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MSK > MSK exam 3 > Flashcards

MSK exam 3 Flashcards

1
Q

Causes of shoulder impingement

A
  • instability of the glenohumeral joint
    - dyskinesia (scapula not moving in correct rhythm with humeral head)
    - poor posture
    - arthritis
    - anatomical predisposition
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2
Q

External Impingement:

A

Rotator cuff and/or bursae are getting compressed or pinched on the superior surface by the acromion.

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3
Q

Internal Impingement

A

The rotator cuff, labrum, or capsule is getting compressed or pinched on the under surface by the humeral head.

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4
Q

Forward Head and Rounded Shoulders

A

o Inhibited neck flexors
o Tight Upper Trapezius and levator scapula
o Tight pectoralis
o Inhibited Rhomboids and Serratus Anterior

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5
Q

What is Codman’s Hike?

A
  • Individuals with shoulder pain or weakness tend to try to lift the shoulder using the shoulder girdle and trunk muscles when reaching overhead.
  • Want to prevent this movement habit from developing.
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6
Q

What is a shoulder dislocation

A
  • Shoulder comes out of the glenoid fossa
  • May spontaneously go back in place or require reduction
  • Risk for recurrent dislocation secondary to stretching out of labrum and capsule or possible tear to the labrum
  • Positive apprehension sign (pain with abduction and external rotation at 90 degrees)
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7
Q

Treatment of a shoulder dislocation

A
  • Sling first 3 to 4 weeks for 1st time dislocations
  • Activity Modification: Diamond shaped safety zone
  • Avoid abduction and external rotation out to side
  • Avoid reaching behind the body or extreme overhead positions
  • Older people at risk for frozen shoulder following dislocation
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8
Q

Strengthening after a shoulder dislocation

A
  • Strengthen subscapularis with internal rotation exercises using theraband. Internal rotation, D1PNF and tripod rocking once paid subsides
  • Strengthen biceps and shoulder flexors below 90
  • Stabilization exercises: Wall ball, reverse Codman’s
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9
Q

What is a SLAP lesion?

A
  • Superior Labrum from Anterior to Posterior tears that occur in the superior labrum at the top of the glenohumeral joint
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10
Q

Understand Proximal Humeral Fractures

A
  • Common fracture, especially in the elderly
  • Greatest ROM increase is between 3-8 weeks
  • Bony healing is typically from 6-8 weeks
  • Return to normal function is between 3-4 mths
  • The majority of humeral head and neck fractures are treated non-operatively
  • Most can be passively moved by the 3rd wk
  • Mobilize as early as possible
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11
Q

Treatment Progression is from:

A

AAROM/PROM slides to AROM and finally resisted
• First 2-3 weeks a shoulder immobilizer
• ROM of elbow wrist and hand
• Codmans Pendulums– early
• Scapular ROM
• 2-3 weeks d/c immobilizer
• Radiographic healing is typically present around 6 weeks

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12
Q

Phase 1 (2-6 weeks)

A
  • Codman’s pendulums
  • Pulley exercises
  • ER with dowel
  • Dowel standing flexion (PROM)
  • Seated PROM flexion using a table or mat
  • Isometrics gentle at week 4
  • Gentle PROM as tolerated by therapist
  • Scapular and cervical ROM
  • ROM of elbow, wrist and hand
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13
Q

Phase 2 (6 wks-2 months)

A
  • Exercise involves early active, light resistive and gentle stretching exercises
  • Supine – active flexion
  • AAROM activities progressing to AROM activities
  • Sit - Raise arm with hands clasped
  • Gentle isometrics
  • Progress to Theraband yellow and red
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14
Q

Phase 3 (3+ months)

A
  • 12 weeks - begin heavier strengthening
  • Rubber tubes/band- blue and green
  • Work conditioning
  • Most pts will do well when emphasis is placed on home exercise program of AROM 6-8 x’s/day for 10 minute sessions.
  • Prevent Codman’s hike
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15
Q

Know the ROM and exercise progression for post rotator cuff surgery

A

•May or may not require surgery
•Depends on size of tear
•Follow post surgery protocol
-Usually 6 weeks in immobilizer ( 8 for large tears)
No active movement during this time except for pendulums.
Usually PROM allowed with motion restriction/precautions
- Weeks 6-12 AAROM and AROM (No strengthening)
- Strengthening starts at week 12

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16
Q

Symptoms of Adhesive Capsulitis

A

• Traumatic and spontaneous onset
• Freezing phase, frozen phase and thawing phase.
• May take up to 2 years but will resolve and have close to normal motion
• Inflammatory Condition: NSAIDs, cortisone injection, ice, ROM, joint mobilization, ice and IFC
• ROM usually includes pendulums, pulleys, dowel exercises, table slides/ball on mat, wall slides.
•

