Shoulder Diagnosis and Treat Flashcards
What’s the main difference between medical and physical therapy based diagnosis?
Medical is health condition based, PT is body function and structure based.
What general concepts are important to consider (according to Reinold) with procedural intervention?
- Need to address multi-systems (vitals, vascularity, senses, motor control)
- Interventions are frequently multi-phasic (progression)
- Patients’ anatomy, pathoanatomy, biomechanics, and impairments are key factors
Many factors impact intervention, name 5 (in no order of importance).
- Pre-morbid status
- Posture - Acuity level; nature/stage of healing
-Fracture
Callus -2-3 weeks
Clinical Union - 4-6 weeks
-no structures moving; different than radiological union
Consolidation - 6-8 weeks
-more maturation and resistance to force - Barriers or hindrances to healing
- age - Patient reactivity level; pain, muscle guarding, effusion, edema
- pain before / after intervention - Patient goals
When thinking about intervention, you obviously want to address the MOST important impairment first. What 3 other elements are key considerations (eluding to intervention structure)?
- Which of the patient’s impairments should be first addressed?
- Which of the four muscle performance and movement control factors above should be addressed with this patient?
-tissue specificity is important to consider
During intervention, it’s necessary to have the appropriate response to the phase of healing. Early on, maximal protection is required. How about intermediate and advanced stages of healing?
Moderate protection and return to function respectively.
Where in the available ROM are joint mobilizations done? How many oscillations and how long for treatment?
At the end of range.
If oscillating use 2-3 oscillations per second for 30-60 seconds, rest one minute, reassess, repeat until maximum gain or patient fatigue (change position, grade, and/or technique if not providing expected benefits)
There are only 3 grades of Kaltenborn mobilizations. What are they?
I: very slight distraction
II: up to the first tissue stop
III: past the first tissue stop into the plastic range
T of F. Oscillations are used all the time?
No, only with treatment.
Does a grade II Maitland go up to the 1st tissue stop? What about a grade IV?
No, II is below the first tissue stop. A grade IV oscillates above first tissue stop.
When doing mobilization with movement, describe the procedure you would take with GH ER and the parameters.
Patient in prone, working on anterior GH capsule. Put arm into maximal ER and apply anterior glide moving in and out of ER as you mobilize.
DOSE
- 30 to 60 seconds of movement
- stop, break and reflect
- did the patient react well?
- is it affecting movement?
- after 2/3/4 times there should be some advancement or gain in motion
TREATMENT
-start at the end of the range
What glide direction does active ABD take the shoulder in?
Inferior glide
When approaching interventions, what is the most common angle biomechanist take? What’s another approach?
Body structure and function (impairment level)
You could approach intervention from an Activity (function) level. Either the exercise used for body structure and function will help regain their function of the actual intervention is functionally (task or part task) based.
Ultimately, participation level gains are what people want. How would you reflect this in your goals?
By stating that the job isn’t done until the patient has regained x,y,z in participation level need.
What is practice pattern 4A and give an example of an impairment, joint mob, STM, TherEx and modality.
Skeletal Dimineralization
COMMON CAUSE
Young female athletes: amenorrhea
Post-menopausal women
JM -None STM -None TE -AAROM > AROM > PROM MOD -None
What is practice pattern 4B and give an example of an impairment, joint mob, STM, TherEx and modality.
Impaired Posture
COMMON CAUSE
congenital torticollis
-spasm of SCM creating a spasms with flexion and side rotation of the neck
-thoracic outlet syndrome
JM -Gr III and IV glides, III distractions STM -Superficial and deep MFR TE -Codman/pendulum > -flexibility > open chain MOD -thermal US
What is practice pattern 4C and give an example of an impairment, joint mob, STM, TherEx and modality.
Muscle Performance
With prolonged immobilization
- decreased tissue moisture
- increased cross linkages
COMMON CAUSES
- osteoporosis
- diabetes
JM
STM
TE
MOD
What is practice pattern 4D and give an example of an impairment, joint mob, STM, TherEx and modality.
Connective Tissue
COMMON CAUSES
- Joint subluxation or dislocation
- Ligamentous sprain
- Tendonosis
JM
STM
TE
-Body blade
MOD
What is practice pattern 4E and give an example of an impairment, joint mob, STM, TherEx and modality.
Inflammation
COMMON CAUSES
- Fascitis
- Osteoarthritis
- Tendonitis
JM
STM
-DFM
TE
MOD
-Cryotherapy, phonophoresis, electrotherapy
What is the typical progression (rough outline) for TherEx?
- AAROM ,AROM, RROM
- SHRC/AI/RS, SRH, Agonist Reversals/PRE/Tband,Isokinetic ex
- Open and closed chain activities
- Stretch - Shortening Activities leading to muscle power gains
- Concentric and eccentric control
- Functional Activities
What would a generic intervention template for hypomobility look like?
Joint mobilization techniques All glides (Gr. III &IV) & Distrx (Gr. III) Self mobilization techniques Soft tissue techniques Massage STM – superficial and deep techniques MFR techniques TherEx PROM and AAROM ® AROM Codman/pendulum exercises Cradling technique Flexibility techniques - HRAC, CR, CRAC Open and closed chain mobility exercises Concentric and eccentric control throughout ROM Modalities Thermal – continuous US, HP Preparation/compliance of tissue
What would a generic intervention template for hypermobility look like?
TherEx
AAROM ® AROM ® RROM (SHRC/AI/RS SRH/agonist reversal/Tband/PREs ® Isokinetic exercise
Use closed and open chain techniques
Supported and unsupported positions
Proprioceptive Training
Body Blade
Orthotic, Protective, Supportive devices
Sling
Taping
What would a generic intervention template for muscle weakness look like?
Reinstitution of correct scapulohumeral rhythm and control Address posture dysfunction TherEx (performed in straight and diagonal planes of movement) AAROM ® AROM ® RROM SHRC/AI/RS ® SRH, Agonist Reversals/PRE/Tband ® Isokinetic ex Open and closed chain activities Stretch - Shortening Activities Concentric and eccentric control Functional Activities Modalities NMES Biofeedback Functional Training Home, avocational, recreational training Small components into full action/motion Slower to faster speeds
During intervention, it’s possible to give different types of feedback. What are they?
- Manual correction
- Tactile feedback
- Verbal Cues
- Fade feedback progression
What is practice pattern 4G and give an example of an impairment, joint mob, STM, TherEx and modality.
Fracture
COMMON CAUSES
- Proximal humerus
- Avulsion fracture
JM
STM
TE
MOD
In clinical decision making, what must occur before anything else?
Identify the problem: PIP and nPIP.
-Next, impairments must be prioritized and interventions planned for each
What is practice pattern 4H and give an example of an impairment, joint mob, STM, TherEx and modality.
Joint Arthroplasty
COMMON CAUSES
- Glenohumeral replacement
- Reverse procedure
Most important factors: prosthetic components
-prosthetic fixation methods
With proximal humeral fractures (PHF), healing of what is predictive of the outcome following a hemiarthroplasty?
Healing of the greater and lesser tubercles.
What is practice pattern 4I and give an example of an impairment, joint mob, STM, TherEx and modality.
Bony or soft tissue surgery
COMMON CAUSES
- ORIF
- Fusions
- Connective tissue repair or reconstruction
ISSUES TO CONSIDER
- Post-op tissue integrity
- Fixation method
- Time since surgery
When addressing a clinical problem, systematically improving muscle performance is essential. What elements need to be considered?
- Strength
- Power
- Endurance
- Motor control
