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2 Therapeutic Exercise > Lecture 7, Hypomobility of Shoulder > Flashcards

Lecture 7, Hypomobility of Shoulder Flashcards

1
Q

Shoulder Stats

A

GH accounts for 12-25% of complaints
increases in frequency w/age
more female vs male

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2
Q

Who is at increased risk for shoulder symptoms?

A

repetitive and forceful work
previous neck and shoulder injuries
high demand work-place
post-stroke
spinal cord injuries

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3
Q

High risk occupations

A

manual labor
dental healthcare providers
hair stylists
overhead athletes

using 1 hand/side for job
regular keyboard use (more than 4 hours)
10% of day spent in 90° of flexion

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4
Q

Where are the symptoms coming from?

A

C-spine
Neurological
Internal organ

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5
Q

C-spine pain

A

pain with cervical ROM
pain distal to elbow

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6
Q

Internal organ pathology

A

visceral referral–refers pain to arm and shoulder

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7
Q

Bottom line for shoulder pain that is not the shoulder

A

clearn the c-spine in the presence of suspected referral
age >30 yrs, non-traumatic origin, neck pain

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8
Q

Broader areas of pain

A

C4 = up the neck, shoulder
C5 = back of the shoulder

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9
Q

Specific area of shoulder pain

A

AC pattern
subacromial pattern
GH pattern

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10
Q

Joint stability of GH is provided by

A

inert = capsule, labrum, ligament

muscles

remember that joint stability is a prereq for full active range of motion

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11
Q

Scapulohumeral rhythm

A

2 degrees of GH motion to 1 degree of scapular rotation

above 90 –> 1:1 ratio

humerus has to ER to clear greater tuberosity

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12
Q

Limitations in the ______ ________ will decrease ability to reach overhead

A

thoracic extension

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13
Q

Hypomobility can be caused by

A

RA
OA
trauma
post-immobilization
frozen shoulder/adhesive capsulitis

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14
Q

Acute phase of Arthritis

A

pain, muscle guarding
swelling deep in capsule

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15
Q

Subacute phase of Arthritis

A

capsular tightness
loss, greatest at ER, followed by abduction
pain at end of ROM
limited joint play

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16
Q

Chronic phase of arthritis

A

progressive increase in capsule tightness
loss of function, aching in deltoid

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17
Q

Definition of Adhesive Capsulitis

A
  1. ROM loss >25% in at least 2 movement planes
  2. at least 50% loss of passive ER
  3. duration of complaints >3 months
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18
Q

Pattern of ROM loss

A

ER
abduction
IR
flexion

19
Q

Risk factors for idiopathic AC

A

female
age over 40 years
having AC on one side for opposite arm involvement

20
Q

Risk factors for secondary AC

A

increased inflammation
diabetes

21
Q

Risk for traumatic AC

A

following a trauma
prolonged immobilization of GH joint

22
Q

Stage 1 of AC

A

inflammatory stage

gradual onset of pain w/movement
RC is strong
3 months duration
no adhesions or contracture at exam

23
Q

Stage 2 of AC

A

painful/freezing

more intense pain at rest, all ROM limited
PT may not be beneficial at this stage
3-9 months
aggressive synovitis at exam

24
Q

Stage 3 of AC

A

frozen

pain only during movement, compensated by scapula
atrophy of deltoid, RC, biceps, triceps
9-15 months
fibrosis at exam

25
Q

Stage 4 of AC

A

thawing

minimal pain, resolving pain
may be showing some improvement in ROM
15-24 months
complex fibrosis at exam

26
Q

Treatment approach for AC

A

level of irritability often reflects the tissue’s ability to accept physical stress

match intervention strategies to level of irritability

27
Q

High level of irritability AC

A

not ready for significant physical stress being applied to the affected tissues

activity modification, manual therapy, low intensity levels for GH exercises, encourage motion at adjacent regions, limit # of visits

28
Q

Moderate level of irritability AC

A

apply controlled physical stress to tissues

progressive manual therapy
mild stretching and strengthening activities
basic functional activities

29
Q

Low level of irritability AC

A

progressive physical stress to tissues

stretching, manual therapy, resistive exercise, higher-demand physical activities

30
Q

Patient Education for AC

A

home exercise programs are highly effective, but patient must have high levels of self-efficacy

corticosteriod injections can also help

31
Q

Common limitations with general GH joint hypomobility

A

inability to reach overhead, behind headm to the side, behind back
dressing, grooming
lifting weighted objects
pain at night

32
Q

Posture with GHJ hypomobility

A

scapular protraction, anterior tilt, elevated

33
Q

Compensation and substitution w/hypomobility

A

scapular elevation

34
Q

Acute phase Goals for GH joint hypomobility

A

maintain soft tissue and joint integrity and mobility
maintain integrity and function
control pain, edema, joint effusion

precaution = pain that increases w/intervention
contraindications = no stretching w/RA

35
Q

Subacute goals for hypomobility

A

progressively incerease joint and soft tissue mobility
correct faulty mechanics
improve joint tracking
improve muscle performance

36
Q

Self-mobilization can be done in the _____ phase

A

subacute

37
Q

Return to function phase goals GHJ hypo

A

progressively increase flexibility and strength
prepare for functional demands

38
Q

GH Distraction

A

indications = testing, initial treatment, general capsular mobility
separating joint can be perpendicular to treatment plane

39
Q

MWM

A

mobilization with movement

  1. No pain should be produced
  2. overpressure is provided to end range
  3. results are expected at time of MWM
  4. results are long lasting
40
Q

What should you do if you produce pain with MWM?

A

change direction of the accessory movement
change the amount of force
technique may not be indicated

41
Q

Indications for MWM

A

full orthopedic exam has been completed
specific biomechanical analysis reveals loss of movement
comparable signs
manual therapy not contraindicated

42
Q

Goals of MWM

A

increase active range of motion
decrease pain at rest with active motion

43
Q

Dosage of MWM

A

6 to 10 times
reassess comparable sign and fatigue level
repeat 2-4 more sets as tolerated

2 Therapeutic Exercise (14 decks)

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