Midterm Review Flashcards
Condition Overview : Shoulder Impingement
- Pain with flexion and/or abduction of GH jt, typically at 90-160 decrees
- Repetitive motion of overhead arm movement
- “Pinching, numbness/tingling, sharp pain at joint line of gh
- Supraspinatus or biceps muscle specifically
Shoulder Impingement : Ax, Mx, Hx
Ax :
1. Shoulder ROM
- Limited in flexion/abduction
2. Neer’s Impingement
Mx :
- Prone : bolster under shoulder
MFR, Kneading, Stripping, Manual Stretch, Squeezing of up traps, O+I biceps tendon/supraspinatus, GTO release
Hx :
1. Around the worlds 3x10
2. Weighted pendelums
Condition Overview : Stage 1 Adhesive Capsulitis
- Less than 3 months
- Limited in external rotation
- Pain present with movement / night / loss of external rotation
- Tender d/t lack of use, ht mm
- Decrease ht in rotator cuff
- Promote circulation & encourage movement as we can
- Focus in on external rotators (infraspinatus, teres minor)
Adhesive Capsulitis (Stage 1) : Ax, Mx, Hx
Ax :
1. Pain free ROM
2. Apley’s Scratch Test
Mx :
- Eff, kneading, stripping, squeezing, O+I, heat w/ barrier
Hx :
1. Pendelums
2. Wall walks
Condition Overview : Adhesive Capsulitis (Freezing Stage)
- 3-9 months
- Intense pain (even at rest)
- Limited ROM every direction
- Tender throughout shoulder girdle, HT/adhesions in rotator cuff
- Focus on reduce pain (release TrP, increase circulation, comp mm)
- Encourage any movement in the joint w/o larger movements (inferior tractions)
- Rotator cuff may be too sensitive, work on surrounding then back towards them
Adhesive Capsulitis (Freezing Stage)
3-9 Months
Ax :
- Pain free aROM
- Apley’s scratch test
Mx :
- Heat w/ barrier on rot cuff while working on surrounding mm
- Eff
- Knead
- Squeeze
- O+I
Hx :
1. Pendelums
2. Wall walks
Condition Overview : Adhesive Capsulitis (Frozen Stage)
- 9-15 months
- Pain ONLY with movement
- Limited gh ROM, increase scapulothoracic mvmt
- Adh, atrophy, TrP in rot cuff
- Focus on maintaining tissue health/engaging muscular tissue how we can, increase circulation, decrease HT
- Encourage movement in the joint
Adhesive Capsulitis (Frozen Stage)
- 9-15 months
Ax : - Px free aROM
- Apley’s scratch test
Mx : - Heat w/ barrier
- Eff to increase circulation
- MFR
- Stripping
- Kneading
- Squeezing
- O+I
Hx
1. Heat w/ barrier 10m
2. Pendelums
3. Wall slides
Condition Overview : Adhesive Capsulitis (Thawing)
- 15-24 months
- Minimal pain, but significant capsular restriction
- Recovering from atrophy, still present around joint
- Tenderness throughout rotator cuff
- Focus on maintaining tissue health/engaging muscular tissue, increase circulation, encourage movement with higher grades of joint play
- Rotator cuff should be good to work/focus on.
- Adding strength back into the joint
Adhesive Capsulitis : Ax, Mx, Hx
Ax :
- Pain free aROM
- Apley’s scratch test
Mx :
- MFR
- Knead
- Strip
- Squeeze
- MET/PNF? Joint play?