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17
Q

Risks of Adhesive Capsulitis

A
  • Over 40 y/o
  • Diabetes
  • Immobility
  • Systemic diseases-over or underactive thyroid, Parkinson’s, cardiovascular disease.
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18
Q

Know the muscles of the rotator cuff

A
  • Supraspinatus
  • Infraspinatus
  • Teres minor
  • Subscapularis
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19
Q

Dupuytrens contracture

A

o Originally thought to be brought to Northern Europe by the Vikings.
o It is hereditary
o Can occur in the feet
o Can be triggered by trauma-fracture, surgery, sprain etc.

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20
Q

Dupuytrens- what tissue it affects

A

Affects the longitudinal fibers of the palmer fascia

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21
Q
  • CRPS: Type I: Occurs after an illness or injury that did not directly damage the peripheral nerves of the affected limb.
A

o Any Lesion
o Localization: Distal Extremity, Independent of lesion
o Spreading of Symptoms: Obligatory
o Spontaneous Pain: Common, mostly deep and superficial orthostatic component
o Mechanical Allodynia: Most patients with spreading tendency
o Autonomic Symptoms: Distally generalized with spreading tendency
o Motor Symptoms: Distally generalized
o Sensory Systems: Distally generalized with spreading tendency

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22
Q

CRPS: Type II: There is an identifiable peripheral nerve injury.

A

o Nerve Lesion
o Localization: Any peripheral site confined to distribution of nerve
o Spreading of symptoms: rare
o Spontaneous Pain: Obligatory, Superficial predominates, no orthostatic component
o Mechanical Allodynia: Obligatory in nerve distribution
o Autonomic Symptoms: Related to nerve lesion
o Motor Symptoms: Related to nerve lesion
o Sensory Systems: Related to nerve lesion

23
Q

Acute phase of CRPS

A
  • First 3 months
  • Beginning to 3 months
  • CLINICAL PRESENTATION
  • Increased hair and nail growth
  • Changes in sweating
  • Increased pain
  • Skin becomes thin and dry
  • Color change red, warm, and swollen but may quickly become cold.
  • Can have swelling
  • Allodynia
  • Hyperalgesia
24
Q

Subacute phase of CRPS

A
  • 3-6 months
  • Decreased hair growth
  • Swelling could spread
  • Stiffness
  • Appearance
  • Joints thicken
  • Muscles atrophy
25
Q

Chronic Phase of CRPS

A
  • 6 months onward
  • Changes are irreversible
  • Severely limited mobility of affected area
  • Contractions of the muscle and tendons that flex the joints
26
Q

Warning Signs of CRPS

A
  • Inflammation
  • Pain out of proportion to injury (not in all cases)
  • Skin color changes
  • Shiny appearance to skin
  • Stiffness
  • Abnormal hair growth
  • Spasms in blood vessels and muscles of the extremities.
  • Temperature variance: Extremities may be either hot or cold and there is often a difference between involved and uninvolved extremities.
  • Osteopenia
  • Insomnia/ Emotional Disturbances
  • ## Dystonia/motor planning difficulty
27
Q

Phase 1: Laterality

A
  • Left/right discrimination is the accuracy and speed of identifying whether a picture or body part is a right or left.
  • Laterality- is lost in patients with CRPS. The brain tunes out the effective limb
  • Restores accuracy and speed of Left Vs. Right
  • 90% correctly identify right from left. Average time is 2.4 seconds to point out the correct body part in normal population.
  • For someone with CRPS it takes twice as long to recognize at 4.7 seconds average.
  • Treatment is to focus on getting them to be able to correctly identify the body part not speed.
28
Q

Phase 2: Imagery

A
  • Imagine the extremity performing motion
  • Static
  • Dynamic
  • Doing a task
29
Q

What is a stellate ganglion block, why is it used and what does it do?

A
  • Many patients experience significant relief from nerve blocks, in which local anesthetic is injected to numb nerves. By relieving pain, blocks can enable more effective therapy, improve mood, and level of activity.
  • Stellate ganglion blocks may be used to numb the stellate ganglion, a cluster of sympathetic nerves at the base of the neck, in an effort to reduce the over-activity of the sympathetic nerves seen in CRPS
30
Q

-

Know what the Watson Carlson Protocol is and why it is used.

