MS Disorders Flashcards
Arthrogryposis
nonprogressive, nongenetic, congenital disorder
characterized by rigid joints of the extremities (usually symmetrical), sausage-like shapeless limbs and weak or nonfunctioning muscles
hip dislocations and contractures (flex, abd, ER), shoulder contractures (add, and IR) and club feet can result
tx: surgery, ROM, splinting, positioning, ADL training, use of ADs
complex regional pain syndrome
abnormal sympathetic reflex resulting from a persistent painful lesion
results in dysfunction of SNS to include pain, circulation and vasomotor disturbances
clinical signs: pain, edema, decreased circulation, osteoporosis, skin dryness, decreased proprioception and atrophy of muscles in close proximity to the involved area
type I: frequently triggered by tissue injury;term describes all patients with the above symptoms but no underlying nerve injury
typeII: experience the same symptoms but clearly associated with nerve injury
tx: modalities to decrease pain, joint mob, WB or closed chain exercises, massage, manual lymphatic drainage, splinting
meds: sympathetic nerve block, surgical sympathectomy, SC stimulation, intrathecal drug pumps
Tx: education for injury prevention, desensitization activities that focus on return to normal activities, flexibility exercises, TENS for pain relief
Colles’ fracture
most common wrist fracture resulting from FOSH
the distal fragment of the radius has a dorsal displacement with a radial shift of the wrist and hand.
tx: casting, early AROM and PROM are essential for ultimate functional recovery, progressive resistance exercises, mobs, closed chain stabilization exercises
Degenerative joint disease (osteoarthritis)
a nonrheumatoid, nonsystemic disease
often affects WB joints by the degeneration of the articular cartilage
any stiffness may be improved with exercise
the onset is usually gradual, initially involving one or a few joints
as the disease progresses, joint motion becomes diminished, flexion contractures occur, tenderness and crepitus or grating sensations appear.
differential dx: normal ESR, abnormal joint radiographs , problems in WB joints
tx:
- NSAIDS
- functional training and education
- ROM exercises
- isometric, isotonic, isokinetic and postural exercises
- ADL training
- continue physical activity
- surgery or joint replacement
- joint protection strategies
fibromyalgia
classified as an immune system disorder of unknown origin that causes tenderness, pain and stiffness in the muscles
often relates to stress, anxiety, fatigue and sleeplessness in women>men
characterized by aching burning in the muscles, “a migraine headache of the muscles,” diffuse pain, or tender points on both sides of the body
differential dx:
- widespread pain in at least 11/18 tender points
- recognition of typical pattern of non rheumatic symptoms and sleep deprivation
- exclusion of other systemic diseases
tx:
- holistic and multidisciplinary approaches are necessary
- ADL education and training
- stress managemet
- meds: analygesics and antidepressants
- local modalities and techniques for muscle pain relief
- aerobic/conditioning exercises
- improve sleeping patterns
Gout or gouty arthritis
metabolic disease marked by elevated level of serum uric acid and deposition of rate crystals in the joints, soft tissues and kidneys
most often affects the feet (* great toe, ankle and mid foot)
severe joint pain commonly at night with warmth, erythema, and extreme tenderness/hypersensitivity
tx:
- anti-inflammatory meds
- daily use of colchicine
- lowering of rate concentration in body fluids with diet, weight loss, and moderation of alcohol
- allopurinol to reduce hyperuricemia
- rest, elevation and joint protection during acute phase
hemophilia
hemorrhagic disorder that is hereditary
results from a deficiency of specific clotting factors
PT concerns:
- hemiarthrosis
- muscle bleeds: can cause pain, swelling, extreme tenderness and possibly permanent deformity. bleeding near peripheral nerves can cause peripheral neuropathies, pain, paresthesia and muscle atrophy. f bleeding impairs a major vessel, ischemia and gangrene can occur.
