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Spring A 2025 > MSK 1 midterm > Flashcards

MSK 1 midterm Flashcards

1
Q

SC joint facts

A

saddle joint
no direct muscle activity

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2
Q

SC joint concave vs convex?

A

vertically: vex on cave
anterior to posterior: cave on vex

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3
Q

AC joint facts

A

dynamic stabilization: delt and trap
no direct muscle activity

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4
Q

ST joint facts

A

ac and sc movements control this joint
movements named in relation to glenoid fossa

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5
Q

GH joint facts

A

synovial joint
only 1/3 of humerus contacts glenoid

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6
Q

passive stabilizers of GH

A

anterior and posterior capsule and labrum
humeral head and glenoid fossa

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7
Q

angle of humeral retroversion

A

35-40 deg

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8
Q

when is EMG increased in biceps and triceps?

A

shoulder flexion and abduction

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9
Q

axioscapular muscles

A

trap*
serr anterior*
levator scapula
rhomboids*
pec minor

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10
Q

how can brachial plexus be injured?

A

stretch
compression

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11
Q

thoracodorsal nerve

A

C6-8
innervates the lat

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12
Q

long thoracic nerve

A

C5-7 raises arm to heaven
innervates serr ant
long, narrow, superficial

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13
Q

dorsal scapular nerve

A

C5
pierces middle scalene
innervates levator scapula and rhomboids

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14
Q

medial winging

A

retraction and elevation
long thoracic involvement
weakness of SA

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15
Q

lateral winging

A

elevation, upward rotation, and protraction
dorsal scap involvement
weakness of rhomboids

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16
Q

what % of special tests and stand alone and have high clinical utility?

A

4%

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17
Q

a line of logic

A

activities that limit participation
symptoms - when better and worse
mobility
neural impairments
most noticeable aspects

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18
Q

symptom modulation

A

disability: high

directional preference exercises
manipulation/mobilization
traction
nerve glides
modalities
active rest

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19
Q

movement control

A

disability: mod

sensorimotor exercises
stabilization exercises
flexibility exercises

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20
Q

functional optimization

A

disability: low

strength and conditioning
work or sport specific exercises
aerobic exercises
general fitness exercises

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21
Q

PT pyramid from

A

advanced performance
movement and control
mobility
tissue healing and symptom modulation
therapeutic alliance

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22
Q

motor learning summary

A

preparation
parameters
feedback
assessment

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23
Q

load

A

< 25% for endurance
> 40% for hypertrophy
> 85% for athletes

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24
Q

volume of exercies

A

optimal is 10 sets/muscle/week

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25
Q

intensity of effort

A

2 reps in reserve

CAN do 2 more

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26
Q

rest interval

A

2 minutes

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27
Q

repitition duration

A

6 seconds is the sweet spot
2-10 seconds range

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28
Q

tendon remodeling

A

treat the donut not the hole
need 48 hrs rest between tendon sessions
eccentric training optimal - 2 sets of 15

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29
Q

stretching

A

30 sec/attempt
total 90+ seconds

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30
Q

nerve glide

A

start at 1x10 everyday of the week
do not progress the day after

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31
Q

motor pattern retraining

A

2-5 minutes
stop when cannot self regulate or doing incorrectly

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32
Q

STAR shoulder

A

staged approach for rehabilitation classification for the shoulder

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33
Q

diagnoses of the shoulder

A

subacromial pain syndrome
adhesive capsulitis
glenohumeral instability
other

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34
Q

self reported measures for the shoudler

A

the DASH
shoulder pain & disability index (SPADI)

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35
Q

5 most common potential red flags

A

tumor
infection
fracture or dislocation
neurologic lesion
visceral pathology

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36
Q

what are the #1 places for visceral referred pain?

A

shoulder and low back

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37
Q

CPR for acute CAD

A

chest pain
SOA
upper abdominal pain or dizziness
men aged >30
women aged >40

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38
Q

screening for yellow flags

A

fear avoidance beliefs questionnaire (FABQ)
tampa scale of kinesiophobia (TSK)

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39
Q

patient profile (who)

A

age
MOI
PMH
occupation
recreation

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40
Q

patient’s current condition (what)

A

chief complaint
SINSS
labs or diagnostic

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41
Q

symptom pattern (who)

A

aggravating factors:
posture
movement

easing factors:
posture
movement
modalities
meds

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42
Q

location of symptoms (where)

A

impingement syndrome - <50% had pain below elbow
rotator cuff tear - >50% had pain below elbow
GHJ arthritis - >80% had pain below elbow

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43
Q

observation

A

starts in waiting room
posture
assess for atrophy

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44
Q

screening for referral: MSK causes

A

olecranon manubrium percussion
rotator cuff screening
bony apprehension test
clear the cervical spine

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45
Q

bony apprehension test

A

hold forearm with elbow at 90 deg angle
abduct and externally rotate arm to 45 deg

+ apprehension

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46
Q

clearing the cervical spine

A

positive ULTT (specifically median)
<60 deg cervical spine rotation on affected side
positive distraction test (relives)
positive spurlings (lateral compression, causes)

