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Musculoskeletal 1 > Shoulder hypo mobility > Flashcards

Shoulder hypo mobility Flashcards

1
Q

What is the abnormal capsular end feel and capsular pattern of a hypo mobile shoulder

A
  • Abnormal capsular end feels: abnormal - sit without creep, leather like
  • Capsular pattern: GH limitation of ER>ABD>IR
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2
Q

Joint assessments of a hypo mobile shoulder

A

Quality, quantity
Joint play, accessory/component motions – limited

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3
Q

Shoulder hypomobility presents as?

A
  1. Joint restriction:
    - Capsular ligamentous tightness
    - AROM = PROM
    - Pain at the end ranges
  2. Muscle tightness
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4
Q

What are the typical causes of hypomobility

A
  • post trauma/injury or surgery
  • protection, immobilization, habitual poor posture
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5
Q

Post trauma/injury or post surgery - tissue repair phase 2:

A
  • : proliferation: peaks 3 weeks tapers 3-6 weeks
  • Controlled mobility: tissue healing, protocol may restrict range
  • Want controlled mobility here while the tissue is being laid down to make it more extensible and align the fibers
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6
Q

Post trauma/injury or post surgery - tissue repair phase 3

A
  • maturation:
  • Window of 14 weeks best influence on scar tissue mobility
  • Progressive - prevent non-yielding scar tissue
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7
Q

Protection, immobilization, habitual poor posture

A
  • Adaptive shortening
  • Hypomobile: involved joint or adjacent joint
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8
Q

Cause of adhesive capsulitis/frozen shoulder

A
  • Cause: idiopathic/insidious onset
  • Generally occurs post injury or post surgery due to immobilization/protection
  • Post surgery - shoulder, cardiac, abdominal
  • Inflammatory process
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9
Q

Incidence of adhesive capsulitis

A
  • Older population: age 40-60
  • Females more likely to get it than males
  • Greater risk patients: diabetes, thyroid disease
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10
Q

Classification types of adhesive capsulitis

A
  • primary
  • secondary
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11
Q

Primary adhesive capsulitis

A
  • idiopathic
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12
Q

secondary adhesive capsulitis

A
  • systemic
  • extrinsic
  • intrinsic
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13
Q

Secondary adhesive capsulitis: systemic

A
  • diabetes
  • thyroid disease
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14
Q

extrinsic secondary adhesive capsulitis

A
  • Humerus shaft fracture
  • CVA
  • Cardiac surgery
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15
Q

Intrinsic secondary adhesive capsulitis casues

A
  • rotator cuff or long head of biceps tendonitis or tear
  • shoulder surgery
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16
Q

Pathogenesis/clinical manifestations of adhesive capsulitis

A
  • Contracture of capsule and ligaments
  • Inflammatory synovitis → capsule fibrosis
  • Capsule fibrosis notes upon arthroscopy (there are certain areas where these are generally located) -Coracohumeral ligament, Capsular ligament, Axillary pouch
  • Shoulder contracture
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17
Q

Limited motion for adhesive capsulitis

A
  • Capsular pattern for shoulder = ER limited > abduction limited > IR
  • Diminished joint play and accessory motions
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18
Q

What are the stages of adhesive capsulitis

A
  • freezing
  • frozen
  • thawing
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19
Q

Freezing stage of adhesive capsulitis - time frame
- signs and symptoms

A
  • 2.5-9 months
  • Inflammatory synovitis
  • Pain at rest
  • ROM progressively decreasing
  • Empty end feel → wont let you move it they are in too much pain
  • High irritability classification
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20
Q

Frozen phase of adhesive capsultits
- time Frame
- signs and symptoms

A
  • 4-12 months:
  • Fibrosis adhesions in joint capsule (capsular fibrosis)
  • Decreased ROM capsule pattern (ER>ABD>IR)
  • Pain at end ranges
  • See RC, deltoid atrophy due to decrease use
  • No inflammation
  • Moderate irritability classification
21
Q

Thawing phase of adhesive capsulitis

A
  • 2-24 months
  • No inflammatory synovitis
  • ROM improving: no/minimal pain except at end ranges
  • Returning to function
  • Low irritability classification
22
Q

What is the irritability classifications (adhesive capsulitis

A
  • high irritability
  • moderate irritability
  • low irritability
23
Q

High irritability classification

A
  • Pain: 7 or higher + night and resting pain
  • Disability score: high DASH
  • End range pain: prior to reaching end range
  • AROM < PROM secondary to pain (they do not want to initiate pain)
24
Q

