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

Shoulder Complex IV: Test 3 Flashcards

1
Q

how do gradual vs acute RC tears come about

A

gradual = degenerative or repetitive stress

acute = high velocity, heavy lifting, or impact

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2
Q

structures involved with RC tear? how are they graded?

A

most common = supra or infraspinatus

possibly others

graded by size and partial or full tear

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3
Q

how often are labrum and LHB involved with RC tear

A

40-73% involved

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4
Q

how can LHB or labrum be involved with traumatic RC tear

A

superior labral anterior/posterior (SLAP) tear
-LHB excess contraction tears labrum
-may have to surgically fixate biceps tendon (tenodesis)

OR

Compression onto labrum with FOOSH

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5
Q

how can LHB or labrum be involved with a gradual RC tear

A

repetitive stresses with/without abnormal mechanics

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6
Q

S&S of a RC tear

A

worse impingement symptoms
increased pain with repeated overhead activity
painful arc around 90
weak/painful resisted (especially FLX, ABD, ER)
possible + stress test
+ special test for cuff and maybe biceps/labrum

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7
Q

All tears cluster test involve what variables

A

> 65 years old

weak ER

night pain

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8
Q

full thickness tear cluster test involves what variables

A

greater than or equal to 60 years old

+ painful arc, drop arm, and infraspinatus test

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9
Q

test/measure for supraspinatus/infraspinatus

A

ER lag sign

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10
Q

drop arm is a high spec test for what muscle

A

supraspinatus

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11
Q

tests/measures for non specific tears

A

empty can (high sensitivity)

Jobe test

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12
Q

subscapularis tests/measures

A

lift off

belly press

bear hug

all high specificity

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13
Q

tPT Rx for RC tear

A

treat as worst case hyper mobility + tissue damage

early ROM with degenerative tears

MET ultimately for stabilization and tissue proliferation of muscle, tendon, and/or labrum

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14
Q

biggest predictor of a tear going to sx is what

A

patients negative perception

regardless of size, retraction, fatty infiltration, age or pain

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15
Q

effectiveness fo corticosteroid injections with RC tear

A

no evidence of effectiveness within 4 weeks of shot

only provides transient relief compared to placebo

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16
Q

describe arthroscopic procedures with arthroplasty for RC tear

A

sewing of fibers back together and reattaching to bone

Full ROM is ensured while under anesthesia

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17
Q

MD Rx for degenerative RC tears

A

PT has successful outcomes without sx (especially with small/partial tears)

surgery = good clinical outcome with P!, ROM, strength, and quality of life and sleep

radiological outcomes not as good

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18
Q

PT effectiveness for acute small to medium tears

A

may help

if not progressing well delays are associated with poor surgical outcomes

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19
Q

surgery effectiveness for small to medium acute tears

A

no difference from PT or slightly more beneficial

more critical in young patients due to higher activity levels

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20
Q

PT effectiveness for multi tendon or massive full thickness tears

A

may help especially in low demand pt or those unfit for sx

increased likelihood of tear progression and arthropathy

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21
Q

effectiveness fo sx for multi tendon or massive full thickness tears

A

challenging with various options

80% satisfaction rate

22
Q

when are joint replacements usually used

A

with irreparable tears

23
Q

when is reverse total shoulder arthroplasty (RTSA) superior

A

superior to hemiarthroplasty in terms of pain relief, function, and active elevation

24
Q

what happens to the joint architecture with a RTSA

A

convex concave joint relationship is reversed

25
Q

outcomes of RTSA

A

90% able to participate in sports without significant restriction if the activity was performed preoperatively (i.e. swim, gold, cycling)

26
Q

Rehab protocol and highlights for RC tear

A

criterion AND time based = best

bracing in 15 degrees ER

TENS for pain

get moving

supervised PT = beneficial

early isometric loading

27
Q

factors for a favorable prognosis after surgery

A

younger
male
higher bone density
no diabetes/obesity
higher fitness level
greater pre-op ROM
smaller or single tear
less retraction/fatty filtration
no biceps/AC involvement