3 criteria has best specificity

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47
Q

apley’s scratch test

A

opposite shoulder - add and IR
sup angle of opp scapula - abd and ER
inferior angle of opp scapula - IR, add, ext

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48
Q

upper quarter Y balance test

A

measure arm length from C7 to longest digit
push up position
stationary arm is test arm
other reaches medially, superolaterally, inferolaterally
sum of 3 movements
normalized score = total / (3 x limb length)

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49
Q

SICK scapula

A

scapular malposition
inferior medial border prominence
coracoid pain
dyskinesis of scap movement

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50
Q

scapular dyskinesis test

A

perform up to 5 reps of shoulder flexion and abduction

+ winging or abnormal movement

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51
Q

scapular assistance test

A

elevate arm and rate pain
clinican manually assists into upward rotation and posterior tilting

+ decrease pain with assistance

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52
Q

scapular reposition test

A

finger anterior to AC
palm on spine of scap
apply pressure into posterior tilt and ER

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53
Q

what is subacromial pain syndrome

A

nontraumatic, unilateral pain
increased pain with movements above shoulder height
44-65% of shoulder pain originates from structures in subacromial space

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54
Q

neer’s sign

A

stabilize scapula
full flexion and IR until pain or end ROM

+ pain reproduced along ant or lat shoulder

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55
Q

hawkins-kennedy test

A

clinician stabilizes pt’s arm in 90 deg flexion
support elbow
full internal rotation

+ if pain is reproduced

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56
Q

painful arc

A

face client to monitor face for pain
active abduction

+ pain in 60-120 deg but none outside of this range

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57
Q

test cluster for subacromial impingement/pain syndrome

A

hawkins-kennedy
painful arc
infraspinatus test

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58
Q

drop arm test

A

affected side held in 90 deg abd
releases support of arm
pt slowly lowers to neutral

+ no control

muscle targeted: supra

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59
Q

full can test

A

arms in 90 deg in scapular plane
thumbs up position
apply inferior force

+ weakness or pain in affected arm

muscle targeted: supra

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60
Q

empty can test

A

arms in 90 deg in scapular plane
thumbs down position
apply inferior force

+ weakness or pain in affected arm compared to full can

muscle targeted: supra

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61
Q

external rotation lag

A

affected side brought to 20 deg abd and full ER
support elbow and wrist
have pt maintain external rotation

+ unable to maintain ER

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62
Q

infraspinatus or external rotation resistance test

A

elbows flexed to 90 deg
clients resists into ER

+ unable to maintain resistance due to weakness or pain

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63
Q

lift off test

A

affected side behind back
ask pt to lift hand off back

+ cannot lift hand off back

muscle targeted: subscap

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64
Q

belly press test

A

elbow flexed to 90 deg with hand on belly
press into stomach

+ elbow moves posteriorly

muscle targeted: subscap

can be used to rule out subscap tear if cannot perform lift off

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65
Q

speed’s test

A

client resists shoulder flexion through 60 deg of motion

+ shoulder pain reproduced

muscle targeted: biceps

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66
Q

yergason’s test

A

elbow flexed to 90 deg, fully pronated
palpate biceps tendon
client resists supination and ER

+ pain over origin of biceps

muscle targeted: biceps

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67
Q

relocation test

A

supine
anterior apprehension test
posterior force over humeral head

+ relief when relocation force is applied

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68
Q

surprise test or anterior release test

A

supine
anterior apprehension
apply posterior force
remove the force

+ shoulder pain after posterior force is removed

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69
Q

diagnostic cluster for anterior instability

A

anterior apprehension
relocation

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70
Q

posterior apprehension test

A

supine
shoulder flexed to 90 deg
add compressive force
add hor add and IR

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71
Q

Jerk test

A

sitting
stabilize scapula and arm in 90 deg flexion and full IR
add compression and slowly move arm into hor add and maintain IR

+ shoulder pain or clicking reproduced

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72
Q

hyperabduction

A

hold scapula down
move clients arm into abduction with elbow on 90 deg of flexion

+ apprehension or abducted past 105 deg

laxity: greater than 105 deg abd
instability: apprehension with > 105 deg abd

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73
Q

biceps load I

A

supine with arm in 90 deg abd, 90 deg flex and full supination
client resist elbow flexion

+ pain or apprehension during resistance

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74
Q

biceps load II

A

120 abd, 90 flexion, full supination
resists elbow flexion

+ pain during resistance

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75
Q

passive compression test

A

side lying with elbow flexed to 90 deg
clinician supports at elbow and scapula
compresses humerus, passively ER at 30 deg abd
extend shoulder while maintaining compression

+ pain or catching of the shoulder

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76
Q

o’brien’s test for labral tear or active compression test

A

sitting with shoulder flexed to 90 deg and horizontally adducted to 10-15 deg
fully IR the shoulder and pronate the elbow
resists flexion
repeat with neutral forearm

