Shoulder Complex III: Test 3

Question 1

Rx for distinct tendonitis AND tendinosis

Answer 1

pt edu on load management

POLICED

NSAIDs

Taping/bracing

Question 2

how do NSAIDs affect tissue healing with tendonitis/tendinosis

Answer 2

short term pain relief if acute

delays healing if the injury is at insertion

poor response and no support in persistent presentation

Question 3

effectiveness of modalities with tendinosis/tendinitis

Answer 3

lack sufficient evidence

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

Question 4

MT performed with tendinosis

Answer 4

restores accessory motion as needed

Question 5

primary purposes of MET with tendinosis

Answer 5

tendon proliferation

possibly spinal stabilization with regional interdependence

Question 6

MET parameters with tendinosis

Answer 6

implement after acuity settles

heavy loads

slower eccentrics

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

Question 7

sets/reps parameters with tendinosis

Answer 7

2-3 sets 10-15 reps to fatigue

2-3 exercises with involved tendon

activity response

Question 8

what does research say about activity response parameters for tendinosis MET

Answer 8

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

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

Question 9

how long should a tendinosis exercise program be

Answer 9

8-12 weeks

Question 10

precautions for heavy loads with tendinosis MET

Answer 10

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

Question 11

complications of tendinosis

Answer 11

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

Question 12

MD Rx for distinct tendon tendinosis

Answer 12

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)

Question 13

PT Rx for impingement

Answer 13

POLICED

modalities

scap taping

Question 14

are modalities beneficial for impingement

Answer 14

most not beneficial

US, LASER, and extra corporal shockwave lack evidence

Question 15

scap taping benefits for impingement

Answer 15

improved short term taping

may provide earlier window for MET and limit ADL provocation

no difference at 6 weeks

Question 16

benefits of JM for impingement

Answer 16

strong reccomendation

GH jt especially

Question 17

how do thoracic spine JM help with impingement

Answer 17

accelerated recovery and reduced pain and disability immediately vs usual care

Question 18

MET dosage for impingement

Answer 18

high dosage is superior to the conventional low dose exercises

primary treatment option should be MET

Question 19

MET for impingement with tendinosis

Answer 19

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

Question 20

3 months result for impingement with tendinosis with proper MET Rx

Answer 20

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

Question 21

avg symptom duration for tendinosis

Answer 21

41 months

Question 22

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

Answer 22

supraspinatus

target with eccentric control with a pulley

Question 23

evidence for cortisone injections for impingement syndrome

Answer 23

conflicting

Question 24

what is subacromial decompression for impingement syndrome

Answer 24

partial anterior acromioplasty due to hooking

distal clavicle resection and coracoclavicular ligament resection

Question 25

outcomes of subacromial decompression

Answer 25

equally or no more effective than exercise aline expensive no important benefits or differences with pain, function, etc

Question 26

recommendation on performance of subacromial decompression

Answer 26

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

Question 27

what is regional dependence

Answer 27

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

Question 28

central mechanisms for regional interdependence

Answer 28

motor cortex may play a role

Question 29

where might there be lower strength with persistent neck pain

Answer 29

in neck, shoulder, and scapular region coexisting LBP is a risk factor for neck pain

Question 30

what should be recruited with overhead reaching

Answer 30

flexors, abductors, and ERs act concentrically extensors, adductors and Its act eccentrically all should relax at rest

Question 31

most common segment issue causing regional interdependence

Answer 31

C5-6

Question 32

what happens with dysfunction with overhead reaching

Answer 32

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

Question 33

results of excessively recruited IRs that occur with overhead reach

Answer 33

humeral head is pulled anterior of coracoid tension created underneath long head of biceps tendon that may lead to possible tendinopathy

Question 34

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

Answer 34

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

Question 35

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

Answer 35

scapula elevated or elevation compensated creates excess tension and compression on supraspinatus

Question 36

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

Answer 36

scapula won't depress efficiently impingement especially over 150 degrees supraspinatus and LHB will impinge and may lead to tendinopathy

Question 37

Rx for regional interdependence

Answer 37

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