28
Q

functional questionarires for frozen shoulder contracture syndrome

A

DASH = disability of the arm, shoulder, and hand
ASES = American shoulder and elbow surgeons shoulder scale
SPADI= shoulder pain and disability index

29
Q

incidence of frozen shoulder

A

2-5.3%

frequently misdiagnosed with any multi directional limitation in ROM

30
Q

risk factors for frozen shoulder

A

females
hypothyroidism
40-65 years of age
previous adhesive capsulitis
diabetes
family Hx

31
Q

etiology of frozen shoulder

A

primary = due to pathology, especially autoimmune

secondary = concomitant injury and period of immobilization

32
Q

pathogenesis of frozen shoulder

A

more often = inflammation of GH joint capsule (persistent inflammation or fibrosis)

possibly also reduced joint volume

33
Q

structures involved with frozen shoulder

A

GH capsule and ligaments

joint space

34
Q

symptoms of frozen shoulder

A

gradual/progressive

functional limits with reaching, sleep, and other basic ADLs

35
Q

symptoms, irritability, ROM, and end feel of stage I frozen shoulder (initial stage)

A

symptoms = gradual; achy at rest, sharp with use; night pain; unable to lie on involved side

high irritability

AROM<PROM

empty/painful end feel

36
Q

symptoms, irritability, ROM, and end feel of stage II frozen shoulder (freezing stage)

A

symptoms = constant pain especially at night

high irritability

mod-severe limits; AROM < PROM

empty/painful end feel

37
Q

symptoms, irritability, ROM, and end feel of stage III frozen shoulder (frozen stage)

A

symptoms = stiffness more than pain; some intermittent pain

moderately irritable

mod-severe limits in ROM with pain at end range; similar AROM and PROM

firm end feel

38
Q

symptoms, irritability, ROM, and end feel of stage IV frozen shoulder (thawing stage)

A

symptoms = minimal to no pain

low irritability

ROM gradually improves

firm end feel

39
Q

tests/measures for frozen shoulder

A

no definitive gold standard

mainly by exclusion

normal radiographs

clinical presentation is most common evidence: early dx is very difficult due to irritability

40
Q

PT Rx for frozen shoulder

A

POLICED

pt edu
-describe natural course of 4 stages
-match intensity of stretching, JM with S&S as always

41
Q

modalities effectiveness for frozen shoulder

A

cryotherapy = additional benefit to JM and modalities for Pain/ROM/function

LASER=evidence for short term and long term functional changes

weak if any evidence for diathermy, ultrasound, and e-stim

42
Q

effectiveness of JM for pain and ROM with frozen shoulder

A

Grade III-V = mod evidence for short and long term benefits

inconsistent benefit for ROM when added to exercise

conflicting evidence

43
Q

effectiveness of STM for ROM/flexibility for frozen shoulder

A

moderate evidence

44
Q

PT MET Rx for frozen shoulder

A

focus primarily on elasticity and mobility increases

also offset disuse, particularly with inhibited muscles

multimodal approach is effective for most patients

45
Q

oral steroids effectiveness for frozen shoulder

A

moderate evidence for short term

46
Q

effectiveness for cortisone injection for frozen shoulder

A

short and mid term benefit

short term when added to therex and JMs

47
Q

effectiveness of manipulation under anesthesia for frozen shoulder

A

questionable effectiveness

recalcitrant conditions respond well

no difference to exercise alone

48
Q

how long does stage I frozen shoulder last

A

1-2 months

49
Q

the course of pain and mobility deficits for frozen shoulder may last up to how long

A

12-18 months

50
Q

general prognosis for frozen shoulder

A

most patients achieve minimal symptoms/deficits with treatment

51
Q

if untreated, what may occur with frozen shoulder

A

may resolve after 12-42 months

about 50% with pain lasting out to 4.5-7 years

DPT 730: MSK (14 decks)

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