Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

4th Semester Therex II > shoulder > Flashcards

shoulder Flashcards

1
Q

Tx post-op total shoulder replacement: Maximum protection phase

CONTRAS

A
  • important to initiate PROM/AAROM exercises within limits
  • forward elevation in plane of scapula to tolerance (up to 120 deg)
  • ER no more than 30 deg
  • No GH extension past neutral
  • IR until forearm rests on chest
  • AROM by 4-6 wks EXCEPT IR (NO active IR for at least 6 weeks)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Total Shoulder replacement: max protection phase ADL precautions

A
  • no reaching behind back or into hip pocket
  • no GH extension past neutral
  • light ADL with elbow at waist level (writing)
  • NWB on the affected UE
  • 1 lb lifting limit
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Total shoulder replacement: moderate protection phase precautions

A
  • gentle stretching after 6-8 weeks
  • week 4-6: no extension past neutral
  • week 6-12: combined adduction, IR and extension permitted
  • progress to low resistance dynamic strengthening of elbow and wrist, ST, and GH joints
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Total shoulder replacement: moderate protection phase ADL precautions

A

week 6-12: limit unilateral lifting to 3 lbs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Total shoulder replacement: minimal protection phase precautions

A

after 12 weeks: bilateral lifting limit 10-15 lbs, gradual return to functional activities

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

TSA (intacts rotator cuff)

Phases:

Immobilization:

ROM restrictions:

A

Phases: phase I = 0-4 weeks, phase II = 4-12 weeks, phase 3 = 12+ weeks

Immobilization:

no immobilizer unless rotator cuff repaired. possible sling only

ROM: 0-4 wks: elevation to 120 deg, ER to 30 deg (arm at side)

4-6 wks: no GH extension past neutral

6-12 wks: combined add, IR, ext permitted

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

TSA (reversed)

phases:

immobilization:

ROM restrictions:

A

phases: phase I = 0-6 weeks, phase II = 6-12 or 16 weeks, phase III = 12+ or 16+

Immobilization: abduction splint worn 24 hrs/day for first 3-4 weeks (up to 6 weeks)

ROM: limit for 12 weeks or more. no GH ext, IR pas neutral, no combined GH ext, edd, IR; 0-20 deg ER and up to 90-120 deg arm elevation in scapular plane

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

TSA (intact rotator cuff)

ROM/exercises etc:

resistance exercises:

A

ROM/exercises etc: PROM to AAROM GHJ (perform in supine 0-3 weeks), AROM GHJ by 4-6 wks

No active IR for at least 6 weeks, gentle stretching after 6-8 wks

Resistance exercises:
phase I = light NWB isos of ST and deltoid mm
phase 2 = submax isos of GH mm, light WBing through UE, no resisted rotation until subscap healed, progress to low-resisted dynamic strengthening

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

TSA (reversed)

ROM/exercises, etc:

Resistance exercises:

A

ROM/exercises, etc: when immobilizer can be removed PROM only of GHJ.

AAROM to AROM of GHJ during phase 2

Resistance exercises: See TSA, but use phase time phases for rTSA

NWBing exercises through week 12

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

TSA ADL precautions

4-6 weeks:

6-12 weeks:

after 12 weeks:

A

4-6 weeks: no reaching behind back, support arm on pillow when supine, light ADL with elbow at waist level, no leaning on involved arm, lifting limit of 1 lb

6-12 weeks: unilateral lifting = 3lbs

after 12 weeks: bilat lifting = 10-15 lbs, gradual return to light functional activities

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

TSA (reversed) ADL precautions:

first 12 weeks

5-7 weeks

12-16 weeks

A

first 12 weeks: no reaching behind back, support arm on pillow when supine

5-7 weeks: light ADL permitted with elbow at waist level, no leaning on involved arm, restricted lifting 12-16 weeks (no heavier than cup o coffee)

12-16 weeks: unilateral lifting = 6 lbs, bilateral lifting = 10-15 lbs, gradual return to light functional activities

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

common impairments with Rotator Cuff Disease and Painful Shoulder Syndromes

A
  • positive impingement sign and painful arc near 90 deg elevation
  • hypomobile posterior GHJ capsule
  • with a complete rotator cuff tear, inability to abduct the humerus against gravity
  • C5 and C6 reference zones
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

referred pain from related tissues: over trapezius to tip of shoulder

A

dermatome c4

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

referred pain from related tissues: over deltoid region and lateral arm

A

dermatome c5

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

referred pain from related tissues: upper trap region

A

diaphragm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

referred pain from related tissues: left axilla and pectoral region

A

heart

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

referred pain from related tissues: tip of shoulder and scapular region

A

gallbladder

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

arthritis/DJD and adhesive capsulitis can be categorized as:

A

joint hypomobility

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

GHJ arthritis cause (3)

A

traumatic injury, or

microtrauma from faulty mechanics/overuse

from lack of movement

20
Q

During the _____ phase of GHJ arthritis:

pain sometime radiates below elbow and mm guarding

ER and abduction ROM limited

pain can disturb sleep

tenderness below edhe of acromion process between ant and middle deltoid

A

acute

21
Q

during the ______ phase of GHJ arthritis:

capsular tightness with limited motion consistent with a capsular pattern

pain at end range

limited joint play

A

subacute

22
Q

during the _____ phase of GHJ arthritis:

significant loss of function secondary to increased capsular tightness

aching localized to deltoid region

A

chronic

23
Q

IF conservative treatment does not work for GHJ arthritis ________ may be performed before considering a TSA

