Lecture 7, Hypomobility of Shoulder

Question 1

Shoulder Stats

Answer 1

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

Question 2

Who is at increased risk for shoulder symptoms?

Answer 2

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

Question 3

High risk occupations

Answer 3

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

Question 4

Where are the symptoms coming from?

Answer 4

C-spine
Neurological
Internal organ

Question 5

C-spine pain

Answer 5

pain with cervical ROM
pain distal to elbow

Question 6

Internal organ pathology

Answer 6

visceral referral–refers pain to arm and shoulder

Question 7

Bottom line for shoulder pain that is not the shoulder

Answer 7

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

Question 8

Broader areas of pain

Answer 8

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

Question 9

Specific area of shoulder pain

Answer 9

AC pattern
subacromial pattern
GH pattern

Question 10

Joint stability of GH is provided by

Answer 10

inert = capsule, labrum, ligament

muscles

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

Question 11

Scapulohumeral rhythm

Answer 11

2 degrees of GH motion to 1 degree of scapular rotation

above 90 –> 1:1 ratio

humerus has to ER to clear greater tuberosity

Question 12

Limitations in the ______ ________ will decrease ability to reach overhead

Answer 12

thoracic extension

Question 13

Hypomobility can be caused by

Answer 13

RA
OA
trauma
post-immobilization
frozen shoulder/adhesive capsulitis

Question 14

Acute phase of Arthritis

Answer 14

pain, muscle guarding
swelling deep in capsule

Question 15

Subacute phase of Arthritis

Answer 15

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

Question 16

Chronic phase of arthritis

Answer 16

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

Question 17

Definition of Adhesive Capsulitis

Answer 17

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

Question 18

Pattern of ROM loss

Answer 18

ER
abduction
IR
flexion

Question 19

Risk factors for idiopathic AC

Answer 19

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

Question 20

Risk factors for secondary AC

Answer 20

increased inflammation
diabetes

Question 21

Risk for traumatic AC

Answer 21

following a trauma
prolonged immobilization of GH joint

Question 22

Stage 1 of AC

Answer 22

inflammatory stage

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

Question 23

Stage 2 of AC

Answer 23

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

Question 24

Stage 3 of AC

Answer 24

frozen

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

Question 25

Stage 4 of AC

Answer 25

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

Question 26

Treatment approach for AC

Answer 26

level of irritability often reflects the tissue's ability to accept physical stress match intervention strategies to level of irritability

Question 27

High level of irritability AC

Answer 27

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

Question 28

Moderate level of irritability AC

Answer 28

apply controlled physical stress to tissues progressive manual therapy mild stretching and strengthening activities basic functional activities

Question 29

Low level of irritability AC

Answer 29

progressive physical stress to tissues stretching, manual therapy, resistive exercise, higher-demand physical activities

Question 30

Patient Education for AC

Answer 30

home exercise programs are highly effective, but patient must have high levels of self-efficacy corticosteriod injections can also help

Question 31

Common limitations with general GH joint hypomobility

Answer 31

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

Question 32

Posture with GHJ hypomobility

Answer 32

scapular protraction, anterior tilt, elevated

Question 33

Compensation and substitution w/hypomobility

Answer 33

scapular elevation

Question 34

Acute phase Goals for GH joint hypomobility

Answer 34

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

Question 35

Subacute goals for hypomobility

Answer 35

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

Question 36

Self-mobilization can be done in the _____ phase

Answer 36

subacute

Question 37

Return to function phase goals GHJ hypo

Answer 37

progressively increase flexibility and strength prepare for functional demands

Question 38

GH Distraction

Answer 38

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

Question 39

MWM

Answer 39

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

Question 40

What should you do if you produce pain with MWM?

Answer 40

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

Question 41

Indications for MWM

Answer 41

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

Question 42

Goals of MWM

Answer 42

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

Question 43

Dosage of MWM

Answer 43

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