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There EX semester 4 > Manage shoulder chap 21 and 17 > Flashcards

Manage shoulder chap 21 and 17 Flashcards

1
Q

Compression and irritation of soft tissues in suprahumeral space

A

Impingement Syndrome

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2
Q

Shoulder Impingement pg 349 shank

this shoulder impingement refers to mechanical compression of the rotator cuff tendoms, primarily the supraspinatus tendon, as they pass under the

A

primary

Mechanical compression
Intrinsic or extrinsic

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3
Q

Testing associated with Subacromial RTC Impingement

A

Neer painful arc test
Pain with shoulder elevation and IR

Hawkins-Kennedy test
Figure 21-1, pg 350 Shankman

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4
Q

Impingement Syndrome

Degenerative changes can also result in decreased ________ __________ between the rotator cuff and the coracoacromial arch

A

subacromial space

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5
Q

Shoulder Impingement

RTC Impingement

what motions cause ?

A

Repeated ABD and ADD motions compromise blood supply to tendon
Primary impingement
Supraspinatus tendinitis
Tears within the RTC

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6
Q

RTC Impingement

What kind of posture may this patient assume?

A

Forwar head, anterior tipped scap wth decrese thoracic mobiltiy

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7
Q

RTC Impingement

Muscle imbalances

A
  1. Hypomobile pec major and minor, levator scapulae, and IR of the GH joint
    1. Stretch or strengthen? ceiling punches
  2. Weak serratus and lateral rotators
  3. Tight GH capsule posteriorly- arm across body
  4. Faulty kinematics with humeral elevation
    1. What activities would allow you to target these imbalances? be aware of shoulder hiking and uncoordinated scap/hum rhythm
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8
Q

scap motion kc 542 and 543

scap/hum rythm

A

for evry 2 degrees of gh flx or abd after first 30 degrees of shldr

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9
Q

What activities could you implement to begin improve scapulohumeral rhythm?

A

brushing hair

washing hair

reaching upward

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10
Q

RTC edu with dressing?

A

put bad arm in shirt first

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11
Q

RTC imp

stages 1,2,3

pg shank 349

and phase of rehab 1,2,3

A
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12
Q

Phase i

A
  • prefuncitonal
    • pt ed
    • control inflammation and promote healing
      • modailties
      • immobilaztion
  • maintain integrity and mobiltiy - pendulums
  • develop support in related regions
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13
Q

RTC Impingemen fyi

Important to modify (not eliminate) activities

A
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14
Q

Shoulder impingement can be very painful in acute stage so your patients may not adhere to your exercise program.

Review ways to foster adherence

K & C Box 1.22

look up

A

look up

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15
Q

What signs and symptoms would indicate that the patient is no longer acute and has moved to the second stage?

A

No inflammation

inc ROM

decrease pain

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16
Q

Phase II – Return to Function

whats involved?

A
  • Patient education
  • Improve postural awareness
  • Advanced scapular stabilization ex
  • OKC exercises
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17
Q

Phase II – Return to Function

If exercise is too difficult, what might you see?

A
  • rowing
  • scaption- full cans /empty cans
  • press ups/ over head press
  • push ups with scap protraction - push ups with a+
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18
Q

What do the exercises target?

  • rowing
  • scaption- full cans /empty cans
  • press ups/ over head press
  • push ups with scap protraction - push ups with a+
A

upper middle lower trap

levator scapula

rhomboid major

pectoralis minor

middle and lowr serratus

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19
Q

Phase III – Return to Activity

whats involved?

A
  • Process is slow and must be done cautiously
    • Endurance
    • Plyometrics
    • Oscillatory training
  • Body blade - Shankman – Fig 21-5
    • Specificity of training
  • Increase speed of exercise performance
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20
Q

RTC-Consider how the exercises differ in each stage.