A

manipulation under anesthesia (MUA)

24
Q

post-manipulation under anesthesia:

arm is kept….

emphasis on ___ and ____ in 90 deg or higher abducted position

A

arm is kept in elevated overhead abduction and external rotation position

emphasis on ER and IR

25
Q

indications for a TSA (5)

A

severe deterioration of one or both surfaces of the GH joint

  • pain
  • loss of shoulder mobility or stability and UE strength
  • loss of UE function
  • acute non-union fracture of the proximal humerus
26
Q

3 types of shoulder arthroplasty:

A
  • total shoulder arthroplasty
  • hemiarthroplasty
  • reverse total shoulder arthroplasty (rTSA)
27
Q

type of shoulder arthroplasty: used when the articular surface and underlying bone of the humeral head have deteriorated but glenoid fossa is reasonably intact (only replace the humeral head)

A

hemiarthroplasty

28
Q

characterized by the development of dense adhesions, capsular thickening, and capsular restrictions

insidious onset and usually occurs between ages 40-65

It is a self limiting function over an 18 month period

A

Adhesive capsulitis

frozen shoulder

29
Q

possible causes of frozen shoulder:

A
  • provoking chronic inflammation in musculotendinous or synovial tissue, along with faulty posture, mm imbalance, and overuse

genetic component

strong association with diabetes and thyroid disease

30
Q

Frozen shoulder stage _____:

  • gradual onset of pain
  • pain increases with movement
  • pain present at night
  • loss of ER
  • intact rotator cuff strength
A

stage 1

Lasts less than 3 months

31
Q

frozen shoulder stage ____:

  • persistent and more intense pain
  • pain at rest
  • motion limited in all directions
  • motion unable to be restored with intra articular injection
A

stage 2

lasts 3-9 months after onset

32
Q

frozen shoulder stage ____:

  • pain only with movement
  • significant adhesions
  • limited GHJ motions
  • excessive scapulothoracic movement
  • atrophy of the deltoid, rotator cuff, biceps and triceps
A

stage 3

9-15 months after onset

33
Q

frozen shoulder stage ____:

  • minimal pain
  • no synovitis but significant capsular restrictions from adhesions
  • motion may gradually improve
  • may never regain normal ROM
A

stage 4

15-24 months after onset

34
Q

structural integrity of the musculotendinous structures and include vascular changes in the rotator cuff tendons, tissue tension, overload, and collagen disorientation and degeneration

involve the deep articular side of the tendons

may progress to articular-side rotator cuff tears

A

intrinsic impingement

35
Q

occurs as a result of mechanical compression of the rotator cuff against the anteroinferior one-third of the acromion in the suprahumeral space during arm elevation

tendon compression results from anatomical or biomechanical factors that decrease the suprahumeral space

A

extrinsic impingement

36
Q

there are primary and secondary extrinsic impingements

secondary impingements are caused from

A

multidirectional instability

or unidirectional instability with or without impingement

37
Q

compression fracture at the posterolateral margin of the humeral head (occurs with anterior dislocation)

A

hill sachs

38
Q

________ impingement occurs in a position of elevation, horizontal abduction, and maximum external rotation

primary in throwing athletes

associated with posterior GH capsule tightness and scapula kinematic alterations

A

internal extrinsic impingement

39
Q

_________ symptoms:

  • near musculotendinous junction
  • results in painful arc with overhead motions
  • pain with provocation tests
  • pain on palpation of the tendon just inferior to the anterior aspect of the acromion when pts hand placed behind back
A

supraspinatus tendonitis

40
Q

_________ symptoms:

  • near musculotendinous junction
  • results in painful arc with overhead, forward, and cross body motions
  • may present as deceleration injury
  • occurs with palpation of tendon just inferior to the posterior corner of the acromion when pt horizontally adducts and ER humerus
A

infraspinatus tendonitis

41
Q

______ symptoms:

  • lesions involves long tendon in bicipital groove beneath or just distal to transverse humeral ligament
  • pain with Speed’s test
  • pain with palpation of bicipital groove
  • rupture or dislocation of bicep tendon may compromise role as a humeral depressor during elevation
A

bicipital tendonitis

42
Q

______ symptoms:

  • same symptoms as seen with supraspinatus tendonitis when inflamed
  • once inflammation reduce, no symptoms with resisted motion
A

bursitis (subdeltoid or subacromial)

43
Q

_____________ occurs in persons over age of 40

occurs after repetitive microtrauma to the rotator cuff or long head of the biceps

with degeneration, calcification and eventual tendon rupture may occur

A

insidious (atraumatic) onset stage 3 impingement syndrome

44
Q

anterior instability special tests (4):

A
  • load and shift test
  • apprehension (crank) test
  • relocation (fowler’s) test
  • rowe test
45
Q

posterior instability special tests: (3)

A
  • load and shift test
  • posterior apprehension test
  • rowe test
46
Q

inferior instability special tests: (3)

A
  • sulcus sign
  • feagin test
  • rowe test
47
Q

labrum special tests (4)

A
  • clunk test (Bankart)
  • obrien test (SLAP)
  • anterior slide test (SLAP)
  • bicep tension test (SLAP)

4th Semester Therex II (5 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions