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Shoulder complex Intervention Flashcards

1
Q

T/F Often early gain or maintenance of shoulder motion is the goal with shoulder intervention.

A

True

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2
Q

Examples of more “Mobility-type” shoulder injuries/disease.

A

Osteoarthropathy

Frozen shoulder

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3
Q

Examples of more “Stability-type” shoulder injuries/disease.

A

Hypermobile shoulder
SLAP
Scapular dyskinesia

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4
Q

What are 4 prognostic factors in regard to healing fractures?

A
  1. Factors affecting healing
  2. Extent of fracture
  3. Type of fracture
  4. Location of fracture
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5
Q

Consider appropriate time frames for tissue loading for fractures by doing what two things?

A
  1. Communicating with medical provider

2. Follow Medical guidelines

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6
Q

T/F Patients with RA will have a constant progression.

A

False, will present with fluctuations between remission and progression

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7
Q

What are 2 pain management considerations for patients with RA?

A
  1. Electrotherapeutic modalities

2. Thermal modalities

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8
Q

Why use Conservative strengthening/ mobility exercises for patients with RA? What should you monitor? What should you avoid?

A
  1. For pain reduction/ maintenance or improvement of ROM, address muscle performance impairments
  2. Symptoms may worsen; monitor response closely and error on side of conservatism
  3. Avoid exacerbating inflammatory response
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9
Q

What type of conservative manual therapy could you use with a RA patient?

A

Oscillatory mobs, likely beginning & mid-range

Monitor response closely if used

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10
Q

While a patient with RA is in remission, what 2 things should you focus on?

A
  1. Strength

2. Manual therapy

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11
Q

For a patient with SC joint sprain type 1 or 2, describe the protection.

A

Typically managed conservatively

3-4 days immobilization

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12
Q

For a patient with SC joint sprain type 3, describe the protection.

A

Shoulder sling or figure 8 strap 2-3 weeks f/b continued protection 2 additional weeks (more sever 2nd degree sprains as well)

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13
Q

Initially, at what range should ROM exercises be performed by patients with SC joint sprains?

A

Mid range

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14
Q

T/F Use manual therapy to address other joints that contribute to shoulder motion for a patient with SC joint sprain

A

True

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15
Q

You can address the tendinosis of a rotator cuff tendinopathy with what two types of stressing that will facilitate healing?

A
  1. Eccentrics

2. Concentric exercise (high rep/low weight/slow movements)

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16
Q

What contributing 4 factors of rotator cuff tendinopathy should you address?

A
  1. Posterior &/or inferior capsule hypomobility - Joint mobs, posterior capsule stretching
  2. Scapulothoracic coordination impairments
  3. AC/SC joint hypomobility – limit posterior tipping/upward rotation
  4. Muscle-tendon unit “tightness”
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17
Q

Why use eccentric loading for tendinosis?

A
  • Tendinosis is a decrease in parallel organization

- Eccentric loading promotes facilitates collagen fiber alignment improving tensile loading capacity and tissue strength

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18
Q

How many weeks of increased eccentric stress to a tendinosis necessary?

A

10-12 weeks

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19
Q

Full can exercise focuses on what muscle? What is the anatomical implications? Biomechanical implications?

A
  • Supraspinatus
  • Enhances scapular position and subacromial space
  • Decrease deltoid involvement
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20
Q

Prone full can exercise focuses on what muscle? What is the anatomical implications? Biomechanical implications?

A
  • Supraspinatus
  • Enhances scapular position and subacromial space
  • High posterior deltoid activity with similar supraspinatus activity
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21
Q

Side-lying ER exercise focuses on what muscle? What is the anatomical implications? Biomechanical implications?

A
  • Infraspinatus and teres minor
  • Shoulder stability and minimal capsular strain
  • Increased moment arm at 0 abduction
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22
Q

Prone ER at 90 abduction exercise focuses on what muscle? What is the anatomical implications? Biomechanical implications?

A
  • Infraspinatus and teres minor
  • Stability challenge and capsular strain
  • High EMG activity
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23
Q

ER with towel rollexercise focuses on what muscle? What is the anatomical implications? Biomechanical implications?

A
  • Infraspinatus and teres minor
  • Proper form without compensation
  • Incorporates ADD
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24
Q

IR at 0 abduction exercise focuses on what muscle? What is the anatomical implications? Biomechanical implications?

A
  • Subscap
  • Position of shoulder stability
  • Similar subscap activity between 0 and 90
25
Q

IR at 90 abduction exercise focuses on what muscle? What is the anatomical implications? Biomechanical implications?

A
  • Subscap
  • Position of shoulder instability
  • Enhances scapular position and subacromial space and less pec activity
26
Q

IR diagonal exercise focuses on what muscle? What is the anatomical implications? Biomechanical implications?

A
  • Subscap
  • More functional exercise
  • High EMG activity
27
Q

Push-up plus exercise focuses on what muscle? What is the anatomical implications? Biomechanical implications?

A
  • Serratus anterior
  • Easy position to produce resistance against protraction
  • High EMG activity
28
Q

Dynamic hug exercise focuses on what muscle? What is the anatomical implications? Biomechanical implications?

A
  • Serratus anterior
  • Perfmored below 90 abduction
  • High EMG activity
29
Q

Serratus punch 120 exercise focuses on what muscle? What is the anatomical implications? Biomechanical implications?

A
  • Serratus anterior
  • Combines protraction with upward rotation
  • High EMG activity
30
Q

The sleeper stretch is a stretch for what?

A

Stretch for subacromial pain syndrome - posterior capsule stretch

31
Q

Three things to work on with a patient with subacromial impingement (take home things)?

A
  1. Sleeping position
  2. Ergonomic training (posture at desk)
  3. Activity modification/avoidance (regular breaks/alt tasks)
32
Q

With subacromial impingement, you want to up train what muscles?

