNOW: For a high irritability PT we want to focus on ROM, stretching, manual therapy: pain free only, typically non-end range
passive interventions primary job is to improve mobility for EX and pt buy in
What is a clinical practice guideline?
A statement put out by experts in that field thats based on a diagnosis and is a giagnt systematic review of not just one top but all topics relating to that presentation
for adhesive capultiits = presentation / risk factors / tests and measures used to. diganosis / document level of impairment / dysfunction / how you track progress over time / what interventions are most supported by the evidence
* makes a good clinical picture for what to do
what are two risk factors (diseases) that could indicate adhesive capsulitits?
diabetes mellitus or thyroid dysfunction
What age group gets adhesive capsulitits the most?
females 40-65 years old
are you more likely to get adhesive capsultiits if you’ve had it in the contralatearl shoulder?
Yes
adhesive pattern of restirction
External rotation –> abduction –> internal rotation
How does the first 3 months of adhesive present
little to no ROM changes (starts tightening up a little - didnt think much of it)
what happens in stage 2 of adhesive capsulitits?
freezing stage
3-9 months
gradual loss of ROM in ER, abd, IR
synovitits present
Explain stage 3 adhesive
frozen stage
month 9-15
stop losing ROM here and presents as very stiff - no progressive continuation of loss of motion - they’re at where they’re gonna be at
stage 4 adhesive capsulitits
thawing stage 15+ months
pain begins to resolve and stiffness does 2
what should u do for adhesive capsultiits?
steriod injection + PT
what EX would we do with an adhesive cap pt?
ROM that match tolerance
NOTE: Education is key on this resolving
KNOW: There is weak evidence for manupulation / mobilization w/ adheasive cap
how long does adhesive last?
15 m
KNOW: Tendins take forever to heal 3 months - over a year
how long is the plan of care for rotator cuff repair?
12-16 weeks
what should we do the most after rotator cuff repair?
PROM - we dont want it to get stiff or stuck
what is the best way to promote blood flow for ar ecent rotator cuff repair?
walking
KNOW: For RTC post op were going to avoid internal and external rotation stretching and any AROM
* we want all PROM
Who typically gets total shoulder arthroplasty
Physical therapy Pts that don’t really respond
typically have OA / proximal humeral fracture
inital precaustions for total shoulder arthroplasty
NOTE: Major problem is dislcoation because when we do this were eseentailly removing the labrum = less stability
avoid extension [ast neutral
Max ER / abduction
what EX would we start with w/ someone w/ a total shoulder?
PROM / gentle isometrics (because muscular tissue typically isnt involved its okay to start w/ this)
what muscle does a reverse total shoulder arthroplasty increase and MA of and why?
Deltoid
because the roll and slide are in the same direction - so we know longer need to worry about rotator cuff activiation pulling the head of the humerus in and down as I go up
positions to avoid after reverse total shoulder
IR / adduction / extension
- think pulling up pants from back
what actvitites can you do right after reverse total shoulder
PROM / gentle isometric
NOTE: theres a good chance they’ll never get full ROM
Who gets latarget procedures?
recurrent anterior instability pts (think lots of bankart lesions)
how is a latarjet done?
we use boney tissue to keep it from going anterior
remove distal coracoid process and attach it to the anterior glenoid
what motion does a latarjet procedure reduce? why
ER
because w/ external rot were getting a posterior roll anterior glide
* this anterior glide is blocked by the boney coracoid being replaced on the anterior part of the glenoid cavity
should you do active movements right after latarjet procedure?
Nope, only passive
KNOW: RPE roughly equates to 1RM
what would be a good way for really weak pts to strengthen
AROM
think MMT 2 for mid delt, instead of doing lateral raises doing supine AROM
if you’re doing power/strength what is you work to rest time?
Very high rest small amount of actvitity
2 reps in 4 minutes
cardiovascular / endurance training work to rest ratio
higher work time
think roughly a 1:1
5 on 5 off
how would we load a tendin that is highly irritable?
isometrics
progress as heavy as possible here
however, we don’t want pain to rise more than 2/10 over where they are
then we would move to heavy slow concentric/eccentric (we want RPE 7-9 here)
‘once thats progressed we can move to low load high velocity
KNOW: w/ tendinopathies we start high load low velocity –> low load high velocity —> high load high velocity
Closed chain good for stabilization (activates all 4 rotator cuff muscles at the same time)
* think a hand pushing on the wall
* start mid range to prevent subluxation (which happens at end range)
explain seated medicine ball use
UE power
explain single arm seated shot pu test
throwing w// 1 arm to test arm to arm