Moderate irritability classification

A
  • Pain: 4-6 + intermittent night and rest pain
  • Diability score: moderate DASH score
  • Pain at end range ROM
  • AROM ~ PROM
25
Low irritability classification
- Pain 3 or less + no night or resting pain - Disability score: low DASH - Minimal pain with end ROM or over pressure - AROM = PROM
26
GH joint play
- GH lateral distraction that can turn into treatment - Looks at extensibility of capsule
27
Arthrokinematics glides
- can also turn into treatment - mobs
28
Inferior glide is needed for what movements
- elevation, abduction, posterior elevation, flexion
29
Anterior glide is needed for what movements
- ER, H abd, extension
30
Posterior glide needed for what motions
- IR, flexion, Hadduction
31
SC joint in - vertical plane - transverse place
- Vertical plan: convex on concave - Transverse plan: concave on convex
32
Joint play assessment of SC joint
- Elevation: inferior glide of clavicular head - Retraction: posterior glide of clavicular head - Protraction: anterior glide of clavicular head - Closed pack: full abduction with full ER
33
SC joint injury
- Rare usually fracture clavicle - Exam: ROM, joint play, strength, palation
34
medical Intervention for SC joint injury
- Partial tearing: rest, immobilization for healing, f/b ROM, exercise - Complete tearing: instability - Surgery, prevent clavicle posterior migration
35
AC joint: supporting ligaments
- acromioclavicular ligament - Coracoclavicular ligament (conoid/trapezoid)
36
Joint play of AC joint
- Assess and can turn into treatment - 2 glides of clavicle on acromion (follow joint plane) - posterior/superior glide - anterior /inferior glide
37
Separated shoulder | What is it and how is it classifyed?
- Step off deformity - Grade 1: acromioclavicular ligament sprain (stretched) - Grade 2: acromioclavicular ligament torn but coracoclavicular ligament sprained - Grade 3: acromioclavicular ligament torn and coracoclavicular ligament torn
38
AC joint injury presentation
- Protect arm held IR and adducted - AC, SC shrug shoulders, protract, retract pain - ACJ ROM = painful arc 140 and above - Increase AC joint play - Palpation AC joint - pain, crepitus, swelling - Decrease strength of shoulder - muscle inhibition
39
Special test for AC joint injury
- +step off deformity +cross over test + AC shear test
40
Fractured clavicle
- Can cause brachial plexus injury or injury to subclavian artery and or vein - Immobilize to heal, surgery not common - Malalignment can compress brachial plexus - Can get swelling down into the UE → move wrist, forearm and shoulder to decrease some swelling and decrease ROM losses
41
Examination of shoulder complex for a clavicle fracture
- As healing allows - Assess ROM and mobility of AC, SC, GH joint - Assess strength of shoulder complex - Note an possible brachial plexus Signs and symptoms
42
Clavicle fracture once healed interventions
- Shoulder complex mobility - ROM - PROM → AAROM → AROM - AC, SC, GH joint mobs as needed
43
What to restore for a clavicle fracture
- Strength of shoulder complex - Submax, multiangle isometrics → AROM, Isotonic
44
Treatment for high irritability classification for shoulder hypomobility - modalities - activity modification - ROM - Manual tech - strength - function - other
- Modalities: yes - Activity modification: yes (don't want to create pain) - ROM, stretch: 5 seconds, pain free, PROM/AAROM - Manual tech: low grade (1 or 2) - Strength: not many - Function: min - low function - Other: steroid injection 4-6 weeks relief
45
what is open pack position for the shoulder
- 55 abduction - 35 ER
46
treatment for Moderate Irritability classification - Modalities: - Activity modification: - ROM, stretch: - Manual tech: - Strength: - Function - Other:
- Modalities: yes - Activity modification: yes - ROM, stretch: 15 seconds PROM, AAROM, AROM - Manual tech: Low to high grades - Strength: not many - Function: basic with pain at end ranges - Other: n/a
47
treatment for Low irritability classification modalities: Activity modification ROM Manual tech Strength Function Other
- Modalities: n/a - Activity modification: n/a - ROM, stretch: end ranges over pressure, TERT - Manual tech: high grade - Strength: increase resistance - Function: high - Other: n/a
48
General treatment outline for hypo mobile shoulder
- Warm up: modalities, easy ROM - Mobilizations: joint distraction, arthrokinematic glides - Stretching TERT - PROM, AAROM, AROM - Strength progression in available range, Isometric submax, multi-angle, AAROM, AROM, isotonic - HEP
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Musculoskeletal 1 (42 decks)

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