Tx:
- splinting
- ice, rest and elevation in acute phase
- chronic- joint protection, maintaining joint function, daily ROM, endurance and strength, ADL training and use of appropriate splints and AD
ITB friction syndrome
an irritation caused by the rubbing of the ITB over the lateral epicondyle of the femur
often occurs in runners from an overuse syndrome
differential dx:
- positive ober’s test
- excessive hip IR in stance
- palpation over ITB insertion
- positive noble compression test
tx:
- stretching
- modalities for pain and inflammation
- STM
- shoe orthosis
myositis ossificans
often caused by trauma to a muscle resulting in hematoma that may calcify or ossify - painful
can be induced by early mobilization and stretching with aggressive PT following trauma to the muscle
frequent locations: quads, brachialis, biceps
dx: radiographs will show calcium deposits
tx:
- conservative with gentle active and AA ROM
- passive stretching or manual overpressure is NOT indicated
osteochondritis dissecans
separation of the articular cartilage from the underlying bone (osteochondral fracture)
usually involving the medial femoral condyle near the intercondylar notch and humeral capitulum and observed less frequently at the femoral head and talar dome
tx:
- if displaced surgery is indicated
- gait training
- functional strengthening
- conditioning
osteomalacia
decalcification of bones
results from vitamin D deficiency, which may cause deformities, fractures and severe pain
tx: pain control and functional mobility training
maintain/improve joint mechanics and CT functions
implement aerobic capacity/endurance conditioning (aquatics)
meds: calcium, vit D, vit D injections
osteomyelitis
acute or chronic bone infection
commonly the result of combined traumatic injury and acute infection
in adults, the disease commonly localizes in the pelvis and vertebrae and is usually a result of contamination related to surgery or trauma
more common in children and immunosuppresed adults
treatment:
- high doses of antibiotics
- infected limb is immobilized by cast
- traction or best rest
- sometimes surgical intervention to drain infection
- chronic infection may require amputation
osteoporosis
the most common metabolic bone disease
affects white females most commonly
depletes bone mineral density, which may predispose the individual to fracture
common sites of fracture include thoracic and lumbar spine, femoral neck, proximal humerus, proximal tibia, pelvis and distal radius
primary postmenopausal osteoporosis is directly related to a decrease in the production of estrogen
treatment: pain management postural education breathing exercises general conditioning pec stretching WB exercises abdominal strengthening (with caution- don't want excessive and repeated flexion of spine as can lead to wedge fractures)
Paget’s disease (osteitis deformans)
a slowly progressive metabolic bone disease
characterized by an initial phase of excessive bone reabsorption followed by a reactive phase of excessive abnormal bone formation. The new bone structure is fragile and weak and causes painful deformities of the external contour and the internal structures.
abnormal osteoclastic and osteoblastic activity
Usually affects several skeletal areas- spine, pelvis, femur and skull
-can result in spinal stenosis, facet arthropathy,
involved sites can fracture easily and heal slowly and usually incompletely
vertebral collapse or vascular changes can lead to paraplegia
treatment
-if asymptomatic: no tx
-symptomatic: drug therapy for pain
joint protection, joint mechanics and CT function, aerobics- aquatic
patellofemoral dysfunction
the patella fails to track properly in the trochlear groove of the femur
instability or pain usually occurs at the first 30 deg of knee flexion
stair climbing, prolonged sitting (moviegoer’s sign), squatting, or jumping may aggravate the condition
differential dx:
- Q angle >18 deg
- positive chondromalacia test: pain under patella with compression of patella and quad contraction
- abnormal tracking of patella during knee flex/ext
tx:
- McConnell’s taping
- VMO strengthening
- ITB and TFL stretching
- shoe inserts to decrease genu valgum and pes planus
- on track brace to reposition patella
- transverse friction massage over lateral retinaculum
- patellar mobs: medial patellar glide and stretching deep fibers of lateral reticulum to decrease patellar tilt
patella positions
normal: patella articular surface is evenly against anterior femur
Patella baja = lower placement
Patella alta = higher placement
a “camel sign” ma be present from a high patella (one hump) and the infrapatella fat pad (second hump)
-less efficient in exerting forces for knee extension
- mob techniques:
- inferior glide for patella alta
- superior glide for patella baja
progressive systemic sclerosis (scleroderma)
a chronic disorder characterized by fibrosis and changes in the internal organs and skin
frequently, accompanied by Raynauds
polyarthralgia is a common early symptom-
heartburn and dyspnea occasionally are the first manifestations
differential dx:
- positive rheumatoid factor test
- multiple system problems in the skin, GI tract, cardiorespiratory system and kidneys
tx:
- maintain joint ROM
- meds
- strengthening
pronator teres syndrome
median nerve entrapment in the pronator teres muscle
pronator teres syndrome test: PT strongly resists pronation of the elbow as it extends from 90 deg flexion
+ test = tingling/paresthesia provoked in the forearm and hand in a median nerve distribution
tx:
- manual nerve glides
- stretching
- AROM
- US
- NMES for nerve healing
Rheumatoid arthritis (RA)
chronic, systemic inflammatory disease
unknown etiology, although an immunological mechanism appears to play an important role
more often in women- peak onset 30-40 y/o
usually involves a symmetrical pattern of dysfunction in the synovial tissues and articular cartilage of the joints of the hands, wrists, elbow, shoulders, knees, ankles and feet
joints of the cspine are commonly involved, potentially leading to subluxation and SC compression
extra articular systems may be involved- cardiovascular, pulmonary, and GI
additional manifestations: eye lesions, infection and osteoporosis
Juvenile RA: onset prior to 16 y/o with complete remission in 75% of children. may affect any number of joints but is characterized chiefly by fever and rash.
