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Fall Semester PM Exam 1 > Nonsurgical Shoulder Complex Pathologies > Flashcards

Nonsurgical Shoulder Complex Pathologies Flashcards

1
Q

When does the fibroplastic stage of healing occur and what is it?

A

it follows the acute inflammatory stage, can last up to 6 weeks, and is the laying down of new tissue

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2
Q

Fibroplasia physiology

A

endothelial and fibroblast cells form capiallary buds and collagen
the formation of a functional scar occurs
increase in viscoelastic properties of new tissues

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3
Q

Maturation

A

can occur for a year post-injury
tissue regains mechanical strength
restoration of normal functioning occurs

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4
Q

Referred Pain

A
  • can be myotomal or dermatomal from C5 or sclerotomal (fascial)
  • can be caused from scapula, thoracic, or cervical
  • visceral pain: cardiac, pulmonary, GI (gallbladder!!!!)
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5
Q

4 different pathologies associated with rotator cuff disease

A

Impingement
tendonitis
bursistis
tendinopathy

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6
Q

T/F there are intrinsic and extrinsic factors for impingment

A

true

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7
Q

define impingement

A

compression of the subacromial contents due to the encroachment of the humerus into the coracoacromial arch

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8
Q

the subacromial space is formed by what and contains what?

A

formed by coracoacromial arch and humeral head

contains rotator cuff tendons, long head of biceps tendon, and subacromial bursa

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9
Q

factors for impingemnt can be divided up into what?

A
  1. intrinsic

2. extrinsic: primary and secondary

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10
Q

Intrinsic factors for impingement (3)

A
  1. changes in vascularity of supraspinatus (critical zone)
  2. cuff degeneration (microtears)
  3. muscle dysfunction
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11
Q

What are force couples and what is their purpose

A

groups of muscles that work synergistically but often in opposite ways. purpose is to stabilize the scapula.
excessive upward rotation of the scapula can cause impingement

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12
Q

General extrinsic factors for impingement

A 
muscles imbalances
poor motor control
postural
functional stressors
anatomical abnormalities
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13
Q

extrinsic primary impingement factors are ____ in nature

A

anatomical

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14
Q

extrinsic primary factors for impingement )3)

A

acromion types
osteophytes
tight posterior capsule

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15
Q

extrinsic secondary factors of impingement are caused by what

A

instability

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16
Q

secondary extrinsic factors of impingement

A

poor force couples
postural deviations
poor motor control

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17
Q

a tight posterior capsule will push the humerus in what direction?

A

anteriorly and superiorly

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18
Q

Neer Stages of Impingement

A

Stage 1: edema and hemorrhage
stage 2: fibrosis and tendonitis
stage 3: degeneration of tendon
(stage 1 and 2 are the same for Jobe classification)

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19
Q

stage 1 impingement

A

edema and hemorrhage

usually due to overuse, pain with prolonged activity

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20
Q

stage 2 impingement

A

fibrosis and tendonitis
pain at rest and with activitiy
mild strength loss

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21
Q

stage 3 impingement Neer

A

degeneration of tendon
partial tear
changes in RTC muscles
weakness, decresed ROM and fxn, pain

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22
Q

difference between stage 3 and 4 impingement for Jobe

A

stage 3= small tear

stage 4 = large tear

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23
Q

pain with tendonitis occurs with active or passive motion?

A

active!

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24
Q

Tendinitis occurs due to what?

A

repetitive stress, especially overuse and eccentric contractions

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25
Q

tendinitis primarily effects what 2 muscles?

A

supraspinatus and long head of biceps, but can effect any of RTC muscles

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26
Q

tendinitis presentation

A

pain with palpation and motion
loss of ROM and strength
end feel is boggy, firm, mushy

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27
Q

5/5 strength presentation with tendonitis tells us what?

A

acute exacerbation of a chronic condition (painter example)

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28
Q

with regards to the critical zone, what muscle are we worried about the vascularization of?

A

supraspinatus

29
Q

most commonly involved bursa with bursitis of shoulder?

A

subacromial bursa (located within the subacromial space)

30
Q

Chronic ____ presents with the same symptoms as ____ and what are they?

A

chronic bursitis presents with the same sx as tendonitis. sx = pain with movement, pain with palpation, loss of ROM and strength

31
Q

bursitis pain is with active or passive motion?

A

both! pain with active and passive motion

32
Q

causes of bursitis

A

due to compression and/or irritation of the bursa

can also occur due to trauma: falling onto hands jams the humeral head into the acromion

33
Q

Bursitis

A

acute is very painful
chronic is associated with tendonitis
present w/ pain w/ AROM and PROM, decreased ROM and strength, tenderness with palpation

34
Q

etiology of RTC tear

A

due to cumulative stress or trauma (FOOSH, espc. older adults)

35
Q

most commonly invovled muscle for RTC tear

A

supraspinatus

36
Q

giveaway symptom for acute RTC tear

A

night pain!

