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adj tech > Manipulation + shoulder > Flashcards

Manipulation + shoulder Flashcards

1
Q

A Manipulation is taking a joint from_____ and moving it through the ________?

A

Neutral

Paraphysiological space

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2
Q

You must move through _______ to get into the paraphysiological joint space

A

Elastic barrier

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3
Q

The 7 stages of joint motion according to sandoz model are?

A 
Neutral 
Joint play 
Physiological barrier 
End play 
Elastic barrier 
Paraphysiological space 
Anatomical limit
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4
Q

Going beyond the anatomical joint limit will result in?

A

Joint trauma/pathology

Plastic deformation

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5
Q

The load deformation curve is?

A

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
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6
Q

Three phases of a manipulation?

A

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)

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7
Q

What is treated with manipulation?

A

Joint fixation/hypomobility

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8
Q

Definition of contraindications

A

“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”

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9
Q

List 3/5 general contraindications

A 
Frank bone
Disc lesion
Local circulatory disturbance 
Neurological disturbance 
Psychological disturbance
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10
Q

List 5/10 absolute contraindications to manipulation

A 
Acutely inflamed arthritis of any type 
Dislocation 
Instability 
Ruptured ligaments
Very recent trauma 
Avascular necrosis 
Fracture 
Malignancy 
Infection diseases
Cauda equina syndrome
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11
Q

List 5 of 17 relative contraindication to manipulation

A 
Hypermobility 
Osteoporosis 
Aneurysm 
Disc herniation 
Pregnancy 
Vertigo 
Psychological intolerances 
Painful rom in all directions
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12
Q

Adequate reaction

A

“Transient subjective discomfort of the patient not influencing work ability”

  • onset 6-12 hours
  • resolves hours-2 day
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13
Q

Exceeding reaction

A

“Objective worsening of the pre-existing complaint - with decreased work capacity”

  • onset 6-12hours
  • spontaneously remission exeeds 2days
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14
Q

Reported complications of cervical spine manipulation

A
  • 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
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15
Q

VBAI

A

Vertebrobasilar Artery insufficiency

  • trauma to vertebral artery wall(dissection)
  • change in flow (infarction) thrombus formation
  • embolism/infarction in the brain (circle of Willis
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16
Q

Wallenbergs syndrome

A

Brain stem infarction associated with occlusion of PICA, hoarseness of voice, trouble swallowing

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17
Q

Locked in syndrome

A

Occlusion of basilar artery (less common) conservation of only vertical ocular movement and blinking

18
Q

Symptoms of VBAI

A 
Dizziness 
Diplopia -double vission
Dysarthria -slurring speech
Dysphagia-difficulty swallowing
Nausea 
Numbness 
Ataxia -altered gate
19
Q

Closed/loose-packed position for glenohumeral joint?

A

Closed : full abduction with external rotation

Loose: 55 degrees abduction with 30 degrees horizontal adduction

20
Q

Loose/closed-packed position of acromioclavicular joint

A

closed: 90 degrees elevation
Loose: physiological rest position

21
Q

Closed/loose-packed position of sternoclavicular joint

A

Closed: full arm elevation
Loose: physiological rest position

22
Q

What is a capsular pattern

A

“Joint inflammation (synovitis/capsulitis) causes a specific order in which joint pain can be felt “

23
Q

Capsular pattern for the shoulder (decreasing stiffness)

A

External rotation (worst)
Abduction
Internal rotation
Flexion (least painful)

24
Q

What are the 5 steps in a observation of any joint/full body?

A 
General survey 
Postural survey 
Gait 
Area specific 
Angles (none for shoulder)
25
Q

What do you look for in general observation?

A
  • Body type (Meso, endo, ecto)
  • Skin (lumps bumps bruises moles[abcde])
  • general health (pallor, rubor, nails, psoriasis, cyanosis etc)
26
Q

What do you look for in postural analysis?

A
  • 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
27
Q

What do you do if you find winging of scapula in postural observation?

A

Test for serrated anterior weakness

  • push ups
  • muscle test for elderly/injured
28
Q

What is the apleys scratch test? What does it test

A

Reach one hand over head other hand around back.
Try to grab hands in middl of back

ROM for shoulder

29
Q

What are degrees for active passive rom of shoulder?

A 
Abduction 170-180
Adduction 50-75
Flexion 170-180
Extension 50-60
Internal rotation 60-100
External rotation 80–90
30
Q

On abduction of the shoulder, if pain is felt between 170-180 degrees what does this tell us ?

A

AC joint dysfunction
-possible rolling/pinching of joint capsule on abduction
(Ac joint rolls back as you get to the end of should abduction)

31
Q

What is Cleidocranial dysotosis

A

Absence of clavicles

32
Q

Common shoulder conditions:
Impingement syndrome?
Where is pain on abduction arc?

A

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

33
Q

Frozen shoulder (adhesive capsulitis)

A
  • Contraction + inflammation of joint capsule
  • reduction/obliteration of axillary capsular fold
  • capsular pattern to AROM + PROM
  • (External rotation - abduction - internal rotation - flexion)*
34
Q

Rotator cuff tear accounts for __% shoulder injury’s
Average age range?
Causes?
Symptoms?

A
  • 50 %
  • 60+ yo
  • repetitive overhead work trauma
  • Anterior shoulder pain, limited shoulder motion, weakness +- crepitus
35
Q

Closed/open packed position for glenohumeral joint?

A

Closed
-full abduction + external rotation
Open
-55* abduction + 30* horizontal adduction

36
Q

open/closed packed position of acromioclavicular joint?

A

Closed
-90* abduction
Open
-physiological resting position

37
Q

Open closed packed position of sternoclavicular joint?

A

Closed
-Full arm elevation
Open
-physiological resting position

38
Q

Capsular pattern of shoulder?

Decreasing stiffness

A

External rotation
Abduction
Internal rotation
Flexion

39
Q

Bony palpation for the shoulder?

A 
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
40
Q

Soft tissue palpation of shoulder?

A

Rotator cuff
-supraspinatus, infraspinatus, teres minor
Subacromial bursa
SCM
upper trap
Deltoid
Rhomboids (like muscle test - arm behind back)

41
Q

ROM for shoulder?

A 
Abduction: 170-180*
Adduction:50-75*
Flexion: 170-180* 
Extension: 50-60*
Internal rotation: 60-100*
External rotation: 80-90*
42
Q

Directions of movement for all shoulder joints (joint play)

A 
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

adj tech (6 decks)

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