+ symptom reproduction or clicking in initial position and absent in second

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77
Q

test cluster for labral pathology

A

biceps load I
biceps load II
speed’s test
passive compression test
active compression test (o’brien’s)

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78
Q

ludington’s test

A

for rupture of biceps long head

interlock fingers on head
press down

+ if unable to feel contraction on affected side

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79
Q

popeye sign

A

ball of muscle on upper arm

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80
Q

cross body adduction test
(acromioclavicular crossover test)

A

stabilize scap
passively horizontally adduct arm

+ reproduction of pain at AC

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81
Q

resisted extension test

A

seated with shoulder in 90 flex and IR
elbow in 90 flex
pt horizontally abducts arm against isotonic resistance

+ pain in AC

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82
Q

cluster for AC joint pathology

A

cross body adduction
resisted extension test
active compression test

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83
Q

rhythmic stabilization

A

indication: weakness, poor co-contraction
goal: train to respond quickly

alternating isometrics

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84
Q

three types of rhythmic stabilization

A

neutral
90 deg flexion
closed chain - quadruped

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85
Q

what part of motor control can a therapist impact?

A

action and perception

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86
Q

define motor learning

A

set of processes associated with practice that lead to changes in skilled movement

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87
Q

what are the three stages in motor learning according to fitts and posner?

A

cognitive - step by step
associative - refinement
autonomous - mastery, takes no thought

where learner focuses attention

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88
Q

what are the three stages in motor learning according to bernstein?

A

establishing - freezing degrees of freedom
refining - reorganizing
exploiting - mechanics and inertia

focus of degrees of freedom

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89
Q

closed loop theory

A

trial and error
perceived correctness
same exact skill

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90
Q

schema theory

A

outcome
variety of practice
emphasize result

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91
Q

cognitive theory

A

best with low cognitive demand
need cognitive demand as they progress

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92
Q

hierarchical

A

revert to processing step by step when under stress

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93
Q

optimal theory

A

motivation helps learn quicker

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94
Q

verbal preparation

A

over explanation hinders learning
focus on what to do
auditory cues

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95
Q

visual prep

A

watching a new movement aids motor learning
observing mistakes and correction helps most

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96
Q

mental prep

A

mental practice aids learning, but physical practice is usually preferable

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97
Q

focus prep

A

an external focus is preferable to an internal focus
external = intended body movement
distance of focus should correspond to proficiency

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98
Q

motivation prep

A

learn better with high self-efficacy
give choices
link to pt goals
positive feedback

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99
Q

distribution

A

rest breaks improve performance and learning

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100
Q

variability

A

high open-task performance
high learning
good for children

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101
Q

contextual interference

A

improves learning and transfer

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102
Q

knowledge of performance

A

dependent on focus
guidance boosts performance

best suited for:
new learners
slow movements
complex tasks
tasks that may injure or fear

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103
Q

knowledge of results

A

preferable
helps to a point
fade out for optimal learning
deliver after a slight delay

2-15 trials

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104
Q

optimal feedback

A

autonomy
enhanced expectations - positive best
feedback allows redirection

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105
Q

effleurage

A

broad strokes
hand in shape of the limb
warm up the tissue

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106
Q

petrissage

A

kneading - increases circulation, mobilizes
rolling - perpendicular to muscle fibers

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107
Q

cross friction massage

A

for tendons
prevent adhesions
must be on target tissue
perpendicular

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108
Q

passive stretching

A

when hypomobility limits ROM
lengthens affected tissue
hold 15-30 seconds, release, repeat
2-4 reps

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109
Q

pec minor passive stretch with towel roll

A

towel between scapulas
thenar eminence below clavicle and press into table

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110
Q

hold/relax

A

when ROM is restricted
primarily for contractile tissue
increase ROM using autogenic inhibition
submaximal isometric contraction for 5-10 seconds
passively move through new ROM
repeat 4-6 times

stabilization should follow

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111
Q

GH joint mobs

A

when limited ROM and pain
loose packed - grade 1-2
end ROM - grade 3-4
~45 seconds or until change
use your body to guide force

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112
Q

GH joint distraction

A

hand on AC to stabilize, pull down just proximal to elbow
hand on AC, pull down with hand in a C just under axilla

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113
Q

GH posterior glides

A

stabilize elbow, push down over GH
stabilize AC, push down through elbow

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114
Q

GH inferior glides

A

come from above
stabilize elbow, push towards axilla

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115
Q

passive ROM

A

PROM restrictions
increase mobility
move through available range
DO NOT hold

flexion, abd, IR/ER

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116
Q

mobilization with movement

A

brian muligan
glide maintained as pt moves

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117
Q

MWM shoulder ER

A

posterior glide of GH
use cane to push shoulder into ER

118
Q

MWM shoulder IR

A

lateral and inferior glide of GH
use towel to pull shoulder into IR

119
Q

ST mobs

A

side lying, all planes
upward rotation with active flexion

120
Q

considerations for effective evaluations

A

referral when needed
diagnosis
prognosis

121
Q

what is subacromial pain syndrome?
(4 examples)

