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

Shoulder Complex V: Test 3 Flashcards

1
Q

prevalence of dislocation

A

GH is most commonly dislocated joint

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2
Q

cause of anterior GH dislocation

A

most common

mechanism = ER and ABD with FOOSH

anterior inferior direction

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3
Q

cause of posterior GH dislocation

A

less common (2-4%)

mechanism = 90 degrees of flexion with FOOSH

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4
Q

structures involved with dislocation

A

stretch/tear capsule/ligaments

possibly labrum (bankart lesion)

possibly SLAP

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5
Q

describe fibrocartilage

A

thicker and concave vs. articular cartilage

outer = thick

inner = thin

widens and deepens joint surface

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6
Q

locations of fibrocartilage

A

shoulder and hip labrum

SC, tibiofemoral, AC, ulnotriquetral, intervertebral, and pubic symphysis joints

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7
Q

cells of fibrocartilage

A

fibro and chondrocytes

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8
Q

what collagen makes up fibrocartilage

A

outer = mainly type I
-resist tension for stabilization
-majority type in all fibrocartilage including labrum

inner = lesser type II, III, and IV
-resist compression for shock absorption

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9
Q

vascularity of fibrocartilage

A

outer = vascular and neural; attributes to proprioception/kinesthesia like ligaments/annulus for stabilization

inner = hypo vascular/hypo neural/alymphatic

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10
Q

etiology of fibrocartilage damage

A

tears including possibly with RTC/dislocations

gradual/repetitive stresses including impingement

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11
Q

describe the healing of fibrocartilage

A

better in periphery

tensile strength initially improves at 3-5 weeks

even greater strength when dense fibrous tissue fills in at 8-12 weeks `

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12
Q

MET focus for distinctive fibrocartilage

A

tissue integrity/proliferation with vascularity issues

stabilization due to stabilizing role of fibrocartilage

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13
Q

other possible damages/involved structures with dislocation

A

fx aka hill Sachs lesion = compression fracture of humeral head

RC tears

neuromuscular structure compromise

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14
Q

symptoms fo dislocation

A

trauma in characteristic position

acute presentation

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15
Q

signs fo dislocation

A

ROM = limit/pain in most directions

RST/MMT = weak/pain in most directions

stress levels = likely + depending on structure involved

possibly + special tests for labrum

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16
Q

what are the special tests for the labrum

A

anterior instability (+ apprehension, + relocation)

anterior labrum (speeds test)

posterior inferior labrum (jerk test)

SLAP

17
Q

special tests for fx

A

olecranon-manubrium percussion test

bony apprehension test

18
Q

PT Rx for dislocation

A

immobilization up to 6 weeks

improve RC activation with contralateral UE use and ips hand squeezing activities

POLICED

19
Q

shorter immobilization periods favor what with dislocation

A

muscle integrity
proprioception
peripheral and central neural activity
dynamic stability

20
Q

MET focus for dislocation

A

stabilization
tissue integrity and proliferation

for anterior dislocation ER, FLX, and ABD are initially contraindicated so do isometrics/isotonics into opposite directions

21
Q

prognosis for shoulder dislocation

A

recurrent dislocations are highly likely of over 30 years old

remember healing of all potentially involved tissue

22
Q

MD Rx for dislocation

A

arthroscopic or open procedure

typically 3-6 month prognosis

Full ROM under anesthesia

follow protocols

23
Q

what is a coracoid transfer

A

reposition of coracoid process and coracobrahcialis and short biceps head to GH neck

24
Q

what is a capsular shift

A

aka capsuloraphy

most commonly done

overlap of torn portions of capsule folds

25
Q

prevalence and etiology of proximal humeral fx

A

common in elderly

FOOSH

involves surgical humeral neck

26
Q

complications present with proximal humeral fracture

A

axillary artery damage = cold/blanche; EMERGENCY; possibly avascular necrosis

adhesive capsulitis from prolonged immobilization

27
Q

etiology of clavicular fracture

A

compression mechanism thru long axis of clavicle

28
Q

location of clavicular fx

A

weak spot at S curve

28
Q

location of clavicular fx

A

weak spot at S curve

29
Q

complications with clavicular fx

A

large displacement may require sx

epiphyseal plate injury as it is the last bone to ossify at 18-25 years of age

30
Q

PT Rx for fx

A

start after clinical union between 4-8 weeks

pain usually not from bone

PT focus on consequences fo prolonged immobilization

31
Q

what is proximal humeral apophysitis

A

aka little league shoulder

rare

most commonly in males/overhead throwers

growth + high activity

32
Q

pathomechanics of proximal humeral apophysitis

A

bone growth > RC lengthening
increased tendon tension
Growth plate = weak spot
most often inflammation
complications = avulsion and/or premature closure

33
Q

symptoms of proximal humeral apophysitis

A

gradual onset of shoulder pain with overuse

“pop” may indicate trauma/avulsion

34
Q

signs of proximal humeral apophysitis

A

impingement like

RST/MMT and lower ER:IR strength ratio in adolescent athletes with GIRD >1

+ impingement test
up to 30% with GIRD > 1

TTP over antero- and posterolateral aspects of proximal humerus (MOST COMMON SIGN)

35
Q

PT Rx for Proximal humeral apophysitis cues

A

pt edu
-soreness rul
-load management
-mvmt (i.e. throwing cues)

POLICED

normalize motion (i.e. improve GIRD ratio)

careful with prolonged stretch

return to play program

36
Q

MET for proximal humeral apophysistis

A

cuff and also trial, scapular, and LE impairments

caution with muscle/tendons attached to growth plate

37
Q

prognosis for proximal humeral apophysitis

A

most return to preinjury levels and as early as 2 months but possibly up to 2-8 months

about 4.5 months to return to competition with an avulsion

growth plate typically closes between 16-20 years old

can become a recurrent/persistent problem

DPT 730: MSK (14 decks)

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