A

Note progression/regressions
Muscles targeted
ISOM vs Resistance?
Mechanical vs. Manual

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21
Q

Surgical Management

Shoulder Impingement and RTC Tears

A

RTC Tears

  • Acute
  • Partial or full tears

Surgical Repair

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22
Q

Factors that Influence Progression of Rehab After Repair of the RTC
Table 17.4
K & C

fyi

A
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23
Q

General Exercise Guidelines and Precautions After Repair of a Full Thickness RTC Tear
Box 17.10
K & C

Mrs T had us highlight look in book

A

fyi

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24
Q

RTC Repair

With small repairs (less than 1 cm) what are the phases

A

Phase I – Prefunctional Phase
Phase II – Return to Function Phase
Phase III – Return to Activity Phase

Review time frames associated with each stage

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25
Q

Terms to be aware of

Positional recruitment

A

Promotes decompression

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26
Q

Rehabilitation after RTC repair or subacromial decompression (SAD) closely follows that of non-operative rehabilitation.
What considerations may a PTA take when working with this patient?

A
  1. size of tear
  2. physcian order
  3. WB restrictions
  4. sling-be aware of poor posture
  5. pre op strength

kc 572 17.4

27
Q

How would treatment differ with a massive RTC repair?

What things may you, as the PTA, take into consideration?

A

faster than the massive

28
Q

Terms to be aware of

Shoulder hiking

A

Compensation

29
Q

Massive RTC Repairs
No active shoulder motion

What exercise could be implemented to keep the joint lubricated and does not require active motion?***

A
  • no active concentric or eccentric contractions for 2-3 months after surgery
  • no active shoulder motion
30
Q

Pendulum Exercise or same as what?

A

Codman’s

31
Q

Massive RTC Repairs

Note: AAROM activities can begin 2-3 mos following surgery

What type of early AAROM exercises would promote return of functional ROM?
How can those activities be progressed into more challenging exercises in the return to function and return to activity stages?

look up

A
32
Q

When avoiding active shoulder motion and active concentric and eccentric strengthening for the first 2-3 months post surgery, what types of exs may be implemented?

phase 1,2,3

A

bikes

isometrics

33
Q

RTC Repairs

Note: Shoulder is immobilized post surgery

Phase I
Isometrics
Added cautiously 4 to 12 wks post surgery
When can resistance be added?

A

wait 3 mos and make sure have FROM

34
Q

When avoiding active shoulder motion and active concentric and eccentric strengthening for the first 2-3 months post surgery, what types of exs may be implemented?

A
35
Q

Adhesive Capsulitis

Affects women more than men
40-60 yrs of age

name 2 types

A
  • Primary idiopathic adhesive capsulitis
  • Secondary adhesive capsulitis
    • Stages I – IV**
    • Note characteristics and time frames for healing
36
Q

547 kc

adhesive capsit

stage 1

2

3

4

A

1

2 freez

3 froze

4 thawed

37
Q

Adhesive Capsulitis

Acute

A
  • Modalities
    • Interventions to promote relaxation of :
    • GH joint
    • Cervical area
    • ST muscles
  • PROM, AROM, AAROM
    • What type of exercises would promote regaining functional ROM?
  • Joint mobilizations

CRPS (RSD)
What exercise(s) may help this patient?
Education
ROM
Edema
STM

38
Q

When pt demos improve GH motion and appropriate scapulohumeral rhythm, strengthening exs can begin

A

deltoids

scapular muscles

RTC muscles

Upper arm muscles

39
Q

Adhesive Capsulitis

Last Phase- whats involved

A

To promote normalized function
CKC resistance
How?
Task specific exercises
Very important to determine functional limitations to guide your treatment and demonstrate progress

40
Q

Adhesive Capsulitis

Clinical Note:
HEP compliance must be continuously encouraged
Education

A

avoid pain provoking symptoms

41
Q

Dislocation/Subluxation

Did you know…
Anterior more common than posterior
Anterior MOI: er and abd
Axillary nerve commonly injured
Posterior MOI: flex, add and IR
Falling on an outstretched arm
RTC tears are sometimes involved
30% in 40 yrs and >
80% in 60 yrs and >

A
42
Q

Why is the method of injury (MOI) important when treating patients with dislocations/subluxations?

