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DPT 730: MSK > Shoulder Complex III: Test 3 > Flashcards

Shoulder Complex III: Test 3 Flashcards

1
Q

Rx for distinct tendonitis AND tendinosis

A

pt edu on load management

POLICED

NSAIDs

Taping/bracing

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2
Q

how do NSAIDs affect tissue healing with tendonitis/tendinosis

A

short term pain relief if acute

delays healing if the injury is at insertion

poor response and no support in persistent presentation

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3
Q

effectiveness of modalities with tendinosis/tendinitis

A

lack sufficient evidence

i.e iontophoresis, ultrasound, phonophoresis, and low level laser treatment

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4
Q

MT performed with tendinosis

A

restores accessory motion as needed

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5
Q

primary purposes of MET with tendinosis

A

tendon proliferation

possibly spinal stabilization with regional interdependence

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6
Q

MET parameters with tendinosis

A

implement after acuity settles

heavy loads

slower eccentrics

possibly 3 sec muscle actions (concentric, then iso, then eccentric)

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7
Q

sets/reps parameters with tendinosis

A

2-3 sets 10-15 reps to fatigue

2-3 exercises with involved tendon

activity response

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8
Q

what does research say about activity response parameters for tendinosis MET

A

mild/moderate increase in pain- possibly up to 5/10

timeframe: pain should go back to baseline before repeating exercises 24-48 hours

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9
Q

how long should a tendinosis exercise program be

A

8-12 weeks

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10
Q

precautions for heavy loads with tendinosis MET

A

deconditioned population

peri-pubescent population until growth plates fuse

locations: humeral head epiphysis at shoulder; last to fuse are ASIS, ischial tuberosity, and base of 5th MT

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11
Q

complications of tendinosis

A

predisposition or prevalence of failed healing

obesity; excess fat absorbs inflammatory cells away from tendon

diabetes; excess glucose impairs collagen production and remodeling

low grade inflammation limits proliferation and remodeling

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12
Q

MD Rx for distinct tendon tendinosis

A

cortisone injections = short term benefits

glycerin trinitrate patches effective by increasing circulation

sclerosing injections to stiffen tendon for pain relief

surgical debridement (expensive/modest success)

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13
Q

PT Rx for impingement

A

POLICED

modalities

scap taping

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14
Q

are modalities beneficial for impingement

A

most not beneficial

US, LASER, and extra corporal shockwave lack evidence

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15
Q

scap taping benefits for impingement

A

improved short term taping

may provide earlier window for MET and limit ADL provocation

no difference at 6 weeks

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16
Q

benefits of JM for impingement

A

strong reccomendation

GH jt especially

17
Q

how do thoracic spine JM help with impingement

A

accelerated recovery and reduced pain and disability immediately vs usual care

18
Q

MET dosage for impingement

A

high dosage is superior to the conventional low dose exercises

primary treatment option should be MET

19
Q

MET for impingement with tendinosis

A

cuff and scapular exercises
HEP with supporting PT visits
MET parameters for tendinosis 1-2x/day
post GH JM

20
Q

3 months result for impingement with tendinosis with proper MET Rx

A

at 3 months:
-70% improved pain/fxn compared to 25% with traditional exercises
-reduced need for subacromial decompression

21
Q

avg symptom duration for tendinosis

A

41 months

22
Q

what specific muscle do we want to target with impingement syndrome with tendinosis that lasted 41+ months

A

supraspinatus

target with eccentric control with a pulley

23
Q

evidence for cortisone injections for impingement syndrome

A

conflicting

24
Q

what is subacromial decompression for impingement syndrome

A

partial anterior acromioplasty due to hooking

distal clavicle resection and coracoclavicular ligament resection

25
Q

outcomes of subacromial decompression

A

equally or no more effective than exercise aline

expensive

no important benefits or differences with pain, function, etc

26
Q

recommendation on performance of subacromial decompression

A

should not be performed if atraumatic and present more than 3 months (aka tendinosis)

27
Q

what is regional dependence

A

theory that differing body regions are biomechanically and neurophysiologically interdependent and impairment in one region can lead to impairment in another (especially if persistent)

28
Q

central mechanisms for regional interdependence

A

motor cortex may play a role

29
Q

where might there be lower strength with persistent neck pain

A

in neck, shoulder, and scapular region

coexisting LBP is a risk factor for neck pain

30
Q

what should be recruited with overhead reaching

A

flexors, abductors, and ERs act concentrically

extensors, adductors and Its act eccentrically

all should relax at rest

31
Q

most common segment issue causing regional interdependence

A

C5-6

32
Q

what happens with dysfunction with overhead reaching

A

excessively recruited IRs that share innervation from C6 with C5,6 jt

inhibition and protective hypertonicity of ERs and depressors

imbalances of position and muscle activity limits optimal motion

excessively recruited scapular elevators that share innervation from C3 with C2-C3 jt

GH and AC joints may also compensate with hyper mobility/instability

33
Q

results of excessively recruited IRs that occur with overhead reach

A

humeral head is pulled anterior of coracoid

tension created underneath long head of biceps tendon that may lead to possible tendinopathy

34
Q

what happens as a result of inhibition and protective hypertonicity of ERs that occurs with dysfunctional overhead reach

A

greater tubercle won’t efficiently move fully out from under the acromion

impingement of supraspinatus and long head of biceps tendon that may lead to tendinopathy

35
Q

what happens as a result of excessively recruited scapular elevators that occur with dysfunctional overhead reach

A

scapula elevated or elevation compensated

creates excess tension and compression on supraspinatus

36
Q

what happens as a result of inhibition and hypertonicity of depressors that occurs with dysfunctional overhead reach

A

scapula won’t depress efficiently

impingement especially over 150 degrees

supraspinatus and LHB will impinge and may lead to tendinopathy

37
Q

Rx for regional interdependence

A

growing body of evidence that resting one area, especially the spine, can influence outcomes at another area that may seem unrelated

DPT 730: MSK (14 decks)

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