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Therapeutic Exercise > Shoulder > Flashcards

Shoulder Flashcards

1
Q

In what direction is the head positioned to stretch levator scapulae?

A

side bend and rotate away, use some flexion

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2
Q

Axial extension, side bending the head away, and rotating the head toward the affected side will stretch what muscles?

A

scalenes

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3
Q

How do you stretch SCM?

A

cervical extension, side bend away, rotate toward

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4
Q

T/F: Upper trap can be stretched by side-bending away and rotating toward the tight side.

A

true

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5
Q

For which shoulder area muscle do you need to stabilize the pelvis when stretching?

A

lats

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6
Q

The standing V stretch stretches what part of the pecs?

A

sternal

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7
Q

How do you stretch infraspinatus?

A

supine, move into IR

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8
Q

How do you stretch serratus anterior?

A

child’s pose

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9
Q

What motions does an anterior glide mobilization facilitate?

A

extension, ER

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10
Q

To improve GH abduction, what kind of glide do you want to do with your mobilization?

A

inferior

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11
Q

What motions does a posterior glide mobilization help?

A

IR, flexion

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12
Q

The self-mob of holding a table and leaning away from it facilitates what kind of glide?

A

inferior

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13
Q

What is the self-mob for an anterior glide?

A

laying back on arms with shoulders almost shrugged-looking

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14
Q

What is the self-mob for a posterior glide?

A

the sleeper stretch into IR (a posterior glide assists with IR)

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15
Q

What shoulder muscles are likely to get tight? Which ones are likely to become weak?

A

tight: levator scap, upper trap, SCM, scalenes, pecs, upper cervical extensors, subscap, teres maj/minor, lats
weak: rhomboids, serratus, middle/lower trap, supraspinatus, infraspinatus, deep cervical flexors

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16
Q

How do you perform the lateral scapular slide test?

A

measure the distance between the inf. angle and SP, and compare that to the other scapula. Do this at 0,45, and 90 degrees

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17
Q

Describe the stages of adhesive capsulitis.

A

1: 0-3 months where it’s beginning to lose ROM
2: freezing, 3-9 months where we’ll start seeing pts
3: frozen, 9-15 months
4: thawing, 15-24 months

can present as deep joint pain or referred pain, but you’ll see a hypomobile joint

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18
Q

What is your typical course of treatment for adhesive capsulitis?

A

mobilize the joint, work on stabilizing and strengthening shoulder muscles to reach thawing period faster

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19
Q

What’s the most common GH instability? How does it present?

A

anterior instability is most common, with humerus elevated, hor abducted, and ER

20
Q

T/F: Deltoid often gets impinged with a shoulder instability.

A

false, supraspinatus does

21
Q

What is a Bankart lesion?

A

inferior and anterior labrum is damaged

22
Q

What motions do you limit for an anterior GH repair?

A

horizontal abduction
extension
elevation

limit these motions for 6 weeks
avoid vigorous stretching for 8-12 wks

23
Q

What muscle can sometimes be incised with an anterior GH repair? What precautions must you take it if it is?

A

subscapularis: limit ER to 5-10 degrees

24
Q

What can lead to posterior instability of the GH joint?

A

FOOSH

25
Q

What factors can cause a longer healing time post-op?

A
  • smokers
  • age
  • tissue quality/bone quality
  • if anchors into bone stay solid (again, bone quality)

3 months for tissue to heal, then rehab time takes even longer (but we see them in those healing months as well)

26
Q

What muscle is sometimes affected with a SLAP tear?

A

long head biceps brachii

27
Q

What are your PROM limitations for a SLAP tear at 2 and 4 weeks?

A

2 wks: limit elevation to 60 deg

4 wks: limit elevation to 90 deg

28
Q

What’s the difference between tendonesis and tenotomy?

A

tendonesis: reattach long head to some part of humerus
tenotomy: surgically cut a tendon and let it resect back itself

29
Q

What limitations are there for posterior GH repairs?

A

limit elevation to 90, IR to neutral or 15-20 degrees, and horizontal adduction to neutral for 6 weeks

30
Q

What position is the humerus held in a sling following an anterior GH repair?

A

slightly abducted, slightly flexed, IR

31
Q

What position is the humerus held in a sling following a posterior GH repair?

A

slightly abducted, slightly extended, neutral rotation

32
Q

For a massive RTC, how long do you need to do PROM for?

A

6 weeks

33
Q

When does the collagen in a tendon start to reform?

A

2 months, followed by sharpey’s fibers at 3 months (mature repair site at 4 months)

34
Q

What can you do in beginning stages for RTC?

A
  • early PROM for 4-8 wks
  • work on elbow/hand/wrist ROM and activation
  • isometrics for scapular stabilizers
  • avoid anterior translation of humerus and tension on rotator cuff
35
Q

What are your main goals in the acute phase of an RTC tear rehab?

A
  • maintain a stable scapulae
  • reduce pain
  • do PROM
  • educate patient on precautions
36
Q

What activities should you tell your RTC patients to avoid?

A
  • no lifting
  • no cross-body adduction
  • no IR behind back
  • no active elevation above waist (limited abd b/c supra is most likely involved)
37
Q

What is the number one reason for a TSA?

A

OA in shoulder

38
Q

T/F: Having a rotator cuff tear is a poor predictor of the TSA outcome for a patient.

A

true, rehab will take a lot longer

39
Q

How long is overall recovery for patients with TSA?

A

1-2 years

40
Q

Which muscle becomes the rotator cuff in a total reverse shoulder arthroplasty?

A

deltoid: done when RTC is completely torn and there’s OA

41
Q

What should you do to rehab a TSA?

A

address ROM in pain-free range, strengthen and range joints above and below, do scapular stabilization, then progress up to shoulder strengthening after 10-12 wks due to RTC tear

42
Q

For which surgery is there a 10-15 pound lifting restriction indefinitely?

A

TSA’s

43
Q

What are your limitations in the first week of PROM for TSAs?

A
  • limit flexion to 90 degrees
  • no IR for 6 weeks
  • only 20-30 degrees ER
  • avoid extension with isometrics
44
Q

Thoracic outlet syndrome could be caused by what nerve and what artery?

A 
nerve = brachial plexus compression
artery = subclavian a. compression
45
Q

What treatments can we do for thoracic outlet?

A
  • change workstations to fit ergonomic needs
  • correct faulty posture and biomechanics
  • teach diaphragmatic breathing
  • kinesio tape
46
Q

Discuss the progression of therapy for TSA.

A
  • start with limits in flexion, ER; no IR
  • begin to progress with flexion and ER, do IR while in abduction, none in adduction. Isometrics for 4 wks
  • progress to AROM and then by wks 6-8, do isotonic strengthening and watch for compensations
  • progress to functional activities and increase endurance, but indefinite weight lifting restriction to 10-15 lbs

Therapeutic Exercise (6 decks)

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