differential dx:
- blood test for a rheumatoid factor
- symptoms usually begin insidiously and progress slowly
- complaints of fatigue, weight loss, weakness and general diffuse MS pain are often initial presentations
- pain is localized to specific joints with symmetrical bilateral presentation
- after periods of rest, intense joint pain and stiffness can last 30 minutes to several hours with the initiation of activities
- deformities of the fingers are common and can include ulnar deviation and swan neck or boutonniere deformities
- MCP and PIP joints are mainly affected, with characteristic pannus formation (inflammatory granulation tissue that covers joint surface), ulnar drift and solar subluxation of MCP joints.
treatment:
- reduce pain
- maintain mobility
- minimize joint stiffness, edema and destruction
- prevent deformities with orthoses
- patient education and continual adherence to tx program; energy conservation is stressed
- meds, rest, ADs, and ice in acute phases
scoliosis
unknown etiology for most cases
can also be caused by structural abnormalities (LLD or herniated lumbar disc)
structural scoliosis is an irreversible curvature with a rotational component demonstrated upon forward flexion of the spine
nonstructural scoliosis is a reversible lateral curve without rotation that straightens as the individual flexes the spine
diff dx:
- xray
- postural analysis
- forward flexion test
tx:
- structural: bracing and/or surgery for placement of Harrington rods along the spine; conservative tx for 45 deg
- nonstructural can be managed with stretching, shoe lifts and postural re-education
- respiratory care may be needed if Cobb’s angle >40 deg
-flexibility, strengthening, estim to improve muscle performance, education for spinal orthoses
Sjogren’s syndrome
a rheumatoid like disorder characterized by dryness of the mucous membranes, joint inflammation and anemia
more common than systemic lupus erythematous (SLE) and less common than RA
differential dx:
- dryness of the eyes and mouth along with joint inflammation
- arthritis occurs in ~33% of the patients and is similar in distribution to RA, but milder and without joint destruction
tx:
- sipping fluids t/o the day
- chewing sugarless hum
- using a mouthwash for dryness
- meds for pain and inflammation
- maintain mobility and function through a regular exercise program
sprain:
degrees?
an injury to a ligament or joint capsules from over stress that damages the fibers either partially or completely
1st degree: some fibers are torn; a small amount of hemorrhaging is present and joint remains stable
Tx:
-prevent joint hypo mobility and disuse atrophy with movements within pain free AROM
-modalities to decrease pain, reduce edema and promote healing
-gradual return to normal functional level
2nd degree: a portion of the ligament or joint capsule is torn, moderate amount of hemorrhaging, some functional loss is present and joint stability remains intact
TX:
-guard against rein jury with limited WB and bracing as needed
-pain free AROM and joint mob should be integrated into the treatment, which includes physical agents to reduce pain and edema
3rd degree: complete disruption or avulsion of the ligament or joint capsule with loss of function, joint instability and pronounced hemorrhaging and swelling in the area. WB is undesirable
TX:
-After 2-3 weeks, the joint has usually healed (is pain free and has normal mobility) and strengthening exercises are used to reduce chance of re-injury
-may require surgical repair to avoid permanent joint instability
-bracing or splinting used to immobilize the joint and allow healing
-proprioception exercises and controlled motion exercises followed by gradual return to functional activities
-strength and mobility exercises used to complete rehab process- can take up to 5-6 months following
differential dx:
- joint palpation
- joint stability tests specific for injured area
- amount of swelling and ecchymosis
- functional/strength tests
systemic lupus erythematosus (SLE)
a chronic, systemic, rheumatic, inflammatory disorder of the CTs
affects multiple organs including skin, joints, kidneys, heart, blood-forming organ, nervous system, and serous membrane. also may affect membranes lining the walls of the body cavities and enclosing contained organs.