A
  1. Inferior trap
  2. Serratus Anterior (posterior tipping)
  3. Subscap (stop anterior migration of humerus)
  4. Infraspinatus and teres minor (limit superior movement of humerus)
33
Q

With subacromial impingement, you want to down train what muscles?

A
  1. Upper trap
  2. Pec major
  3. Posterior deltoid
34
Q

What is your goal for stage 1 of adhesive capsulitis? (pre-adhesive stage)

A
  1. ROM maintenance (my job to increase their job to maintain at home)
  2. pain management
35
Q

What is your goal for stage 2/3 of adhesive capsulitis? (frozen and maturation)

A
  1. ROM maintenance
  2. pain management
  3. compensation training
  4. muscle performance
  5. manage impairments following medical intervention
  6. Could be to educate patient/ establish independence with HEP (with instruction to return once thawing stage achieved as needed)
36
Q

What is your goal for stage 4 of adhesive capsulitis? (thawing)

A
  1. Improve ROM

2. muscle performance

37
Q

What education can you offer a patient with adhesive capsulitis?

A
  1. Activity modification (sleeping, lifting/carrying tech, ergonomics)
  2. activity avoidance
  3. progression of pathology
38
Q

What pain modulation can you offer a patient with adhesive capsulitis?

A
  1. Oscillations
    2 thermal modalities
  2. Ultrasound, estim with mobility/stretching
39
Q

What joints can you mobilize in for patient with adhesive capsulitis? What for?

A
  • GHJ, SCJ, ACJ, STJ, C-Spine, T-Spine

- Reduce pain and increase motion

40
Q

T/F Shoulder mobility and stretching exercises alone are better in providing short term (4-6) week pain relief than shoulder mobility and stretching exercises with intra-articular corticosteroid injections.

41
Q

If a patient with adhesive capsulitis is not responding to conservative interventions, what may be utilized?

42
Q

What muscles should be stretched in a patient with adhesive capsulitis?

A 
Upper trap
Pectoralis Major and minor
Lev Scap
SCM
Posterior Joint Capsule
43
Q

With AMBRI type shoulder instability what interventions should you focus on?

A
  1. Rotator cuff coordination/ strength/ endurance
  2. Peri-scapular coordination/ muscle performance
  3. Dynamic stabilization & proprioceptive training
  4. Activity modification as appropriate
  5. Muscular stability especially in extreme functional ranges
44
Q

With TUBS type shoulder instability what interventions should you focus on?

A
  1. Muscle performance
  2. Address other tissue injuries as appropriate
  3. Address hypomobility following immobilization period
  4. Address other hypomobility as appropriate (example; posterior G-H capsule with anterior instability)
45
Q

Conservative management of SLAP lesion includes:

A
  1. Address impairments
  2. Common intervention strategies
    - Pain management interventions
    - Rotator cuff coordination/ strength/ endurance
    - Peri-scapular coordination/ muscle performance
    - Dynamic stabilization & proprioceptive training
46
Q

When treating a bicep tendinopathy, what interventions are used?

A
  1. Pain management
  2. Eccentrics
  3. Other contributing factors
    - Posterior capsular hypomobility
    - ACJ/ SCJ hypomobility
    - Shoulder girdle coordination/ weakness
47
Q

What 3 modulations of pain are used in shoulder interventions?

A
  1. Address Guarding
  2. Joint Oscillations/ Thrust
  3. Thermal Modalities
48
Q

What 4 things focused on for interventions of mobility of shoulder?

A
  1. “Down training”
  2. Joint mobs
  3. Stretching
  4. Soft Tissue Mobilization
49
Q

What 5 things focused on for interventions of stability of shoulder?

A
  1. Coordination
  2. Endurance Training
  3. Strength Training
  4. Dynamic Stability Training
  5. Plyometrics
50
Q

T/F Massage, joint mobilization, and exercise more beneficial than exercise only for impingement syndrome

A

True, B level evidence

51
Q

T/F Joint mobilization are better than soft tissue mobs impingement syndrome

A

False, weak evidence

52
Q

T/F Higher grade mobs are better than lower for adhesive capsulitis

A

False, weak evidence

53
Q

What 5 directions for GH joint mobs?

A

Caudal (inferior)
Dorsal (posterior)
Ventral (Anterior) - prone
Traction - arm at 0 abduction and pull perpendicular from body
Long Axis Traction - arm open pack and pull caudal (inferior)

54
Q

What direction for AC joint mobs?

A

Ventral - mobilize distal clavicle and stabilize acromion

55
Q

What 2 directions for SC joint mobs?

A

Caudal (slightly lateral force) - mobilize proximal clavicle
Traction - mobilize distal clavicle and stabilize manubrium

56
Q

What are the 4 goals for coordination training of the shoulder?

A
  1. Improve proprioceptive function (mechanoreceptors, muscle spindles)
  2. Co-activation of agonists/antagonist for improved force couples
  3. Improve force dispersion in GH joint
  4. Decrease time for amortization phase (time between eccentric and concentric phases)
57
Q

What are plyometrics?

Ex for shoulder:

A

Powerful eccentric deceleration followed by fast concentric contraction
ex: rebounder throwing exercises (eccentric control with catch at end range)

58
Q

4 goals of mobility exercises?

A
  1. Pain modulation
  2. Improve guarding
  3. Improve coordination
    - Neutral position first couple of weeks
    - Then move to isometric type stability
  4. Address tissue “tightness”
    - Capsule
    - Muscle-tendon unit
59
Q

What muscles do you want to strengthen in shoulder interventions?

A
  1. Lower Trap
    Ex: PNF exercises
  2. Mid Trap
  3. Thoracic paraspinals

MSK (18 decks)

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