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MSK 1 - Shoulder > Shoulder Complex- Tendon Rx thru Regional Interdependence > Flashcards

Shoulder Complex- Tendon Rx thru Regional Interdependence Flashcards

1
Q

What should patient education with tendons be?

A

Load management

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2
Q

What do NSAIDs do with tendon healing?

A
  • Short term pain relief in acute presentation
  • Delays healing if injury at insertion
  • poor response and no support in persistent presentation
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3
Q

What does bracing do? What are some examples?

A

decreases resistance arm
- neoprene sleeves on involved muscles / taping PRN/ straps

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4
Q

What are modalities with tendon rx? What is the issue with these?

A

Iontophoresis
ultrasound
phonophoresis
low-level laser treatment

** lack sufficient evidence

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5
Q

What is the soreness rule with ADLs?

A

Symptom reproduction is not what we want with exceptions
- ok for mild symptoms during or 24 hours after activity but NO longer

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6
Q

What is manual therapy used for with tendon rx?

A

restore accessory motion as needed

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7
Q

What should be the primary and ultimate goal for tendinosis based on what is happening?

A

Repair
collagen production
tendon proliferation
strength

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8
Q

What are the primary purposes of MET with tendinosis?

A
  • tendon proliferation
  • possible spinal stabilization if regional interdependance
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9
Q

What are the parameters for tendinosis MET?

A

Implement after any acuity settles and for all structural changes in tendon, including tears

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10
Q

What is the load for tendinosis?

A

Heavy

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11
Q

What actions do we want for tendinosis?

A

Slower eccentrics
Possibly 3 second muscle actions ( concentric/ isometric/ and eccentric)

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12
Q

What actions and ranges do we want with tendinosis?

A
  • isometric loading without compression from lengthening - in a shortened position
  • isometric loading without compression from lengthening - neutral to a shortened position
  • isotonic loading with compression from lengthening - isotonics from a. lengthened position
  • isometric loading in weigh bearing
  • plyometric loading
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13
Q

How many sets and reps with tendinosis?

A

2-3 sets of 10-15 reps to fatigue (heavy load)

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14
Q

How many exercises do we want to be doing with the involved tendon?

A

2-3

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15
Q

What increase in pain can we expect as an activity response?

A

mild to moderate - up to a 5/10

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16
Q

How long until pain should ease back to baseline levels?

A

before repeating exercises - 24-48 hours

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17
Q

How often can we repeat the exercises a week?

A

Every other day but may increase to daily in higher level patients

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18
Q

How long is the program for tendinosis?

A

8-12 weeks

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19
Q

Why would we have precautions with heavy loads to fatigue? (What populations)

A
  • deconditioned population
  • peri-pubescent population until growth plates fused
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20
Q

What growth plates do we need to fuse to do heavy loads to fatigue?

A
  • humeral head epiphysis at shoulder
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21
Q

What growth plates are the last to fuse?

A

ASIS, Ischial tube, and base of 5th metetarsal

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22
Q

What are some potential complications with tendinosis rx?

A
  • predisposition or prevalence of “failed healing response”
  • obesity = excessive fat absorbs inflammatory cells away from tendon
  • diabetes = excessive glucose impairs collagen production and remodeling
  • low grade and persistent inflammation
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23
Q

What is low grade and persistent inflammation associated with?

A

Systemic diseases and SAD

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24
Q

What does low grade inflammation and persistent inflammation limit?

A

Proliferation and remodeling

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25
Q

Are there benefits for cortisone injections for tendon rn?

A

short term benefits yes

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26
Q

What is a rx that effectively increases circulation?

A

glycerin trinitrate

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27
Q

What can stiffen the tendon for pain relief?

A

Sclerosing injections

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28
Q

why is surgical debridement less ideal and last option?

A

Expensive
modest success

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29
Q

What are some future options for tendon rx?

A

growth factors and stem cells

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30
Q

What do we need to know about modalities with impingement syndrome?

A

Most not beneficial
US, LASER, EXTRA-CORPOREAL SHOCKWAVE lack evidence

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31
Q

What can scapular taping help with?

A

Improved short term pain
an earlier window for MET and limit ADL provocation

32
Q

What do we know about Jm for impingement syndrome?

A

Strongly recommended
GH jt

33
Q

Why are earlier JM benefits throughout the cervicothoracic spine beneficial?

A

support regional interdependance

34
Q

What can JM do for the thoracic spine?

A

Accelerated recovery and reduced pain / disability immediately

35
Q

When are JMs most effective?

A

added to exercise

36
Q

How would we know if its tendinosis or not?

A

timing - 3 months / enough for changes to occur

TTP

Unsuccessful past PT

37
Q

What would happen if the condition was a mix of excess motion & tendinosis?

A

Hypermobile - coordination is impaired
- will become tendinosis eventually

38
Q

How many sets and reps of exercises for tendinosis?

A

3 sets 30 reps mild loads

39
Q

What is more superior to conventional low dose exercises for impingement syndrome?