37
Q

RTC tear pain

A

pain with acute tear, may be diffuse but specific upon palpation
chronic or complete tear may not have pain
night pain very common overall

38
Q

RTC tear

A

complete tear is palpable: firm and bony

ROM: look at quality of mvmt. often will substitute with abduction because supraspinatus does first 30 degrees

39
Q

causes of adhesive capsulitis

A

idiopathic (insidious onset), can be due to trauma, post surgery, or neuropathic

40
Q

who does adhesive capsulitis affect

A

females more than males, age 40-60

41
Q

physical presentation of adhesive capsulitis

A

decreased scapulohumeral rhythm, less than 90-135 degrees elevation, 50-60% of normal ER

42
Q

name the stages of adhesive capsulitis (4)

A
  1. pre-adhesive
  2. freezing
  3. frozen
  4. thawing
43
Q

Pre-adhesive stage of adhesive capsulitis

A

gradually lose motion, may not be aware it is happening, pain with use, capsular end feel, minorly decreased ROM, commonly misdiagnosed
stage 1

44
Q

freezing stage of adhesive capsulitis

A

stage 2
very painful!!!!
synovial thickening, trigger points, can last for several weeks (10-36), open end feel

45
Q

frozen stage of adhesive capsulitis

A

stage 3

pain decreases, stiffness, weakness, lasts 4-12 months

46
Q

thawing stage of adhesive capsulitis

A

lasts 5-42 months

decreased pain, increased ROM, end feel softens, increased functional use of UE

47
Q

purpose of PT for adhesive capsulitis if it will resolve without PT?

A

reduce the overall amount of ROM patient will lose
keep patient functional
education on reoccurance - must do exercises for life

48
Q

AC joint separation

A

occurs from falling on shoulder or FOOSH
we can treat type 1 and 2 conservatively via taping or bracing
can physically see separation in types 4,5,6

49
Q

most common fracture type for UE

A

humeral

50
Q

presentation of fractures

A

pain, limited ROM, altered scapulohumeral rhythm
non-displaced fracture will be immoblized in sling. no cast. can move it. work on ROM within first 2 weeks of injury to prevent adhesive capsulitis

51
Q

presentation of labral tears

A

catching, popping, sx like impingement, instability, pain, scapular dyskinesia

52
Q

SLAP stands for

A

superior labral anterior to posterior

53
Q

most common type of SLAP leasion

A

type 2
can progress over time from 1-4
long head of biceps attaches to labrum

54
Q

clicking, popping usually indicates what?

A

labral tear (Stage 3 or 4)

55
Q

etiology of anterior shoulder instability

A

force into abduction and ER, FOOSH, posterior blow to shoulder
present with subluxation or dislocation

56
Q

pathologies associated with anterior shoulder instability

A

anterior capsule lesions, bankart lesion, hill sach lesion, brachial plexus injury

57
Q

Hill-SACH lesion

A

small compression fracture on posterior aspect of humeral head. occurs during an anterior dislocation. Technically the fracture is on the anterior aspect but it is considered posterior when in an abducted, ER position

58
Q

posterior shoulder instability

A

force into IR and adduction

labral tear or reverse hill sach can occur or compression fracture of humral head

59
Q

multidirectional instability is due to

A

occupational, recreational or congenital
throwers, swimmers, gymnasts
present similar to impingement with pain, potential subluxing

60
Q

pathologies associated with multidriectional instability

A

loose labrum and multi-laxity of capsule

61
Q

Snapping scapula

A

causes: bursistis, muscle imbalances, bony alignment, luschka’s tubercles (bump on superior medial border of scapula)
pain, crepitus, potential scapular winging

62
Q

presentation of arthritis (OA or RA)

A

pain, joint deformity, decreased ROM and strength, functional impairments
chief complaint will be pain

63
Q

what is thoracic outlet syndrome?

A

compression of the neurovascular bundle producing neurovascualr compromise. 90% is neurogenic ( rather than vascular)

64
Q

etiology of thoracic outlet syndrome?

A

postural deviations, compression injuries, muscle hypertonicity of scalenes, cervical rib, soft tissue abnormalities

65
Q

epidemiology of thoracic outlet syndrome?

A

female more than males ,age 20-50, history of trauma, type a personality

66
Q

presentation of thoracic outlet syndrome?

A

diffuse pain radiating to arm that is non-dermatomal
fatigue and ache, weakness, paresthesias
hand feels cold = vascualr
costal breather, postural deficits
dull achy sensation that progresses down arm, arm feels heavy

67
Q

common compression sites of thoracic outlet syndrome?

A

scalene triangle
costoclavicular space (1st rib and clavicle)
pec minor and chest wall

68
Q

Scapular dyskinesis

A

abnormal motion of the scapula

due to weak traps, SA, muscle imalances, nerve palsy, muscle tightness

69
Q

difference btwn bursitis and adhesive capsulitis with ROM

A

AROM and PROM equally as painful = adhesive capsulitis

bursitis will get more PROM than active before being limited by pain

Fall Semester PM Exam 1 (5 decks)

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