Shoulder Complex- Tendon Rx through Regional Interdependence Flashcards
With Tendon Rx, what are the treatment options?
Pt. education about load management
POLICED
NSAIDS
Bracing/taping
With Tendon Rx, NSAIDS are a ____-_____ relief in _______ presentation
short-term
acute
Which tendon Rx has a poor response and no support in persistent presentation?
NSAIDS
With NSAIDS, it _______ healing if injury is at the insertion
delays
With Tendon Rx, modalities such as : iontophoresis, ultrasound, phonophresis, and low-level laser treatment, it _______ sufficient evidence
A. gains
B. lacks
C. acquires
B.
With tendinosis, what is the soreness rule?
Soreness begins after 8-12 hours of exercise and can last up to 24-48 hours
With tendinosis, ________ therapy can restore accessory motion as needed
manual
What should be the primary goal for tendinosis with MET?
proliferating the tendon and possible spinal stabilization (if regional interdependence)
With tendinosis, you should implement MET after any ________ settles and for ALL _______ changes in the tendon (including tears)
acuity; structural
Which of the following are the ideal and ultimate sets, repetitions, and loads to improve a tendinosis condition?
A. 2-3 sets of 10-15 repetitions with heavy loads
B. 2-3 sets of 20-25 repetitions with heavy loadS
C. 2-3 sets of 10-15 repetitions with moderate loads
D. 1-2 sets of 10-15 repetitions with moderate loads
A.
For tendinosis, ________ eccentrics are encouraged
slower
Isometric loading without compression from lengthening, the isometrics are in a ___________ position
shortened
Isotonic loading without compression from lengthening, the isotonics from __________ into shortened position
neutral
Isotonic loading with compression from lengthening, isotonics loading from a __________ position
lengthened
What are examples of isometric loading in weight bearing?
UE weight shifting, planks, push ups
What are examples of plyometric loading?
ball bounces, tosses, and throwing
With tendinosis, activity response can have a ______ to _______ increase in P! (possibly 5/10)
mild; moderate
What is the time frame for MET with tendinosis?
8-12 week program
What are some precautions with heavy loads for MET and tendinosis?
deconditioned population
young people (growth plates)
What could complicate the healing response for tendinosis?
obesity- excessive fat absorbs inflammatory cells way from the tendon
diabetes- excessive glucose impairs collagen production and remodeling
low grade and persistent inflammation- associated with SAD diet and systemic disease/ limits proliferation and remodeling
MD Rx: Cortisone injections are a _____-_____ benefit
short-term
MD Rx: Glycerin trinitrate patches effective by increasing ___________
circulation
MD Rx: Sclerosing injections help to ________ tendon for P! relief
stiffen
What is the last option for MD Rx with Tendon conditions?
surgery
What are the PT Rx for impingement syndrome?
POLICED, modalities, and scapular taping
US, LASER, Extra-corporeal shockwave _________ evidence with impingement syndrome
lack
Scapular taping improved _____ ______ P!
short term
What is the strongest manual PT Rx recommendation at GH joint?
JM
With JM in the thoracic spine, it had an _________ recovery and ________ P! and disability immediately vs usual care
accelerated; reduced
JM added with exercise are _______ effective than exercise alone
more
What is the primary treatment option for impingement syndrome?
MET
With MET and tendinosis, it has to be > than ____ months of symtoms
6
With MET and tendinosis, it should include ______ and _______ exercises
RC and scapular exercises (MT/LT/Rhom/SA)
With MET and tendinosis, your patient should have an ______ with supporting PT visits
HEP
At 3 months, there should be ____% improved P! function with MET
70
What is the prognosis typically for impingement syndrome?
earlier improvements, if no tendinosis or tears
MD Rx: With subacromial decompression, there is partial ______ acromioplasty due to hooking
anterior
With subacromial decompression, there is distal ________ resection and ________ ligament
clavicle; coracocclavicular
Subacromial depression should NOT be performed if _______ and present > ___ months
atraumatic; 3
____________ is when differing body regions are biomechanically and neurophysiologically interdependent and impairment in one region can contribute to impairment in another, particularly if persistent
regional interdependence
A pt. will have significant lower strength in what 3 areas when persistent with neck pain?
neck, shd, and scapula
Lower ____ and Lower ______ strength are persistent with neck P!
hip; back
Remember that co-existing ______ is a risk factor for neck P!
LBP
With regional interdependence, recruit what you need for __________ ________
overhead reaching
Where is the most common segment for dysfunction with regional interdependence?
C5-C6
Imbalanced overhead reaching: Excessively recruited ____’s share innervation from _____ with C5/6 segment and inhibition of _____’s
IR
C6
ER
With imbalanced overhead reaching, the humeral head is pulled anterior and into _____
IR
With imbalanced overhead reaching, it creates excess ______ and _______ underneath the _______ head of the biceps tendon
tension
compression
long
Imbalance with overhead reaching:
Excessively recruited scapular elevators that share innervation from _____ with C2,3 segment
C3
Imbalance with overhead reaching at C2,3 creates excess tension and compression underneath the _______ tendon
supraspinatus
With inhibition of the depressors, there will be impingement at how many degrees?
150
C2,3 jt. dysfunction: The supraspinatus and long head of Biceps tendons will impinge which can lead to __________
A. tendinosis
B. tendinopathy
C. tendinitis
B.
With the C2,3 jt. dysfunction, which two shoulder joints can lead to hypermobility/instability?
GH and AC
Inhibited mm. develop protective _______ at rest
hypertonicity aka “tightness”
With regional interdependence, address _______ and involved _______
mechanics; tissues