A

High dose MET

40
Q

Which is more, kinesthetic impairment or proprioceptive?

A

Kinesthetic

-more difficult for shoulder, more symptoms the farther the arm is from the body due to a longer moment arm

41
Q

How long for us to know it’s tendinosis?

A

more than 6 months of symptoms, up to three years

42
Q

What kind of exercises should we do with tendinosis?

A

Cuff (SIT) and scapular exercises (MT/LT/Rhom/SA)

43
Q

What are the MET parameters for tendinosis?

A

1-2x a day

44
Q

What can we expect at 3 months after seeing tendinosis using proper MET parameters?

A

70% will have improved pain/function (vs. 25% with traditional exercises
- reduced need for subacromial decompression

45
Q

How long is the average symptom duration for tendinosis?

A

12 months

46
Q

What does tendinosis include?

A

Partial tears, NOT full musculotendon tears

47
Q

What do we want to focus on with MET for tendinosis involving the RC?

A

scapular eccentric control and movement patterns

48
Q

At three months how many will have improved pain? function?

A

8/10 improved pain, 10/10 improved function

49
Q

What would you do with a tendinosis case that lasts 41 months?

A

HEP & supporting PT
- targeting supraspinatus eccentric control with pulley
- MET 2x day

50
Q

How many/ what kind of tendinosis patients can we expect to avoid surgery using proper MET?

A

5 of 9 patients except those with labral tears and full tendon tears

51
Q

In what cases would we expect earlier improvements with impingement syndrome?

A

no tendinosis or tears

52
Q

Does MET as described for tendinosis provide benefits? what kind?

A

Yes LONG TERM

53
Q

Is there sufficient evidence for cortisone injections for impingement syndrome?

A

NO Conflicting evidence

54
Q

What is subacromial decompression?

A

partial anterior acromioplasty due to hooking
- distal clavicle resection and coracoclavicular ligament
- coracomial ligament resection

55
Q

What are the outcomes of a subacromial decompression?

A

Equally or NO more effective and more expensive than exercise alone
- no differences with pain, function, or quality of life vs. placebo or other intervention

56
Q

When should a subacromial decompresson not be performed?

A

if atraumatic and present less than 3 months

57
Q

What is regional interdependance?

A

Differing body regions are biomechanically and neurophysiologically interdependent and impairment in one region can contribute to impairment in another, particularly if persistent.

58
Q

What areas have significantly lower strength with persistent neck pain?

A

neck, shoulder and scapular strength
- ALSO lower hip and LB strength with persistent neck pain

59
Q

What is a risk-factor for neck pain? (co-existing pain here)

A

LBP

60
Q

What may play a role in regional interdependance?

A

Central mechanisms such as the motor cortex

61
Q

What groups do we need to reach overhead?

A
  • concentrically: flexors, ER, abductors
  • eccentrically: extensors, adductors, and IRs
  • RECRUIT WHAT YOU NEED
62
Q

What most common segment for regional interdependance?

A

c5-6 joint dysfunction

63
Q

What action is affected with C5-C6 dysfunction?

A

Overhead reaching - imbalanced

64
Q

Why is overhead reaching affected with C5-6 dysfunction?

A

Excessively recruited IRs that share innervation from C5-C6, 6 segment and inhibition of ERs

65
Q

What happens to the humeral head when reaching overhead with regional interdependance?

A

humeral head pulled anterior and into IR

66
Q

What happens when the humeral head is pulled anterior and into IR?

A

-creates excess tension and compression underneath long head of biceps
- ERs wont efficiently move humeral head and greater tubercle fully out from underneath acromion

67
Q

What can excessively recruited IRs lead to?

A

Tendinopathy

68
Q

What can happen with C2,3 jt dysfunction?

A

Also imbalance with overhead reaching

69
Q

Why is overhead reaching affected with C2,3 dysfunction?

A
  • Excessively recruited scapular elevators that share innervation from that segment
  • Inhibition of depressors
70
Q

What happens with excessively recruited scapular elevators?

A

Scapula elevated or elevation compensation
- creates excess tension and compression underneath supraspinatus tendon and tendinopathy

71
Q

What happens with inhibition of depressors while overhead reaching?

A

Scapula wont depress efficiently
- impingement especially over 150 degrees due to the SS not coming back and down out of the way
- biceps tendon also impinged

72
Q

What can the excessive recruitment of scapular elevators and inhibition of depressors lead to?

A

tendinopathy
GH and AC jt hypermobility/instability

73
Q

What do inhibited muscles develop at rest?

A

Protective hypertonicity (AKA tightness)

74
Q

What interventions are only partly healpful with inhibited muscles?

A

Symptomatic interventions such as dry needling. modalities, etc - ONLY TEMPORARY

75
Q

What do we need to address with rx for regional interdependance? (very non specific)

A

mechanics and involved tissues

76
Q

What is there a growing body of evidence for involving RX for regional interdependence?

A

Treating adjacent areas, particularly the spine, can influence outcomes at another area that may seem unrelated

MSK 1 - Shoulder (5 decks)

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