Shoulder Complex III (Rx) - exam 3

Question 1

What are some Distinctive Tendon Rx’s- Tendinitis and Tendinosis: (4)

Answer 1

Pt. education - load management
POLICED
NSAIDs
Bracing

Question 2

Effects of NSAIDs regarding Tendinitis and Tendinosis?

Answer 2

-Short-term P! relief in acute presentation
-Delays healing in injury at insertion (needs inflammation to heal)

Question 3

iontophoresis, ultrasound, phonophoresis and low-level laser treatment lack sufficient evidence at this time:

Answer 3

modalities

Question 4

Soreness rule:

Answer 4

no more than mild P! during or up to 24 hours after exercise and quality of movement not affected

Question 5

What is the PRIMARY purpose of Tendinosis MET: (2)

Answer 5

Tendon proliferation
Possible spinal stabilization with regional interdependence

Question 6

Tendinosis Rx paramenters:
implement time?
load type?
action type?

Answer 6

-implement after any acuity settles
-heavy loads
actions
–slower eccentrics
–3 sec. mm. actions (conc, isometric, and ecc.)

Question 7

Tendinosis Rx parameters:
sets x reps?
exercises?

Answer 7

2-3 set of 10-15 reps to fatigue
2-3 exercises involved tendon

Question 8

Activity response of Tendinosis Rx Parameters:

Answer 8

-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

Question 9

Tendinosis Rx MET parameters:
_______ wk. program
_______ with _______ to fatigue

Answer 9

8-12 wks
precautions w/heavy loads

Question 10

Excessive fat absorbs inflammatory cells away from the tendon is known as___________

Answer 10

obesity

Question 11

Excessive glucose impairs collagen production and remolding is known as________

Answer 11

diabetes

Question 12

Both diabetes and obesity improve the healing phase of tendinosis. T or F

Answer 12

False- impairs

Question 13

Low-grade inflammation is associated with:
Persistent inflammation limits:

Answer 13

systemic diseases and/or poor diet
proliferation and remodeling

Question 14

MD Rx:
Cortisone injection:
Glycerin trinitrate patches:
Sclerosing injections:

Answer 14

-shorts term benefits
-effective by increasing circulation
-stiffen tendon for P! relief

Question 15

MD Rx tendinosis- worst-case scenario/last option
Future options:

Answer 15

surgical debridement
growth factors and stem cells

Question 16

PT Rx for impingement syndrome: (3)

Answer 16

POLICED
Modalities
Scapular Taping

Question 17

MOST modalities are beneficial. T or F

Answer 17

False; MOST are not beneficial

Question 18

Scapular taping has long-term P! relief. T or F

Answer 18

False; improved short-term P!
-may provide an early “window” for MET and limit ADL provocation

Question 19

PT Rx: JM for impingement syndrome
________ recommendation
________jt.

Answer 19

Strong
GH

Question 20

JM supports regional interdependence as shown in the cervicothoracic. JM should be added to ________ for more effectiveness.

Answer 20

exercise

Question 21

What is the PRIMARY treatment option for impingement syndrome?

Answer 21

MET

Question 22

What should MET dosage be for impingement syndrome?
Should you do MET every day?

Answer 22

-High-dose MET superior to conventional low-dose exercise
-It depends; every other day, later progress to every day, never 2x/day

Question 23

PT Rx for tendinosis:
> ______mths of symptoms
________ and _______ exercises
______ w/ supporting PT visits
MET parameters for tendinosis______
________JM

Answer 23

-6 months
-Cuff (SIT) and Scapular exercises (MT/LT/ Rhom/SA)
-HEP
-1-2x/day
-Post GH

Question 24

At 3 mths. of a successful PT Rx for tendinosis:

Answer 24

70% with improved P!/function vs 25% traditional exercises
reduced need for Sx

Question 25

Subacromial decompression reccomendation:

Answer 25

should NOT be performed if atraumatic and present > 3 mths. aka tendonosis

Question 26

Is subacromial decompression more effective than exercise alone?

Answer 26

equally or no more effective and more expensive

Question 27

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:

Answer 27

regional interdependence

-lower hip and LB strength with persistent neck P!
-spine P! can cause extremity P!

Question 28

What cervical segment is most common for impingement?

Answer 28

C5-6 dysfunction
MOST common segment for impingement

Question 29

Dysfunction w/overhead reaching:

What shares the innervation and excessively recruited from C6 with C5,6 jt.

Answer 29

Internal Rot. (subscapularis, lats, and pec major)

Question 30

What happens when you have excessive recruitment of IRs?

Answer 30

humeral head pulled anterior of coracoid process
creates excess tension and compression underneath LHB
leads to possible tendinopathy

Question 31

Dysfunction w/overhead reaching:

What happens when you have inhibition and protective hypertonicity of ERs?

Answer 31

-Greater tubercle won’t effectively move fully out from under the acromion.

-Impingement of supraspinatus and LHB that may lead to tendinopathy –> more impingement

Question 32

What can you expect to see with C2, 3 dysfunctions regarding impingement syndrome?

Answer 32

excessively recruited scapular elevators — creates excessive tension and compression on supraspinatus

Question 33

Dysfunction w/overhead reaching:

If impingement is occurring more often at higher levels what is happening?

Answer 33

-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

Question 34

GH and AC jt. may also ________ with hypermobility/instability to reach higher.

Answer 34

compensate