Shoulder impairments part 2 Flashcards
Outcome questionnaires for shoulder (DONT HAVE TO KNOW)
- DASH
- SPADI (Shoulder Pain and Disability Index) (the most common for shoulder specific)
- SDQ (The Shoulder Disability Questionnaire)
- The ASES (The American Shoulder and Elbow Surgeon’s Standardized Shoulder Assessment).
SLAP lesions
type of labral tear- biceps long head town away from the top of the labrum
- Superior lesion
- Humerus can dislocate anterior and superior
Depends on what activity we are doing but it doesn’t totally dislocate because other structures keep it in place but it will hurt and be painful.
Frozen Shoulder
Extremely Painful- capsule gets very thick, an inflammatory condition, gets super inflamed and thickens, hardens, and if the capsule is tight then the humeral head cant spin (cant rotate, get full motion) very painful and can get it for any reason
Diabetes, hormonal problems and thyroid conditions get it easier than most.
Risk factors for frozen shoulder
- over 40
- Diabetes
- Immobility
- Systemic diseases- over or underactive thyroid, Parkinson’s, cardiovascular disease
Adhesive Capsulitis
- Traumatic and spontaneous onset
- Freezing phase, Frozen phase, and thawing phase
- May take up to 2 years but will resolve and have close to normal motion
- Inflammatory condition: NSAIDS, cortisone injection, ice, ROM, joint mobilization, ice and IFC
- Freezing phase is the most painful phase- cannot sleep at night, shoulder gets very stiff and a lot of ROM is lost both passively and actively.
Adhesive capsulitis stages
- pain with movement and at rest and range starts to decrease
- Frozen phase: shoulder is stiff and there is marked ROM loss but less pain.
- Thawing phase: ROM slowly starts to improve
Therapeutic management of adhesive capsulitis
- anti-inflammatory modalities
- joint mobs
- education in HEP of AAROM and PROM exercises
- Scapular ROM
- Codmans Pendulums
- Sleeping posture
*no resistance, no aggressive stretching- do not cause more inflammation
medical interventions
- cortisone injection
- NSAIDS
- Cox 2 inhibitors
Manipulation or Capsular Release
- Manipulation non-invasive but high risk of injury
- Capsular release: arthroscopic capsular release
- Therapy the day of manipulation
- Therapy daily for 1 week then 3 times a week
shoulder separation
involves clavicle and ligaments
-AC joint dislocation=shoulder separation
Proximal Humeral fractures
- common fracture, especially in the elderly
- Greatest ROM increase is between 3-8 weeks
- Boney healing is typically from 6-8 weeks
- Return to normal function is between 3-4 months
*know if the fracture is stable or not stable
Proximal Humeral fractures
- the majority of humeral head and neck fractures are treated non-operatively
- most can be passively moved by the 3rd week
- mobilize as early as possible
Treatment progression-
-AAROM/PROM slides to AROM and finally resisted
Normally bones start out active but for these we can actually start passive before active.
The older the person is it may effect how soon they are referred to you.
Rockwood and Matsen 3 phases rehab
Phase 1 (0-6 weeks)- movement of affected and unaffected parts
Phase 2 (6 weeks- 2months)- early active light resistive and gentle stretching
Phase 3 (3 months+)- begin heavier strengthening
Humeral fractures
- Most patients will do well when emphasis is placed on home exercise program of AROM 6-8 times a day for 10 minutes
- prevent Codman’s hike
all of this is for fractures that are stable.
Unstable fracture
- must be immobilized or repaired
- parts can move easily- pieces can become misaligned