A

so you can allow for healing and don’t stretch the stuff that just got stretched

43
Q

Dislocation/Subluxation

Terms to know:

Bankart Lesion**
Hills-Sachs Lesion**

A

Bankart Lesion** avulsion of the capsule ad glenoid labrum off the anterior rim of the glenoid resulint from atnerior dislcoation kc 578

Hills-Sachs Lesion** impact of fx of the post lat aspect of humerad d/t anterior shoiulder instabiltiy shank 354

44
Q

Dislocation/Subluxations

Common Impairments
Common Functional Limitations/Disabilities

579 shank

Operative and Nonoperative Management

A
45
Q

Dislocations/Subluxations

Prefunctional Phase

A

Progressive IR/ER can begin once pt can demonstrate near max isometrics

46
Q

Dislocations/Subluxations

Return to Function Phase

A

Combined Shoulder ABD and ER are avoided
3 months after immobilization (sling)

physician will tell you

47
Q

Dislocation/Subluxation

Hallmark of return to function phase

A
  • Progressive strengthening of
    • RTC
    • Anterior shoulder muscles
    • Scapular stabilization exercises
  • Eccentric strengthening
48
Q

Dislocations/Subluxations

Always address scapulohumeral rhythm

A

Focus on normalized scapular motion and stabilizations ex

49
Q

How can PTA address functional motions and enhance proprioception through therapeutic exercise?

A

kc 356-7 shank

50
Q

Dislocations/Subluxations

Corrective Surgery for Capsular Redundancy

See Pg 356 – Shankman
NOTE: Recommended slow and protected ER performed up to 12 weeks post op
ER incrimination listed in Shankman pg 356

A
51
Q

Dislocations/Subluxations

Clinically, remember:
The degree and direction of shoulder motion is specific to

A
  • Surgical procedure
  • Wishes of the physician
  • Direction of the PT
52
Q

Dislocations/Subluxations

Elevation is normally progressed to______degrees (or pt tol) 6 wks post op
ABD

A

135

53
Q

TSA

Prefunctional or Acute Stage
Positioning
Box 17.5 K & C
Precautions
Box 17.6 K & C

A
54
Q

What types of exercises may promote motion in the early phase of rehab, as tolerated by patient and allowed by the physician?

556-557 kc

A

wand ex

scap mobs pg 363 shank

55
Q

TSA

Functional use can be expected around _____months postoperatively

A

4

56
Q

Goals of TSA

A

Pain relief
Functional mobility

57
Q

Monitor pt carefully of TSA

A

Be aware of signs of hardware loosening
Tissue damage

58
Q

What is TOS?

A

Encompasses a variety of clinical problems in the shoulder region
Thoracic Inlet Syndrome may be used as considered more anatomically appropriate
Figure 20-17 – Shankman
Figure 13.19 – K & C

59
Q

Common TOS Symptoms

A

Radicular pain
Numbness
Tingling
Weakness
Skin and temp changes consistent with neurovascular tissue compression

60
Q

What is TOS?
Pg 395-98 K & C
Brachial plexus in the thoracic outlet

A

Contributing factors
Common functional limitations
Guidelines for Managing TOS

61
Q

TOS-Tests***

A

Adson’s maneuver/Halstead
K & C
Wright Allen Test
Pt’s hand is up with arm abducted from side.
Pt instructed to look away
If radial pulse disappears, test is positive
Military Brace Test
Roos Test

62
Q

Shoulder Impingement pg 349 shank

This shoulder impingement is realted to glenohumeral instabilty that creates a reduced subacromial space because the humeral head elevates and minimizes the area under the coracoacromial ligament.

A

secondary shoulder impingement

63
Q
A

There EX semester 4 (7 decks)

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