lecture 5 Flashcards by Tyler Winn

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

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KNOW: For a high irritability PT we want to focus on ROM, stretching, manual therapy: pain free only, typically non-end range

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passive interventions primary job is to improve mobility for EX and pt buy in

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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

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what are two risk factors (diseases) that could indicate adhesive capsulitits?

diabetes mellitus or thyroid dysfunction

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What age group gets adhesive capsulitits the most?

females 40-65 years old

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are you more likely to get adhesive capsultiits if you’ve had it in the contralatearl shoulder?

Yes

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adhesive pattern of restirction

External rotation –> abduction –> internal rotation

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How does the first 3 months of adhesive present

little to no ROM changes (starts tightening up a little - didnt think much of it)

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what happens in stage 2 of adhesive capsulitits?

freezing stage
3-9 months
gradual loss of ROM in ER, abd, IR

synovitits present

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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

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stage 4 adhesive capsulitits

thawing stage 15+ months

pain begins to resolve and stiffness does 2

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what should u do for adhesive capsultiits?

steriod injection + PT

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what EX would we do with an adhesive cap pt?

ROM that match tolerance

NOTE: Education is key on this resolving

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KNOW: There is weak evidence for manupulation / mobilization w/ adheasive cap

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how long does adhesive last?

15 m

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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