Shoulder Complex III (Rx) - exam 3 Flashcards
What are some Distinctive Tendon Rx’s- Tendinitis and Tendinosis: (4)
Pt. education - load management
POLICED
NSAIDs
Bracing
Effects of NSAIDs regarding Tendinitis and Tendinosis?
-Short-term P! relief in acute presentation
-Delays healing in injury at insertion (needs inflammation to heal)
iontophoresis, ultrasound, phonophoresis and low-level laser treatment lack sufficient evidence at this time:
modalities
Soreness rule:
no more than mild P! during or up to 24 hours after exercise and quality of movement not affected
What is the PRIMARY purpose of Tendinosis MET: (2)
Tendon proliferation
Possible spinal stabilization with regional interdependence
Tendinosis Rx paramenters:
implement time?
load type?
action type?
-implement after any acuity settles
-heavy loads
actions
–slower eccentrics
–3 sec. mm. actions (conc, isometric, and ecc.)
Tendinosis Rx parameters:
sets x reps?
exercises?
2-3 set of 10-15 reps to fatigue
2-3 exercises involved tendon
Activity response of Tendinosis Rx Parameters:
-mild to moderate increase in P! - possibly up to 5/10
-timeframe P! should ease back to baseline levels before preparing for exercise 24-48hrs
Tendinosis Rx MET parameters:
_______ wk. program
_______ with _______ to fatigue
8-12 wks
precautions w/heavy loads
Excessive fat absorbs inflammatory cells away from the tendon is known as___________
obesity
Excessive glucose impairs collagen production and remolding is known as________
diabetes
Both diabetes and obesity improve the healing phase of tendinosis. T or F
False- impairs
Low-grade inflammation is associated with:
Persistent inflammation limits:
systemic diseases and/or poor diet
proliferation and remodeling
MD Rx:
Cortisone injection:
Glycerin trinitrate patches:
Sclerosing injections:
-shorts term benefits
-effective by increasing circulation
-stiffen tendon for P! relief
MD Rx tendinosis- worst-case scenario/last option
Future options:
surgical debridement
growth factors and stem cells
PT Rx for impingement syndrome: (3)
POLICED
Modalities
Scapular Taping
MOST modalities are beneficial. T or F
False; MOST are not beneficial
Scapular taping has long-term P! relief. T or F
False; improved short-term P!
-may provide an early “window” for MET and limit ADL provocation
PT Rx: JM for impingement syndrome
________ recommendation
________jt.
Strong
GH
JM supports regional interdependence as shown in the cervicothoracic. JM should be added to ________ for more effectiveness.
exercise
What is the PRIMARY treatment option for impingement syndrome?
MET
What should MET dosage be for impingement syndrome?
Should you do MET every day?
-High-dose MET superior to conventional low-dose exercise
-It depends; every other day, later progress to every day, never 2x/day
PT Rx for tendinosis:
> ______mths of symptoms
________ and _______ exercises
______ w/ supporting PT visits
MET parameters for tendinosis______
________JM
-6 months
-Cuff (SIT) and Scapular exercises (MT/LT/ Rhom/SA)
-HEP
-1-2x/day
-Post GH
At 3 mths. of a successful PT Rx for tendinosis:
70% with improved P!/function vs 25% traditional exercises
reduced need for Sx
Subacromial decompression reccomendation:
should NOT be performed if atraumatic and present > 3 mths. aka tendonosis
Is subacromial decompression more effective than exercise alone?
equally or no more effective and more expensive
The theory is that differing body regions are biomechanically and neurophysiologically interdependent and impairment in one region can contribute to impairment in another, particularly persistent.
example:
regional interdependence
-lower hip and LB strength with persistent neck P!
-spine P! can cause extremity P!
What cervical segment is most common for impingement?
C5-6 dysfunction
MOST common segment for impingement
Dysfunction w/overhead reaching:
What shares the innervation and excessively recruited from C6 with C5,6 jt.
Internal Rot. (subscapularis, lats, and pec major)
What happens when you have excessive recruitment of IRs?
humeral head pulled anterior of coracoid process
creates excess tension and compression underneath LHB
leads to possible tendinopathy
Dysfunction w/overhead reaching:
What happens when you have inhibition and protective hypertonicity of ERs?
-Greater tubercle won’t effectively move fully out from under the acromion.
-Impingement of supraspinatus and LHB that may lead to tendinopathy –> more impingement
What can you expect to see with C2, 3 dysfunctions regarding impingement syndrome?
excessively recruited scapular elevators — creates excessive tension and compression on supraspinatus
Dysfunction w/overhead reaching:
If impingement is occurring more often at higher levels what is happening?
-inhibition and protective hypertonicity of depressors
-scapula won’t depress effectively
-impingement > 150 b/c scapula won’t go back and down
-supraspinatus and LHB tendons will impinge —-lead to tendinopathy
GH and AC jt. may also ________ with hypermobility/instability to reach higher.
compensate