A

44-56% of all condition that cause shoulder pain

subacromial impingement
RC related shoulder pain
RC tendinopathy
RC disease

122
Q

subacromial pain syndrome: MOI

A

relative over use

123
Q

subacromial pain syndrome: impairments

A

anterior/lateral shoulder pain
painful arc
limited GH mobility
kyphosis
decreases pec minor length
scapular weakness

124
Q

subacromial pain syndrome: pain pattern

A

deltoid region
overhead

125
Q

subacromial pain syndrome: risk factors

A

excessive or recent increase in overhead

126
Q

subacromial pain syndrome: obseravtions

A

posture
scapular dyskinesis

127
Q

subacromial pain syndrome: examination

A

good ROM; painful arc
decreased scapular uprot and post tilting
weakness in abd, ER, IR, flexion
3/5 positives in cluster
no instability

128
Q

subacromial pain syndrome: manual therapy

A

high irritability:
grade 1-2 mobs
spine manipulation
soft tissue mobs to pec
light rhythmic stabilization in neutral

low to moderate irritability:
grade 3-4 mobs, maybe at end ROM
ST, AC, SC mobs
cross friction and other STM
hold/relax for mobility
RS in varying degrees of ROM

129
Q

subacromial pain syndrome: therapeutic exercises

A

high irri:
isos in neutral
scapular setting
table slides

mode irri:
resistive
pec stretching
scap retraction
thoracic mobs into ext and rotation

low irri:
increase load and ROM of above
pec stretching with arms in abd/ER
prone scapular strengthening

130
Q

primary impingement

A

structural problem
narrowing of subAC space

osteophytes
hooked acr
bursitis
tendinopathy of RC and biceps

131
Q

secondary impingement

A

functional problem

shoulder muscle imbalance
laxity/instability
scap dyskinesis
postural dysfunctions

132
Q

full thickness rotator cuff tear: MOI

A

traumatic will require imaging
atraumatic is likely degenerative

133
Q

full thickness rotator cuff tear: impairments

A

pain with mvmt
tender greater tub or acr
sling position
atrophy, lag signs
sever ROM restriction

134
Q

full thickness rotator cuff tear: tear length classification

A

small: <1 cm
medium: 1-3 cm
large: 3-5 cm
massive: 5+ cm

135
Q

full thickness rotator cuff tear: pain pattern

A

ant and lat shoulder, down arm
worse at night

136
Q

full thickness rotator cuff tear: risk factors

A

age
falls in younger and older

137
Q

full thickness rotator cuff tear: observation

A

arm in sling position

138
Q

full thickness rotator cuff tear: examination

A

smaller tears may be weak and painful with resistance
massive have profound weakness and lag
shrug with elevation

139
Q

full thickness rotator cuff tear: CPR

A

age > 65
pain at night
weakness in ER

140
Q

full thickness rotator cuff tear: manual therapy

A

high irri:
preserve ROM
grade 1-2 mobs
RS in neutral

low to mod irri:
grade 3-4 capsular restrictions
RS in varying angles
hold/relax for ST restrictions

141
Q

full thickness rotator cuff tear: therapeutic exercise

A

small to medium - nonsurgical:
strengthening in neutral to elevation
balance ER/IR force couples
stretching posterior capsule
scapular muscle strengthening

large and massive - nonsurgical:
AAROM to RROM
strengthen deltoid and intact RCs to gain functional elevation

142
Q

long head of biceps tendinopathy or tendon rupture: MOI

A

continuous/repetitive shoulder motions
excessive abd with ER
for rupture: heavy lift, FOOSH

143
Q

long head of biceps tendinopathy or tendon rupture: impairments

A

pain in superior and anterior shoulder and with overhead
pain with resisted flexion but not abd
tender bicipital groove, possible popping
possible signs of instability with labral involvement

144
Q

what are examples of long head of biceps tendinopathy or tendon rupture?

A

bicipital tendonitis
bicipital tendinosis
biceps tendon rupture

145
Q

long head of biceps tendinopathy or tendon rupture: pain pattern

A

deep ache of sup and ant shoulder, possible arm pain
pain with lift, push, pull

146
Q

long head of biceps tendinoapthy or tendon rupture: risk factors

A

overhead

rupture:
heavy lift
FOOSH
age
corticosteriod use

147
Q

long head of biceps tendinoapthy or tendon rupture: observations

A

poor scap mobility
kyphosis

148
Q

long head of biceps tendinopathy or tendon rupture: examination

A

pain on palpations of bicipital groove
pain with resisted flexion not abd
+ speed’s, yergason’s ludington’s for rupture

149
Q

long head of biceps tendinoapthy or tendon rupture: manual therapy

A

joint mobs:
GH - post and inf
thoracic spine
ST if hypomobile

STM/MFR:
cross friction to prox biceps tendon
STM to pecs/traps
RS

150
Q

long head of biceps tendinoapthy or tendon rupture: therapeutic exercise

A

scap setting iso holds to resistance
RC isos if irri high
banded and isotonic RC if low irri
thoracic ext and rotation

follow pot-op protocol

151
Q

adhesive capsulitis: MOI

A

synovial inflam with adhesions

Primary: insidious onset
secondary: trauma, immobilization, CRPS

152
Q

what are the 4 stages of adhesive capsulitis?

A

pre freezing
freezing
frozen
thawing

153
Q

adhesive capsulitis: impairments

A

progressive loss of active and passive movements

154
Q

adhesive capsulitis: systemic considerations

A

DM, thyroid disorder, autoimmune
septic arthritis, malignancy, PMR

155
Q

adhesive capsulitis: pain pattern

A

acute: localized in arm/down the arm, night pain
chronic: localized, not awakened at night

156
Q

adhesive capsulitis: risk factors

A

females aged 45-60
history of AC in contralateral limb

157
Q

adhesive capsulitis: observation

A

shrug with elevation
arm in add/IR

158
Q

adhesive capsulitis: examination

A

restricted ROM in capsular pattern

159
Q

adhesive capsulitis: manual therapy

A

scap mobs
GH mobs
passive stretching
ST mobs, hold/relax

160
Q

adhesive capsulitis: therapeutic exercise

A

acute:
exercises to restore ROM (wand, pulleys)
isos
pendulums

chronic: self-stretching the capsule
wall climbing
PNF for functional ROM

161
Q

what % of GH dislocation are anterior?

A

90%

162
Q

glenohumeral instability: MOI

A

traumatic
atraumatic: repetitive OH
with or without RC tear, fracture, brachial plexus injury

163
Q

glenohumeral instability: impairments

A

anterior instability
GIRD
posterior shoulder tightness
weakness esp IR

164
Q

waht is glenohumeral instability?

A

shoulder pain and motor coordination deficits

165
Q

glenohumeral instability: pain pattern

A

variable

166
Q

glenohumeral instability: risk factors

A

bimodal age: M15-29, F70+
traumatic 7x more likely in males

167
Q

glenohumeral instability: observation

A

altered muscle recruitment patterns

168
Q

glenohumeral instability: examination

A

posterior shoulder tightness, check MRS
apprehension with ROM
IR strength deficits in anterior instability
+ apprehension, relocation and hyperabd
fear avoidance
+ beighton’s
may also have + impingement tests

169
Q

glenohumeral instability: manual therapy

A

differs based in classification of instability
GH mobs as needed, avoid hypermobile areas
ST mobs
thoracic mobs
RS for proprioception

170
Q

glenohumeral instability: therapeutic exercise

A

early:
RC and scap muscle activation
adress proprioception

middle:
resistive exercises <90
controlled AROM in safe ROM

late:
strengthening provocative positions

SINEX for traumatic
waston for atraumatic

171
Q

labral lesion: MOI

A

repetitive OH
trauma

172
Q

labral lesion: impairments

A

pain - worse with heavy, pushing, OH
popping in rotation
weakness
posterior shoulder tightness

173
Q

types of labral lesions

A

SLAP tear
bankart lesion

174
Q

labral lesion: pain pattern

A

anterior and superior arm pain
dead arm

175
Q

labral lesion: risk factors

A

age <40
FOOSH, OH

176
Q

labral lesion: observation

A

popping, cluncking with mvmt

177
Q

labral lesion: examination

A

scap winging with elevation
decreased upward rotation
anterior glide of humeral head
+ o’brien’s, biceps load tests
possible instablity

178
Q

labral lesion: manual therapy

A

GH 1-2 mob for pain
GH 3-4 mob for ROM
STM or post RC, lats, pecs
RS

179
Q

labral lesion: therapeutic exercise

A

stabilization for force couples
strengthening starting in midrange and progressing to end range. IR/ER ratios
thoracic ext and rotation mobility
strengthening tight tissues - lats, RC, pecs

in overhead athlete:
max contribution of core and LE

180
Q

proximal humeral head fracture: MOI

A

FOOSH
direct blow to shoulder

181
Q

what is the third most common type to fracture in adults?

A

proximal humeral head fracture

182
Q

proximal humeral head fracture: impairments

A

pain: severe and sharp, radiates down arm
very limited ROM

183
Q

proximal humeral head fracture: pain pattern

A

severe, sharp shoulder pain
may radiate down arm

184
Q

proximal humeral head fracture: risk factors

A

bimodal age
falls, trauma
higher in females 2:1

185
Q

proximal humeral head fracture: observation

A

swelling, bruising down arm and across chest
may be immobilized

186
Q

proximal humeral head fracture: examination

A

very limited ROM
stiffness after immobilziation

187
Q

proximal humeral head fracture: manual therapy

A

may depend on type and grade
passive ROM as tolerated
ER may be restricted by physician

188
Q

proximal humeral head fracture: therapeutic exercise

A

AROM gripping, wrist, forearm, elbow, scap pro/ret
PROM to AAROM, AROM once healing occurs
submaximal isos
theraband