unknown etiology
differential dx:
- symptoms include malaise, overwhelming fatigue, arthralgia, fever, arthritis, skin rashes (butterfly rash over nose and cheeks), photosensitivity, anemia, hair loss, raynaud’s, kidney involvement
- other skin manifestations can indicate vasculitis, resulting in lesions in the digits, necrotic leg ulcers, or digital gangrene
tx:
- topical corticosteroid creams for skin lesions
- patient education for energy conservation, good nutrition, and skin care
- ROM
- ergonomic and postural training
TMJ syndromes
dysfunctions of this joint can be divided into 3 diagnostic categories
1- joint abnormalities that result from trauma, arthritis, disease or neoplasm
2- congenital structural defects. may include- meniscus, ligaments that control movement of the disc, the condyles, the fossa or the articular tubercles
3- loss of functional mobility of unknown etiology. may result from increased activity in the muscles of mastication as the result of stress and anxiety
differential dx: exam for joint noise, joint locking, AROM of the jaw, lateral deviation of the mandible during depression or elevation, decreased strength, tinnitus, headaches, FHP, and pain with movement
SPECIFIC CONDITIONS
1-Synovitis and capsulitis:
- pain located in pre auricular (anterior to ear) area
- unable to fully close back teeth together
- opening 40 mm and deviates toward the noninvolved side
3-Disc displacement with reduction
- patient reports joint noises with opening and closing equal to “pops” or “clicks”
- palpation over lateral poles reveals an opening click (the reduction of the disc) and a closing click (the disc displacing anterior to the condyle). these noises = the “reciprocal click”
4- disc displacement without reduction
- patient reports intermittent locking without joint noises
- opening of mandible is limited to 20-25mm with deflection toward involved side
- limited lateral excursion toward the opposite side of the involved joint
TX:
- postural re-ed
- modalities for pain
- inflammation reduction
- biofeedback
- joint mob
- AROM and muscle strengthening exercises
- patient education for eating soft foods and decreasing habits that stress TMG (biting nails or pencils)
- instruct patient in maintaining the rest position of the tongue (upright postural position of the tongue on the hard palate
tibial fracture
TYPES:
- march fractures of the inferior 1/3 of the tibia, common in persons who take long walks when they aren’t used to this activity
- spiral factures occur at the junction of the middle and inferior thirds resulting from severe tibial torsion during skiing
- compound fractures can occur from a direct blow to the tibia
*most common long bone to be fractured and suffer compound injury
TX:
- casting
- possible ORIF with hardware
- poor blood supply- even stable fractures may take up to 6 months to heal
- after healing is complete, early AROM and PROM are essential for ultimate functional recovery.
- progressive resistance exercises, mobs and closed chain stabilization exercises are needed to complete the rehab process
torticollis (wryneck)
occurs when the SCM continuously contracts (spasm and/or tightness). Results in the lateral bending of the head to the affected side with rotation of the chin to the opposite side
usually develops in utero and is considered congenital. May also be acquired by pressure on the spinal accessory nerve, inflammation of the glands of the neck or muscle spasm
TX:
- modalities to reduce spasm
- stretching
- biofeedback
- postural education and training
Total hip replacement precautions
avoid excessive hip flexion and adduction past neutral
avoid ER with an ant/lat approach and IR with a post/lat approach
avoid low chairs and crossing involved leg
WB orders and precautions determined by surgeon
-cemented,- exercise and WB usually can proceed more rapidly than if cements
sleep with abduction pillow and avoid vigorous stretching
need to increase extensor and abductor strength for efficient gait pattern
Rheumatoid conditions
ankylosing spondylitis
Gout
psoriatic arthritis
RA
ankylosing spondylitis
“Marie-Strumpell disease, Bechterew’s disease, rheumatoid spondylitis”
progressive inflammatory disorder of unknown etiology that initially affects the axial skeleton
initial onset (usually mid and LBP >3 months) before 40 y/o
1st symptoms include back pain, morning stiffness and sacroiilitis
results in kyphotic deformity of the cervical and thoracic spine and a decrease in lumbar lordosis
degeneration of peripheral and costovertebral joints may be observed in advanced stages
affects men 3x more than women
Gout
genetic disorder of purine metabolism, characterized by elevated serum uric acid (hyperuricemia). Uric acid changes into crystals and deposits into peripheral joints and other tissues (kidneys).
