Manipulation + shoulder Flashcards
A Manipulation is taking a joint from_____ and moving it through the ________?
Neutral
Paraphysiological space
You must move through _______ to get into the paraphysiological joint space
Elastic barrier
The 7 stages of joint motion according to sandoz model are?
Neutral Joint play Physiological barrier End play Elastic barrier Paraphysiological space Anatomical limit
Going beyond the anatomical joint limit will result in?
Joint trauma/pathology
Plastic deformation
The load deformation curve is?
Neutral zone (space from neutral to elastic barrier)
Elastic zone (same as paraphysiologica space) Must add more force the deeper into the joint you get
Three phases of a manipulation?
1) preload (initial force to elastic barrier)
2) thrust phase (quick impulse taking the joint through the elastic barrier into the paraphysiological space)
3) recovery phase (bringing joint back to neutral from peak thrust phase)
What is treated with manipulation?
Joint fixation/hypomobility
Definition of contraindications
“A problem identified before a procedure is applied that would make application of the treatment inadvisable because of its potential to cause harm or delay appropriate treatment”
List 3/5 general contraindications
Frank bone Disc lesion Local circulatory disturbance Neurological disturbance Psychological disturbance
List 5/10 absolute contraindications to manipulation
Acutely inflamed arthritis of any type Dislocation Instability Ruptured ligaments Very recent trauma Avascular necrosis Fracture Malignancy Infection diseases Cauda equina syndrome
List 5 of 17 relative contraindication to manipulation
Hypermobility Osteoporosis Aneurysm Disc herniation Pregnancy Vertigo Psychological intolerances Painful rom in all directions
Adequate reaction
“Transient subjective discomfort of the patient not influencing work ability”
- onset 6-12 hours
- resolves hours-2 day
Exceeding reaction
“Objective worsening of the pre-existing complaint - with decreased work capacity”
- onset 6-12hours
- spontaneously remission exeeds 2days
Reported complications of cervical spine manipulation
- Vertebrobasilar strokes
- Horner syndrome (nerve supply to face disrupted)
- paralysis of the diaphragm
- cervical myelopathy 2 degree to meningeal hemorrhage
- pathological fracture and dislocation
- cervical disc protrusion
VBAI
Vertebrobasilar Artery insufficiency
- trauma to vertebral artery wall(dissection)
- change in flow (infarction) thrombus formation
- embolism/infarction in the brain (circle of Willis
Wallenbergs syndrome
Brain stem infarction associated with occlusion of PICA, hoarseness of voice, trouble swallowing
Locked in syndrome
Occlusion of basilar artery (less common) conservation of only vertical ocular movement and blinking
Symptoms of VBAI
Dizziness Diplopia -double vission Dysarthria -slurring speech Dysphagia-difficulty swallowing Nausea Numbness Ataxia -altered gate
Closed/loose-packed position for glenohumeral joint?
Closed : full abduction with external rotation
Loose: 55 degrees abduction with 30 degrees horizontal adduction
Loose/closed-packed position of acromioclavicular joint
closed: 90 degrees elevation
Loose: physiological rest position
Closed/loose-packed position of sternoclavicular joint
Closed: full arm elevation
Loose: physiological rest position
What is a capsular pattern
“Joint inflammation (synovitis/capsulitis) causes a specific order in which joint pain can be felt “
Capsular pattern for the shoulder (decreasing stiffness)
External rotation (worst)
Abduction
Internal rotation
Flexion (least painful)
What are the 5 steps in a observation of any joint/full body?
General survey Postural survey Gait Area specific Angles (none for shoulder)
What do you look for in general observation?
- Body type (Meso, endo, ecto)
- Skin (lumps bumps bruises moles[abcde])
- general health (pallor, rubor, nails, psoriasis, cyanosis etc)
What do you look for in postural analysis?
- Posterior, laterals, anterior.
- Line plumb line up
- muscles, bony structures, level of major areas(shoulders, hips, gluteal folds, knees, etc)
- lower crossed/upper crossed
- feet etc
What do you do if you find winging of scapula in postural observation?
Test for serrated anterior weakness
- push ups
- muscle test for elderly/injured
What is the apleys scratch test? What does it test
Reach one hand over head other hand around back.
Try to grab hands in middl of back
ROM for shoulder
What are degrees for active passive rom of shoulder?
Abduction 170-180 Adduction 50-75 Flexion 170-180 Extension 50-60 Internal rotation 60-100 External rotation 80–90
On abduction of the shoulder, if pain is felt between 170-180 degrees what does this tell us ?
AC joint dysfunction
-possible rolling/pinching of joint capsule on abduction
(Ac joint rolls back as you get to the end of should abduction)
What is Cleidocranial dysotosis
Absence of clavicles
Common shoulder conditions:
Impingement syndrome?
Where is pain on abduction arc?
1)Long head of biceps/supraspinatus tendon or sub acromial bursa vulnerable to sub acromial impingement
2)Pain would be felt with in 45-60 degrees
And 120 degrees
Frozen shoulder (adhesive capsulitis)
- Contraction + inflammation of joint capsule
- reduction/obliteration of axillary capsular fold
- capsular pattern to AROM + PROM
- (External rotation - abduction - internal rotation - flexion)*
Rotator cuff tear accounts for __% shoulder injury’s
Average age range?
Causes?
Symptoms?
- 50 %
- 60+ yo
- repetitive overhead work trauma
- Anterior shoulder pain, limited shoulder motion, weakness +- crepitus
Closed/open packed position for glenohumeral joint?
Closed
-full abduction + external rotation
Open
-55* abduction + 30* horizontal adduction
open/closed packed position of acromioclavicular joint?
Closed
-90* abduction
Open
-physiological resting position
Open closed packed position of sternoclavicular joint?
Closed
-Full arm elevation
Open
-physiological resting position
Capsular pattern of shoulder?
Decreasing stiffness
External rotation
Abduction
Internal rotation
Flexion
Bony palpation for the shoulder?
SC joint Clavicle AC joint Acromion Tip of coracoid process Lesser tuberosity of head of humerus Bicipital groove Greater tuberosity Inferior angle of scap Spine of scapula (T3 spinous process level) Supra+infra spinous fossa
Soft tissue palpation of shoulder?
Rotator cuff
-supraspinatus, infraspinatus, teres minor
Subacromial bursa
SCM
upper trap
Deltoid
Rhomboids (like muscle test - arm behind back)
ROM for shoulder?
Abduction: 170-180* Adduction:50-75* Flexion: 170-180* Extension: 50-60* Internal rotation: 60-100* External rotation: 80-90*
Directions of movement for all shoulder joints (joint play)
Acromioclavicular: -S-I -I-S Sternoclavicular: -S-I -I-S Scapulotharacic: -Internal rotation -External Rotation Glenohumeral joint: -A-P -P-A -M-L -L-M -Compression -S-I (0*, 15*, 90*) -Internal rotation -External rotation