189
Q

acromioclavicular injury: MOI

A

force to top of shoulder
FOOSH where humeral head moves superior to acr
primary or secondary OA

190
Q

acromioclavicular injury: impairments

A

scapular depression in lig tear
palpable step off clavicle
pain in sup shoulder; insidious OA
ROM limitations secondary to pain

191
Q

3 types of acromioclavicular injury

A

AC joint sprain
AC joint separation
AC joint OA/arthropathy

192
Q

acromioclavicular injury: pain pattern

A

top of shoulder
possible ant shoulder

193
Q

acromioclavicular injury: risk factors

A

traumatic: age <35 male, contact sports
OA: heavy manual work, OH trauma

194
Q

acromioclavicular injury: observation

A

trau: post or sup migration of clavicle
OA: small bump at ACJ

195
Q

acromioclavicular injury: examination

A

trau: palpation/paxinos sign
+ cross body add, active compression, resisted extension

196
Q

acromioclavicular injury: manual therapy

A

AC mobs if hypomobile
ST mob if hypo
PROM, GH mobs to increase ROM
modalities as needed for pain

197
Q

acromioclavicular injury: therapeutic exercise

A

P to AROM as tolerated
avoid hor add, IR, and end ROM initially
RC and scap strengthening
delt and trap strengthening

198
Q

posterior internal impingement: MOI

A

repetitive OH
younger, active

199
Q

what is posterior internal impingement?

A

impingement of posterior RC between glenoid and humeral head

200
Q

posterior internal impingement: impairments

A

pain in post shoulder
joint hypermobility
post capsule and soft tissue restriction
poor scapular retraction and posterior tilt
GIRD

201
Q

posterior internal impingement: pain pattern

A

post or lateral shoulder pain

202
Q

posterior internal impingement: risk factors

A

generalized hypermobility
repetitive OH
GIRD

203
Q

posterior internal impingement: observation

A

prominent medial scap

204
Q

posterior internal impingement: examination

A

RC weakness, tender under posterior acr
+ apprehension and relocation
posterior pain
poor scapular movements
posterior capsule and RC stiffness
+ scapular relocation test

205
Q

posterior internal impingement: manual therapy

A

mobs:
posterior GH
ST retraction and post tilt

ST:
posterior RC
pec minor

RS for stability
hold/relax for mobility

206
Q

posterior internal impingement: therapeutic exercise

A

stretching of tight: post capsule, RC, pec minor
strengthening of scap retractors and RC
re ed of proper scap movements

207
Q

glenohumeral osteoarthritis: MOI

A

degen changes over time
heavy labor
prior trauma

208
Q

what % of pts with shoulder pain have symptomatic OA?

A

5%

209
Q

glenohumeral osteoarthritis: impairments

A

progressive stiffness and loss of ROM
crepitis in ROM
pain worse at night
pain with joint compression

210
Q

glenohumeral osteoarthritis should be suspected in which pts?

A

> 60 with adhesive capsulitis

211
Q

glenohumeral osteoarthritis: pain pattern

A

worse at night and with activity

212
Q

glenohumeral osteoarthritis: risk factors

A

age >60 with AC
females
previous shoulder injury
heavy manual labor

213
Q

glenohumeral osteoarthritis: observation

A

shrug sign with elevation

214
Q

glenohumeral osteoarthritis: examination

A

crepitus with ROM
weakness

215
Q

glenohumeral osteoarthritis: manual therapy

A

gentle ROM
1-2 mobs for pain
3-4 mobs for mobility
RS for stability
hold/relax for mobility

216
Q

glenohumeral osteoarthritis: therapeutic exercises

A

joint protection for OA!!!!

mild to mod:
gentle stretching and self mob
rc and scap strengthening
thoracic ext/rot

possible medical management for symptoms

217
Q

posterior SC mob with movement

A

horizontal adduction
airplane position then to clapping position

218
Q

inferior SC mob with movement

A

shoulder flexion

219
Q

AC joint mobs

A

inferior - push on clavicle
posterior - push on acromion

220
Q

thoracic spine mob

A

push down into table
can be central or unilateral

221
Q

define nerve sliders

A

lengthening one joint while tensioning at another
in acute

222
Q

define nerve tensioners

A

lengthening across all moving joints
in chronic

223
Q

median nerve slider and tensioner

A

slider:
flex elbow, extend wrist
extend elbow, flex wrist

tensioner:
flex and extend elbow with wrist extension

224
Q

ulnar nerve slider and tensioner

A

slider:
flex elbow, flex wrist
extend elbow, exend wrist

tensioner:
flex and extend elbow with wrist extension

225
Q

radial nerve slider and tensioner

A

slider:
depress scap with hip, abd arm and elevate shoulder

tensioner:
maintain scap depr while abd the shoulder

226
Q

3 self mobilization glides

A

caudal:
careful if hypermobile or nervy
hold onto sitting surface and lean opposite

anterior:
least often
propped up on elbows on back

posterior:
push up position with stomach on table

227
Q

AAROM into elevation (3 examples)

