lecture 5

Question 1

What is SINSS?

Answer 1

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

Question 2

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

Question 3

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

Question 4

What is a clinical practice guideline?

Answer 4

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

Question 5

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

Answer 5

diabetes mellitus or thyroid dysfunction

Question 6

What age group gets adhesive capsulitits the most?

Answer 6

females 40-65 years old

Question 7

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

Answer 7

Yes

Question 8

adhesive pattern of restirction

Answer 8

External rotation –> abduction –> internal rotation

Question 9

How does the first 3 months of adhesive present

Answer 9

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

Question 10

what happens in stage 2 of adhesive capsulitits?

Answer 10

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

synovitits present

Question 11

Explain stage 3 adhesive

Answer 11

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

Question 12

stage 4 adhesive capsulitits

Answer 12

thawing stage 15+ months

pain begins to resolve and stiffness does 2

Question 13

what should u do for adhesive capsultiits?

Answer 13

steriod injection + PT

Question 14

what EX would we do with an adhesive cap pt?

Answer 14

ROM that match tolerance

NOTE: Education is key on this resolving

Question 15

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

Question 16

how long does adhesive last?

Answer 16

15 m

Question 17

KNOW: Tendins take forever to heal 3 months - over a year

Question 18

how long is the plan of care for rotator cuff repair?

Answer 18

12-16 weeks

Question 19

what should we do the most after rotator cuff repair?

Answer 19

PROM - we dont want it to get stiff or stuck

Question 20

what is the best way to promote blood flow for ar ecent rotator cuff repair?

Answer 20

walking

Question 21

KNOW: For RTC post op were going to avoid internal and external rotation stretching and any AROM
* we want all PROM

Question 22

Who typically gets total shoulder arthroplasty

Answer 22

Physical therapy Pts that don’t really respond

typically have OA / proximal humeral fracture

Question 23

inital precaustions for total shoulder arthroplasty

Answer 23

NOTE: Major problem is dislcoation because when we do this were eseentailly removing the labrum = less stability

avoid extension [ast neutral
Max ER / abduction

Question 24

what EX would we start with w/ someone w/ a total shoulder?

Answer 24

PROM / gentle isometrics (because muscular tissue typically isnt involved its okay to start w/ this)

Question 25

what muscle does a reverse total shoulder arthroplasty increase and MA of and why?

Answer 25

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

Question 26

positions to avoid after reverse total shoulder

Answer 26

IR / adduction / extension

• think pulling up pants from back

Question 27

what actvitites can you do right after reverse total shoulder

Answer 27

PROM / gentle isometric

NOTE: theres a good chance they’ll never get full ROM

Question 28

Who gets latarget procedures?

Answer 28

recurrent anterior instability pts (think lots of bankart lesions)

Question 29

how is a latarjet done?

Answer 29

we use boney tissue to keep it from going anterior

remove distal coracoid process and attach it to the anterior glenoid

Question 30

what motion does a latarjet procedure reduce? why

Answer 30

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

Question 31

should you do active movements right after latarjet procedure?

Answer 31

Nope, only passive

Question 32

KNOW: RPE roughly equates to 1RM

Question 33

what would be a good way for really weak pts to strengthen

Answer 33

AROM

think MMT 2 for mid delt, instead of doing lateral raises doing supine AROM

Question 34

if you’re doing power/strength what is you work to rest time?

Answer 34

Very high rest small amount of actvitity

2 reps in 4 minutes

Question 35

cardiovascular / endurance training work to rest ratio

Answer 35

higher work time

think roughly a 1:1
5 on 5 off

Question 36

how would we load a tendin that is highly irritable?

Answer 36

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

Question 37

KNOW: w/ tendinopathies we start high load low velocity –> low load high velocity —> high load high velocity

Question 38

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)

Question 39

explain seated medicine ball use

Answer 39

UE power

Question 40

explain single arm seated shot pu test

Answer 40

throwing w// 1 arm to test arm to arm