A
  • Scrub and carry (compression and distraction)
  • Dystrophile: Device used to measure amount of weightbearing a person can perform.
  • The goal is to bear as much weight as possible through the affected arm. Common for the pain and swelling to slightly increase 1st few days of the protocol, but positive results usually observed within the 1st week of treatment.
  • Begin with 3 minutes/ 3 times a day &progress to 10-15 minutes/3 times a day.
  • Scrubbing on a plywood board while in the quadruped position. Scrub every 2 hours starting at 3 to 5 minutes and work up to 10 minutes.
  • Carrying a weighted bag in the affected hand. Grade up the weight as quickly as possible according to tolerance .
  • Functional Activities: washing windows, wiping counters, ironing, scrubbing bath tile, carrying groceries, sanding wood
31
Q

Know what CRPS stands for:

A
  • Complex Regional Pain Syndrome
  • Previously referred to as Reflex Sympathetic Dystrophy. In 1993 the International Association for the Study of Pain proposed a name change to Complex Regional Pain Syndrome.
  • Name changed suggested because the term reflex sympathetic dystrophy implied that the sympathetic nervous system was the primary cause. Not all individuals with CRPS have sympathetic symptoms.
  • Involves several physiological and psychological systems.
  • Process is progressive without intervention.
32
Q

What is an osteophyte?

A
  • Osteophyte formation at the MP level can cause trigger finger as it can hinder tendon excursion through the A1 pulley system
33
Q
  • Heberden’s Nodes:
A

Distal Phalanx osteophytes

34
Q

Bouchard’s Nodes:

A

Proximal Phalanx Osteophytes

35
Q

Know OTs role in the conservative management of CMC joint arthritis and what exercises we would prescribe and no prescribe

A
  • Educate in web space stretch
  • Splinting to support CMC
  • Selective strengthening of stabilizing muscles
  • Webspace Stetch
  • Metagrip: Handlab.com
  • Isometric Strengthening of the 1st interossei
  • Air ball squeeze for 10 repetitions/10 second holds
  • Rubber band extension for 10 repetitions/10 second holds
  • Goal to maintain the natural arc of the thumb which reduces forces at the CMCJ
  • Various types: dorsal, volar, MP free
  • MP only and placed at 30 degrees
36
Q

RA

A
  • Autoimmune disorder
  • Immune system attacks the body
  • Destroys soft tissues and ligaments
  • Results in pain and deformity
  • Can coincide with other forms of arthritis
  • Control Inflammation through medication
37
Q

To Splinting to prevent deformity? RA

A
  • ulnar drift
  • resting hand splint
  • wrist support
38
Q

Cozen’s test

A

c. Positive Finding: pain along lateral epicondyle or muscle weakness may indicate lateral epicondylitis

39
Q

Long Finger test

A

pain along lateral epicondyle or muscle weakness

40
Q

Finklestein’s

A

positive for De Quervain’s

41
Q

• Drop arm test: have them standing and bring arm out to 90 degrees abduction then have them lower their arm back down to their side slowly

A

• Tests for rotator cuff tear – choppy lowering could indicate tear in rotator cuff

42
Q

• Full can test: arm out to 90 degrees in scapular plane with thumb up – provide resistance similar to a MMT

A

• Tests for rotator cuff tears

43
Q

• Speed’s test: arm out straight to 90 in full supination

A

• Tests the biceps tendonitis and superior labral tear

44
Q

• Hawkin’s/Kennedy

A

• Tests for impingement of biceps and supraspinatus, as well as AC joint arthritis

45
Q

Neer test

A

impingement under acromion

46
Q

Froment’s sign

A

• Tests for ulnar nerve neuropathy, specifically testing for adductor pollicis

47
Q

Apley’s stratch test

A

o Positive finding: Asymmetrical results from side to side are positive. The inability to touch the opposite shoulder is indicative of limited glenohumeral adduction, internal rotation, and horizontal flexion. Limits in scapular protraction may also produce asymmetrical results

48
Q

Supraspinatous

A

abduction of the humerus

49
Q

Teres Minor

A 
Lateral rotation (external rotation) and extension of humerus, assist in stabilizing head    
                                           Of the humerus on the glenoid fossa during humeral elevation.
50
Q

Subscapularis

A

: Internal rotation of humerus at the shoulder and assists in stabilizing head of the humerus on the glenoid fossa during humeral elevation.

51
Q

Infraspinatous

A 
Lateral rotation (external rotation), assists in stabilizing head of humerus on         
                                           glenoid fossa during humeral elevation .
52
Q

Freezing phase:

A

Pain with movement and at rest and range starts to decrease

53
Q

Frozen phase:

A

Shoulder is stiff and there is marked ROM loss but less pain.

54
Q

Thawing phase:

A

ROM slowly starts to improve

MSK (4 decks)

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