A

supine AA elevation:
on back
use uninjured arm to move injured arm

forward bow:
hands on table
squat through shoulder ROM

wall slides:
forearm against wall and go through ROM

228
Q

3 codman’s pendulums

A

uninjured hand on table, use body’s momentum to move injured arm

CW/CCW circles
forward/backward
side to side

229
Q

wand AAROM

A

can be done sitting for supine

flexion
abd - best in sitting
external rotation

230
Q

shoulder internal rotation AAROM

A

wand BBIR stretch:
hands behind back and pull wand up
make sure not to flex thoracic spine

towel BBIR stretch:
injured arm behind back, uninjured in front and pulls towel done

231
Q

pulleys

A

high irri:
flexion
scaption
abduction

low irri:
BBIR

232
Q

posterior capsule stretching

A

sleeper stretch:
lay on injured arm
hand on wrist
make sure not to rotate

horizontal adduction stretch:
supine
pull injured arm across body at elbow

233
Q

scapular setting

A

standing or sitting
draw scapula into retraction and depression
“tuck into back pocket”
make sure to do it unilateral

234
Q

shoulder isometrics

A

when pt is high irri but cleared for strengthening
arm at 90/90 for each
use a towel
in doorway

extension
ER
flexion
IR
adduction
abduction

235
Q

basic theraband shoulder exercises

A

grip strength helps activate muscles
doorway

ER - watch protraction, towel
IR - watch thoracic rotation, towel
abduction
extension
flexion
adduction

236
Q

supine or standing flexion and diagonals

A

flexion:
straight up above head

resisted diagonals with D2 pattern:
watch shoulder hiking
take sword out of pocket
thumb to hip, thumb points behind body

237
Q

dumbbell rotator cuff/shoulder strengthening

A

full cal abduction:
in scapular or frontal plane

side lying ER:
something you add early and take out late
skeleton key for practical
many scapula compensations
elbow to side, towel for comfort

238
Q

serratus strengthening

A

supine punch:
supine
arm straight and protract to punch
can go from 90/90

standing band punch:
identical to supine but standing

239
Q

scapular wall slides

A

stay in pain free ROM
press through hand rather than elevating through shoulder girdle to decres ulnar tension
push elbow into wall
can add band to wrists

240
Q

standing theraband extensions/rows (low level)

A

extensions:
band at waist level
keep arms straight through extension

low rows:
for high irri
band at waist level
depress and retract scapula
straight arms to 90/90
pinch scaps together

241
Q

standing theraband high row and horizontal abduction (higher level)

A

high row:
band comes from above head
straight arms to flexed elbows
pinch scaps

resisted horizontal abduction:
band at waist level
arms straight in front to straight out at sides
“give a hug and come out of it”

242
Q

prone middle trap strengthening progression

A

retraction without arm movement:
no shoulders at ears
pinch scaps
arms at 90/90

retraction with forearm lift:
no shoulders at ears
pinch scaps
arms at 90/90

retraction with horizontal abduction (T’s):
arms straight out to the side

retraction with resisted horizontal abd:
rare
band under table

torando drill position can be good for a young athlete

243
Q

prone lower trap strengthening progression

A

retraction/depression with or w/o forearm lift:
arms on table above head

retraction/depression with modified arm lift:
hands on back of head
watch for trunk ext

retraction/depression with arm lift (Y’s):
core can wear out before shoulder
can do unilateral

retraction/depression with arm lift (Y’s) with resistance:
rare to add resistance

244
Q

muscle length: pec major/minor

A

pec major stretch:
put elbow on corner of wall and push forward

pec minor stretch:
arms behind back and push away form back

arm by side pec stretch:
stretched both muscles
push GH into corner of wall

245
Q

thoracic mobility: extension

A

sitting:
in chair with hands behind head or neck

supine:
foam roller right below scapulas

can hold or do small oscillations

246
Q

thoracic mobility: rotation

A

side lying
both legs bent
arms out in front (alligator arms)
bring top arm to other side of body (opening a book)
head and eyes will follow moving arm

progression: straighten bottom leg and keep top leg bent

247
Q

what are examples of anti-inflammatories?

A

OTC: ibuprofen, naproxen
prescription only: meloxicam, celebrex, oral corticosteroids

248
Q

who benefits from anti-inflammatories?

A

pts with pain/inflammation

249
Q

what are implications for PT treatment with anti-inflammatories?

A

screening for systemic manifestations

250
Q

what are examples of analgesics?

A

OTC: acetaminophen
prescription: opioids

they act on the CNS

251
Q

who benefits from analgesics?

A

pt with pain that did not respond to NSAIDs

252
Q

what are implications for PT treatment with analgesics?

A

screening for systemic manifestations

253
Q

what are corticosteroid injections?

A

local administration of steroid into joint
greater pain relief than oral
can weaken bone or tendon

254
Q

who benefits form corticosteroid injections?

A

pts with slow progress due to pain
PT + injection is better than either treatment alone

255
Q

what are implications for PT treatment with corticosteroid injections?

