shoulder Flashcards
shoulder instability as unidirectional is mostly seen at?
anteriorly
1 combined abd and ext rot
2 arm in flexion and internal rotation
which one will lead to posterior and anterior instability of the shoulder?
1= anterior instability
2= posterior instability
avulsion of the anteroinferior labrum from the glenoid is called?
bankart leasion
Congenital & Acquired capsuloligamentous laxity is?
multidirectional instability posteriorly
with bankart lesion, patient’s arm should be placed in ER or IR?
ER
with reverse bankart lesion, the patient’s arm should be placed in ER or IR?
IR
what are the dynamic stabilizers?
deltoid
rotator cuff muscles
biceps long head
how many phases do we have for shoulder instability injury?
Phase I: Weeks 0–4 acute
Phase II: Weeks 4–8 subacute
Phase III: Weeks 8–12 chronic
Phase IV: >12 weeks functional
the brace removal is done in phase 3, chronic 8-12
true or false?
false, in subacute 4-8 weeks
AAROM is done in which phase?
give examples
phase one
flexion, abduction, lateral rotation
for bankart tear internal rotation is not allowed
for reverse bankart tear external rotation is not allowed
for applying ROM during phase one
true or false?
true
isometric strengthening, mobility, scapula, and isotonic theraband exercises are done in which phase?
2nd phase
give example of mobility exercise
wand
most seen compensation movement with shoulder instability
is?
shoulder elevation
what are the main muscles for scapula exercises in shoulder instability?
lower trapezius
serratus anterior
which muscle should we strengthen when there is the elevation of shoulder?
lower trapizuis
in which position we can strengthen the lower trapezius?
prone
standing
with holding for 5-10 sec then repeat 5 times
in 2nd phase list the duration of each type of exercise:
isometric
mobility
scapula exercises
isotonic
isometric= 10 times each/ 3 daily
mobility= 10 times each/ 4 daily
scapula= 5-10 times each
isotonic= 20 times each/ 3 daily
which exercises are done in phase three?
advanced ER
advanced IR
scapula setting exercises
lower trapezius in prone
serratus anterior in 4-point kneeling
WB ( wall push-ups, 4-point kneeling push-ups)
list the extrinsic etiologies of rotator cuff syndrome
Extrinsic Cause
Bony Factors
Type of Acromion
Osteophytes
or
Soft Tissue Factors
Subacromial bursitis
Thickened coracoacromial ligament
list the intrinsic factors of rotator cuff syndrome
Intrinsic Factors
Degenerative Cuff Failure
Traumatic Cuff Failure
Reactive Cuff Failure
list the type of acromion
type one= flat, normal
type 2=curved, dipping and downward
type 3= hooked
what are the impingement syndrome stages?
Stage I, involves edema and/or hemorrhage. <25 years, associated with an overuse injury, at this stage the syndrome is reversible.
Stage II, 25 to 40 years. Fibrosis, irreversible tendon changes.
Stage III, >50 years of age, involves a tendon rupture or tear.
the pain is radiating to which aspect of the rotator cuff?
and what is the most ROM is stiffened?
pain, lateral aspect and may radiates to deltoid insertion
ROM stiff, IR
adhesive capsulitis is known as?
frozen shoulder
for a frozen shoulder, all ROM is affected
true or false?
true
the male is more affected than female in frozen shoulder
true or false?
false
what are the primary and secondary types of frozen shoulder
Primary
independent of other pathologies
Secondary
after trauma or another condition
Systemic, e.g DM
Extrinsic to GH, e.g. Fx
Intrinsic to GH, e.g. Rotator Cuff tear
what will have with a frozen shoulder initially?
hyperplasia of the capsule leading to thickening
what are the phases of a frozen shoulder?
1- pre adhesive or painful 0-3 M
2- freezing 3-9 M
3- stiffness or frozen 9-15 M
4- thawing or recovery 15-24 M
A-full ROM under anesthesia
B-Synovial hyperplasia
-Fibroblastic proliferation
-ROM w/wo anesthesia
C- ROM Pain diminished or plateau especially the anterior aspect of GH
D-Painless stiffness and progressive improvement in ROM
list which one is for phase 4,2,3,1in frozen shoulder
4=D
3=C
2=B
1=A
what will happen to the ROM in the frozen shoulder?
Limitations in A/P GH
ROM >50%
Scapulothoracic ROM increase
Ext Rot (with the arm at side) decreases significantly
the adduction limitation is seen with a frozen shoulder
true or false?
false, abduction
shoulder strength in frozen shoulder is affecting mostly?
IR and flexors muscles
Inspection: atrophy, symmetry
Palpation: AC, cuff tenderness
Range of motion: active, passive
Strength: ER and elevation power, lag
Provocative: impingement sign, the arc of pain
are related to?
physical examination
how to test the supraspinatus muscle?
jobe or empty can
neer and hawkins tests are for?
impingement syndrome
how to test subscapularis muscle?
lift off test
homeblower test is for?
teres minor muscle
Icing (20 min, 3-4 times per day) with relative rest are applied in the acute phase of rehab
true or false?
true
how the patient will sleep with a frozen shoulder?
sleep with a pillow between the trunk and arm to decrease tension on the supraspinatus tendon
the recovery phase includes what?
Restoration of shoulder ROM,
Normalization of strength and dynamic muscle control,
Proprioception and dynamic joint stabilization.
After the pain has been managed, restoration of motion can be initiated by?
Codman pendulum exercises.
Wall walking
Stick or towel exercises
how Normalization of strength and dynamic muscle control is done?
1- Perform strengthening in a pain-free range only to The scapular stabilizers include the rhomboids, levator scapulae, trapezius, and serratus anterior
2- Strengthening the rotator cuff muscles.
how to strengthen the supraspinatus muscle?
Pendulums
Trap Fly
how to strengthen the infraspinatus muscle?
Pendulums
Upper Ext Rotation
External Rotation
how to strengthen teres minor?
Horizontal Abduction
Laying External Rotation
Sleeper Stretch
how to strengthen subscapularis?
Internal Rotation
Int/Ext Rotation Stretch
Passive Int Rotation
Probably the best use for isokinetic exercise machines is ?
objective side-to-side comparison of strength
Scapular stabilizer are strengthened by shoulder shrug, push-up and shoulder press
true or false?
true
for improving stabilizing we start with CKC and then progress to OKC with PNF for propioception
true or false?
true
program:
isometric
OKC
eccentirc
propioception CKC then OKC
true or false?
true
Pain or tenderness in the front of the shoulder, which worsens with overhead lifting or activity,
Pain or achiness that moves down the upper arm,
An occasional snapping sound or sensation in the shoulder
are symptoms of?
biceps tendonitis