most frequently at knee and great toe
dx tests identify monosodium rate crystals in synovial fluid and/or CT samples
psoriatic arthritis
chronic, erosive inflammatory disorder of unknown etiology, associated with psoriasis
erosive degeneration usually occurs in joints of digits as well as axial skeleton
coxa vara
femoral neck shaft angled inward
coxa valga
femoral neck shaft angled outward
>125 deg
(normal 115-125)
may result from necrosis of femoral head occurring with septic arthritis
femoral antetorsion/anteversion
femoral neck angles anteriorly 10-15 deg from frontal plane to form anterior anteversion angle
excessive anteversion >25-30 deg
femoral neck rotated forward –> execessive IR “toe in”
femoral retroversion
femoral neck angles anteriorly 10-15 deg from frontal plane to form anterior ante version angle
excessive retroversion= excessive ER “toe out”
Internal tibial torsion:
distal aspect of tibia rotated or twisted medially as compared to its proximal end
Genu varum
knees are lateral in relation to the ankle
“bowlegged”
Genu valgum
knees come together or almost touch
“knock kneed”
Talipes Equinus
DF limitation, the toe is in a down position
Talipes Calcaneous
the heel down position
PF is limited
talipes equinovarus
ankle and foot are down and in “club foot”
Pes cavus
high arched or supinated foot
Pes planus
low arched foot, pronated “flat foot”
valgus heel
the rearfoot is deviated toward the outside resulting in a pronated heel
hallux valgus
the 1st MT has an abduction deformity “bunion”
osteogenesis imperfecta
inherited disorder transmitted by an autosomal dominant gene
characterized by abnormal collagen synthesis, leading to an imbalance between bone deposition and reabsorption
cortical and cancellous bones become very thin, leading to fractures and deformity of WB bones
tx: bone/joint protection, joint mechanics and CT functions, aerobic apacity/endurance- aquatics
osteochondritis dissecans
a separation of articular cartilage from underlying bone (osteochondral fracture)
usually involves medial femoral condyle near intercondylar notch or humeral capitulum; less observed at femoral head and talar dome.
surgical intervention if fracture is displaced
tx: joint/bone protection, flexibility exercises, aerobic endurance, strengthing
myofascial pain syndrome
“trigger point” = focal point of irritability within a muscle
=taut, palpable band within a muscle
Active: tender to palpation and have a characteristic referral pattern of pain when provoked
Latent: palpable taut bands that are not tender but can be converted into an active TP
onset: sudden overload, overstretching and/or repetitive/sustained muscle activities
tx: flexibility exercises, manual therapy (STM, joint mobs), spray and stretch, dry needling, hot, cold, TENS, desensitization with manual pressure, strengthening
tendonosis/tendonopathy
common tendon dysfunction whose cause and pathogenesis are poorly understood
-often referred to as tendonitis although no inflammatory response noted
histological characeristics: hypercellularity, hypervascularity, no indication of inflammatory infiltrates, and poor organization and loosening of collagen fibrils
meds: acetaminophen, NSAIDS, steroid injection
tx: flexibility, manual therapy (STM, joint mobs), endurance, strengthening with emphasis on eccentrics, aerobic capacity, thermal agents for pain, education
bursitis
inflammation of ursa secondary to overuse, trauma, gout or infection
S&S: pain with rest, limited A&P ROM due to pain but not in capsular pattern
meds: acetaminophen, NSAIDS, steroid injection
tx: flexibility, manual therapy, aerobic capacity, thermal agents, education
muscle strains
inflammatory response within a muscle following a traumatic event that caused micro tearing of the musculotendinous fibers
pain and tenderness
meds: acetometophen and NSAIDs
tx: flexibility, manual therapy, aerobics, thermal agents for pain, education
List of shoulder conditions
glenohumeral subluxation and dislocation
instability
labral tears
thoracic outlet syndrome
acromioclavicular and sternoclavicular joint disorders
subacromial/subdeltoid bursitis
rotator cuff tendonosis/tendonopathy
internal (posterior) impingement
bicipital tenonosis/tendonopathy
proximal humeral fractures
adhesive capsulitis
glenohumeral subluxation and dislocations
95% occur in anterior-inferior direction
-occurs when abducted UE is forcefully ER, causing tearing of inferior GH ligament, anterior capsule and occasionally gleaned labrum