- Active/ Passive assisted ROM
Hx :
- Pec stretch
- External rotation isometric holds
Condition Overview : ITB Contracture
- Pain along the full ITB, firm ITB to touch
- HT in TFL, vastus lateral, biceps femoris, hip flexors
- Weakness in glute med, vastus medialis and adductors
ITB Contracture : Ax, Mx, Hx
Ax :
1. Gait
- Leaning towards unaffected side
- Increased pronation
- Hip drops
- Shorter stride length
2. Ober’s test
Mx :
- MFR
- Kneading & Stripping lat stuctures
- O+I hip flexors (rec fem)
- Tapotement medial strcutures
Hx :
- Hip flexor stretch (90-90)
- Clam shells, sidelying abductions for glute med
Condition Overview : ITB Friction
- Pain at the LATERAL FEMORAL CONDYLE, can radiate up and down the leg
- Firm ITB to touch, ropey “cord like” distal end
- Inflammation at the femoral condyle, heat and swelling
- HT in TFL, vastus lateralis, rectus femoris, hip flexors
- Weak in glute med, vastus medialis and adductors
ITB Friction : Ax, Mx, Hx
Ax :
1. Gait
- Leaning towards unaffected side
- Increased pronation
- Hip drops
- Shorter stride length
Mx :
- MFR itb
- Kneading/Stripping lat. structures
- O+I hip flexors
- Tapotement med. l structures
- MET/PNF quads
- Long. Str
Hx :
- Hip flexor str. (90-90)
- Clamshells
Condition Overview : Patellofemoral Syndrome
- Pain along lateral leg
- Firm ITB
- HT in TFL, vastus lateralis, rectus femoris, hip flexors
- Weakness in glute med, vastus medialis, adductors
- Patella that sits medially at rest, but lateral tracking with movement
- Adhesions around patella
Patellofemoral Syndrome : Ax, Mx, Hx
Ax :
1. Gait
- Leaning towards unaffected side
- Increased pronation
- Hyperextended knees
- Trendelenburg
2. Waldron’s
Mx :
- MFR
- Kneading / Stripping med. structures
- ATK around patella
- O+I rec fem
- Tapotement medial structures
- MET/PNF
- Long. str
Condition Overview : Dupuytren’s Contracture
- Thickening of palmar fascia - development of palmar nodules, tender to palpate
- Flexion deformity in the 4th & 5th digits @ MCP and IP joints
- HT, TrP and adhesions in to flexors of forearm
- Extreme or no limitation in 4th & 5th digits
Dupuytren’s Contracture : Ax, Mx, Hx
Ax :
1. aROM
- Limited in extension
2. Palpation
- Nodules in palm of hand
- Tight, taut, rope like, thickened
- Tender
- Cooler d/t reduce blood flow
Mx
- MFR
- Kneading
- Stripping
- aROM
- O+I
- Jt. Mob @ IP’s of digits
- TrP
Hx :
1. Palmaris longus stretch
2. Prayer hands stretch
Surgery (Moderate protection)
- Scar tissue mobilization, fascial restriction, adhesions
- NO hydro over hardware
Ax :
1. ADL
2. Gait (if lower)
3. aROM
4. Muscle length and/or strentgh
Mx :
- Heat proximal to injury site
- MFR
- Stripping/kneading
- Frictions on scar tissue
- O+I, GTO
Hx :
Location dependant
Hip replacement
- Sit/Stand exercises
- Standing hip abduction
Tibia
- Seated tib ant stretch
- Self mx
- Calf raises
Slap Lesion
- Pendulum exercises
- Isometric shoulder exercises
- Wall angels
- Scapular retraction
MCL rupture & reconstruction
- Towel stretch for hamstrings
- Single leg stand
- Standing hamstring curls
Surgery : Minimum Protection
Ax :
- ADL
- Gait (if lower)
- aROM
- Muscle length and/or strength
Mx :
- Heat proximal to injury site to move circulation
- MFR
- Stripping
- Kneading
- Squeezing
- Frictions on scar tissue
- O+I, GTO
- MET/PNF
Hx :
Location dependant
Hip replacement
- Sit/Stand exercises
- Standing hip abduction
Tibia
- Seated tib ant stretch
- Self mx
- Calf raises
Slap Lesion
- Pendulum exercises
- Isometric shoulder exercises
- Wall angels
- Scapular retraction
MCL rupture & reconstruction
- Towel stretch for hamstrings
- Single leg stand
- Standing hamstring curls
Condition Overview : Osteoarthritis
- Chronic degenerative disorder primarily affecting the articular cartilage of synovial joints
- Px in mornings
- Typical presentation seen in the hands, knees, hips and spine
- Joint enlargement
- Bouchard’s and Heberden’s nodes
Osteoarthritis : Ax, Mx, Hx
Ax :
1. ADL (sit/stand for low body), ADL (grip strength for upper)
2. Range of motion
Mx :
- MFR
- Kneading
- Stripping
- Passive stretch
- O+I
- Heat w/ barrier
- MET/PNF
Condition Overview : Rheumatoid Arthritis
- Autoimmune, chronic, inflammatory, systemic disease, affecting the synovial lining joint
- Swelling and signs of inflammation
- Loss of ROM d/t weakness
- Joint stiffness
- Bilateral and symmetrical symptom presentation
- Swan neck deformity
Rheumatoid Arthritis : Ax, Mx, Hx
Ax :
1. aROM (Wrist/fingers)
2. ADL’s (grip strength)
Mx :
Additional bolsters under hands/feet to create positional drainage
Eff
MFR
Kneading
Stripping
Ice mx
Compressions
Hydro : Contrast for circulation
Hx :
Hands
- Passive ROM of wrist flexion and extension
- Finger spreads with bands
- Isometric hand exercises
- Hydro contrast for circulation
- Ankle alphabet
- Marble pickups