A

avoid activity for 48 hrs then gradually return to activity
numbing agents may damped pain signals which results in overdoing

256
Q

what is viscsupplementation?

A

sodium hyaluronate - glucosaminoglycan found in CT
series of 3-5 injections
brand names - supartz, hyalgan

257
Q

who benefits from viscosupplementation?

A

pt with RC tear, adhesive capsulitis and OA

258
Q

what are implications for PT treatment with viscosupplementation?

A

avoid strenuous activity for 48 hours
routine activity is ok
not as beneficial as cortisone or prolo

259
Q

what is prolotherapy?

A

hypertonic dextrose injections create acute inflammation, leads to improved healing

260
Q

what are some frequent injection sites of prolo in the shoulder?

A

corocoid process
subscapularis tendon
greater tuberosity

261
Q

who benefits from prolotherapy?

A

after failed RC repair or with RC lesions
less evidence for AC and OA

262
Q

what are implications for PT treatment with prolotherapy?

A

follow dr recommendation
possible activity restriction
has a relatively low risk

263
Q

what is subacromial decompression?

A

arthroscopic removal of bony overgrowth of acromion
with or without bursectomy

264
Q

who benefits from subacromial decompression?

A

pts not successful with conservative treatment

265
Q

what are implications for PT treatment with subacromial decompression?

A

no structures require specific protection
based on tissue irritability
progress as quickly as pt tolerated
full return to function between 6 weeks to 3 months

266
Q

what is a rotator cuff repair?

A

torn tendon reattached
open vs arthroscopic

open has higher risk, longer recovery, is for a more complicated case

267
Q

who benefits from from rotator cuff repair?

A

younger pts with traumatic MOI or pts participating in high demand activities

268
Q

what are implications for PT treatment with rotator cuff repair?

A

protocols

269
Q

describe the surgical management of SLAP lesions

A

debridement
biceps tenotomy/tenodesis
SLAP repair
Bankart repair - 3:00-6:00
combined

270
Q

who benefits from the surgical management of SLAP lesions?

A

pts who do not respond to conservative management

271
Q

what are implications for PT treatment with surgical management of SLAP lesions?

A

protocols!

272
Q

general protocol considerations for debridement

A

fastest recovery
ADLs as tolerated
fix biomechanical issues

273
Q

general protocol considerations for biceps tenotomy/tenodesis

A

no resisted biceps work for 6 weeks

274
Q

general protocol considerations for SLAP repair

A

early - immobilized, no shoulder AAROM/AROM, elbow AROM, WB on UE, or reaching behind back (IR)

intermediate - no resisted elbow flexion, lifting > 10 lbs

275
Q

general protocol considerations for bankart repair

A

early - no shoulder AROM, WB on UE, lifting

intermediate - no lifting > 10 lbs
after 12 weeks, no limit
after 6 months, return to sport

276
Q

what is a capsular shift/plication?

A

surgical technique to tighten the capsule
folding
can be arthroscopic or open

277
Q

what is thermal capsulorrhaphy?

A

surgical technique to tighten the capsule
thermal or radiofrequency laser
heating to cause capsule to shrink in unilateral instability

278
Q

who benefits from capsular shift/plication and thermal capsulorrhaphy?

A

pts with GH instability

279
Q

what are implications for PT treatment with capsular shift/plication and thermal capsulorrhaphy?

A

ROM restriction initially post-op to reduce re-stretching of capsule

280
Q

what is manipulation under anesthesia?

A

surgical procedure in which shoulder is moved through full ROM to tear adhesions
relatively quick procedure

281
Q

what are the risks of manipulation under anesthesia?

A

fracture
dislocation
brachial plexus injury

282
Q

who benefits from manipulation under anesthesia?

A

pt with AC who does not succeed with conservative treatment

283
Q

what are implications for PT treatment with manipulation under anesthesia?

A

aggressive ROM post-op
daily for 1st week

284
Q

what is an anatomical total shoulder arthroplasty?

A

implants preserve convex on concave relationship of shoulder joint

285
Q

who benefits from anatomical total shoulder arthroplasty?

A

pt with primary OA and intact RC

286
Q

what are implications for PT treatment with anatomical total shoulder arthroplasty?

A

immobilization for 2-8 weeks
protect the subscapularis

287
Q

what is a reverse total shoulder arthroplasty?

A

implants change the convex on concave relationship of the shoulder to concave on convex

288
Q

who benefits from a reverse total shoulder arthroplasty?

A

pt with OA without intact RC, fractures, tumors

289
Q

what are implications for PT treatment with reverse total shoulder arthroplasty?

A

abduction sling initially, followed by regular sling for 4 weeks
now rely on delt when moving shoulder
dont have to protect RC

290
Q

anatomic vs reverse total shoulder: which has less restrictions?

A

reverse

291
Q

anatomic vs reverse total shoulder: biggest difference in rehab?

A

reverse has resistance earlier

Spring A 2025 (6 decks)

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