posterior dislocations are rare- occur with multidirectional laxity of GH joint
-occurs with horizontal adduction and IR
complications include:
- compression fracture of posterior humeral head- Hill sachs lesion
- tearing of superior gleaned labrum from anterior to posterior- SLAP lesion
- avulsion of anterior inferior capsule and ligaments associated with glenoid rim- Bankart’s lesion
- bruising of axillary nerve
following surgical repair avoid apprehension position
shoulder instability
1- traumatic- common in young throwing athletes
2- atraumatic- congenitally loose CT
characterized by popping/clicking and repeated dislocation/sublux of GHJ
unstable injuries require surgery to reattach the labrum to glenoid (bankart)
tx:
- restore function without pain
- functional training- restore strength, endurance, coordination, flexibility
- joint mobs
- surgery- sling 3-4 weeks, after 6 weeks more specific training; full fitness 3-4 months
GH labral tears
classified as superior, inferior, SLAP or bankart
- SLAP- tear of the rim above the middle of the socket that may also involve the biceps tendon
- Bankart- tear of the rim below the middle, also involves the inferior GH ligament
S&S:
- shoulder pain can’t be localized to a specific point
- pain made worse by OH activities when arm is behind the back
- weakness
- instability
- pain on resisted flexion of biceps
- tenderness over front of shoulder
unstable injuries require surgery to reattach labrum to glenoid; bankart requires sx
dx: exam, MRI or arthroscopic surgery (gold standard)
tx:
- return of function without pain
- functional training- strength, endurance, coordination, flexibility
- underlying causes addressed- instability
- joint mobs
- following surgery: sling 3-4 weeks, after 6 weeks more sports specific training, full fitness 3-4 months
Thoracic outlet syndrome
compression of neuromuscular bundle (brachial plexus, subclavian A and V, vagus and phrenic nerves and the sympathetic trunk) in thoracic outlet between bony and soft tissue structures
common areas of compression:
- superior TO
- scalene triangle
- between clavicle and 1st rib
- between pec minor and thoracic wall
surgery may be performed to remove a cervical rib or release ant/middle scalene
special tests: adson’s, roos, wright, costoclavicular
PT:
- depends on cause of compression
- postural re-ed
- functional training
- correct biomechanical faults
- manipulations- 1st rib to diminsh pain and soft tissue guarding
acromioclavicular and sternocalvicular joint disorders
MOI: fall onto shoulder with UE adducted or collision with another individual during sport
3 grades
UE is positioned in neutral with use of sling in acute phase to avoid shoulder elevation
surgery is rare due to tendency of AC joint degeneration following repair
PT:
- return of function without pain
- functional training
- manual therapy to AC and SC joints and surrounding tissues : STM, joint mobs
rotator cuff tendonosis/tendonopathy
tendons of RC are susceptible to tendonitis, due to relatively poor blood supply near insertion of muscles
results from mechanical impingement of the distal attachment of the RC on the anterior accordion and/or coracoacromial ligament with repetitive OH activities
special tests: supraspinatus test, Neer’s impingement test
Impingement syndrome- shoulder
characterized by soft tissue inflammation of the shoulder from impingement against the accordion with repetitive OH AROM
special tests: Neer’s impingement, supraspinatus, drop arm
surgical repair: avoid shoulder elevation >90
PT:
- restore posture
- correct muscle imbalances and biomechanical faults
Internal (posterior) impingement -shoulder
characterized by an irritation between the RC and greater tuberosity or posterior glenoid and labrum
OH athletes
special tests: posterior internal impingement test
Bicipital tendonosis/tendonopathy
most commonly an inflammation of the long head of biceps
results from mechanical impingement of proximal tendon, between anterior accordion and bicipital groove of humerus
special test: speed’s test
proximal humeral fractures
Humeral neck fractures:
frequently occur with a fall onto outstretched UE among older osteoporotic women. Generally doesn’t require immobilization or surgical repair; fairly stable fracture
Greater tuberosity fractures
more common in middle aged and elder adults. usually related to a fall onto the shoulder, doesn’t require immobilization
PT:
- early PROM important in preventing capsular adhesions
- functional training without pain
