Shoulder Intervention Flashcards
proliferation is also known as _______
what does this stage entail?
regeneration
revascularization / rebuilding tissue
what is needed during proliferative/regenerative phase? what does this do / what is the principle associated with it?
stimulus = promote optimal regeneration
- tissues will respond to the loads placed upon them via mechanotherapy
what is balanced during the remodeling phase
tissue synthesis and degradation
protein synthesis allows for ______? this is seen in ________?
generation of contractile proteins and increase the density of the myofiber
remodeling phase
explain the role of PT in ______ phase & days
- inflammation
- proliferation
- remodeling
protect and load within tolerance (1-6)
load within tolerance (4-24)
load it up son (21 - 2+ years)
how to facilitate self-management
help patient identify personal barriers / goals
assist in identification of optimal strategies
- avoid symptom exacerbation through problem solving
support patient / identify ways to measure effectiveness of self-management
what increases likelihood for pain behavior and disability
passive approaches
MCID for PSFS
0.8-3.0
MCID for QUICK-Dash
8.0-15.9
MCID for Penn Shoulder Scale
11.4
MCID for SPADI
- RTC
- Arthroplasty
- Adhesive Capsulitis
- Shoulder Disorders
15.4
18
8
21.5
modalities indicated for high irritability/acute shoulder treatment
heat and Estim
- pain
self-care indication for high irritability/acute shoulder treatment
pt education
- position of comfort
- activity modification to limit tissue inflammation/pain
pain management indication for high irritability/acute shoulder treatment
joint manipulation @ area / surrounding region and segments
general aerobic exercise
manual therapy indication for high irritability/acute shoulder treatment
low intensity joint mobilization in pain free accessory ranges
mobility exercise indication for high irritability/acute shoulder treatment
pain free:
PROM
AAROM
neuromuscular re-education indication for high irritability/acute shoulder treatment
biofeedback for muscle activation
muscle performance indication for high irritability/acute shoulder treatment
pain free isometrics
AROM through available range
encourage use of unaffected regions
what modalities can be implemented early in rehab process? what are they for?
e-stim
ultrasound
iontophoresis
- all for improved blood flow and decreased pain levels
early rehab submaximal exercise indication
somewhere between 5-50% of max
- increases blood flow during exercise
- hyperemia after
modality indication for moderate irritability/proliferative phase of shoulder treatment
heat and estim
- for pain as needed
self-care indication for moderate irritability/proliferative phase of shoulder treatment
pt education on progressing activities to gain motion / function w/o producing tissue inflammation or pain
pain management indication for moderate irritability/proliferative phase of shoulder treatment
joint manipulation at other regions/segments
general aerobic exercise
manual therapy indication for moderate irritability/proliferative phase of shoulder treatment
moderate intensity jt mobilization with progressed amplitude and duration into tissue resistance
—-w/o producing post treatment tissue inflammation and associated pain
stretching exercises indication for moderate irritability/proliferative phase of shoulder treatment
gentle to moderate
- progressing intensity and duration into resistance w/o producing posttreatment inflammation and pain
neuromuscular re-education indication for moderate irritability/proliferative phase of shoulder treatment
control in midrange of motion
focus on quality and control of load
integrate gains in mobility during normal scapulohumeral movements during reach activities
muscle performance indication for moderate irritability/proliferative phase of shoulder treatment
RROM through available range
use of unaffected regions
self care indication for low irritability/remodeling phase of shoulder treatment
pt education on progression to high demand functional / recreational activities
pain management indication for low irritability/remodeling phase of shoulder treatment
joint manipulation at other regions/segments as needed
manual therapy indication for low irritability/remodeling phase of shoulder treatment
end range jt mobs
high amplitude, long duration into tissue resistance
stretching exercise indication for low irritability/remodeling phase of shoulder treatment
progress intensity/duration into tissue resistance w/o inflammation and pain production
neuromuscular re-education indication for low irritability/remodeling phase of shoulder treatment
integrate gains of mobility into scapulohumeral motions related to performance of patient’s functional/recreational activities
muscle performance indication for low irritability/remodeling phase of shoulder treatment
functional/recreational activities that focus on progressive load and time based on pt goals
activities that stress multiple systems
general intervention concepts related to mobility deficits at shoulder
improve joint mobility
improve muscle length
retrain muscles through new range
A level interventions for Shoulder Mobility (ACapsulitis) CPG
corticosteroid injection
–> intra-articular combined with shoulder mobility and stretching for 4-6 weeks
B Level interventions in shoulder mobility (ACapsulitis) CPG
pt education
- natural course of disease description
- promotion of activity modification
- match stretch intensity to level of irritability
stretching exercise / improve muscle length
- match of intensity to level of irritability
C level intervention in shoulder mobility (ACapsulitis) CPG
modalities
- shortwave diathermy, US, estim paired with mobility and stretching exercise
joint mobilization
- GHJ to reduce pain / increase motion
translational manipulation
- under anesthesia, if not responding to conservative intervention
medical interventions for adhesive capsulitis
corticosteroids
manipulation
hydrodilation
capsular release
general intervention concepts related to muscle power deficits
match of intervention to patient’s irritability and impairments
education on activity modification
improve tissue tolerance
improve force production
normalize movement and improve kinetic chain
medical intervention
how to improve:
tissue tolerance
force production
movement in the kinetic chain
loaded active exercise
train rotator cuff muscles / scapulothroacic muscles
improve precipitating mechanics or weakness that led to pathology
medical interventions related to MPD at shoulder
oral anti-inflammatories
corticosteroid injection
surgery (stage 2-3 patho)
what is recently becoming to be supported by literature for muscle power deficits at the shoulder? how so?
scapular focused activity
- will decrease pain / disability
what general exercises can be used to improve kinetic chain ability in shoulder rehab
core exercises (closed chain)
thoracic mobality
general concepts related to movement coordination impairment interventions
improve coordination/muscle activation (no kidding)
normalization of movement
reduce stress to tissue via stabilization
reduction of stress to tissues can be done by
bracing
specific interventions related to:
– muscle activation
– normalization of movement
coordinated co-contraction
dynamic joint stability
weight bearing activities
graded loading/functional return
explain the biomechanical effects of manual therapy
small amounts of joint movement will lead to improved position and movement
explain neurophysiological effects of manual therapy on the spinal cord
pain reduction via nociceptor, dorsal horn and descending pathway inhibition of spinal cord
may also improve chemical mediators secondary to injury and CNS thresholds
– both manipulation and mobilization
explain how platelet rich plasma therapy works
cellular therapy - regenerative medicine where blood is collected, centrifuged and then reinjected into target site
initiate tissue repair through natural healing response via new connective tissue synthesis and revascularization
post-treatment guidelines following platelet rich plasma therapy
stretching around 2-7 days
strengthening around 2-3 weeks
post-injection NSAID restriction >2 weeks
return to full activity at 4-6 weeks
protection phase for rotator cuff repair
sling/abduction pillow for 2-8 weeks
no AROM / PROM at 2 weeks
no weight bearing
protective phase considerations for total shoulder replacement
Phase 1 - 0 to 6 weeks
passive/AAROM
flexion <90 degrees
ER 0-20 degrees - subscapularis protection
protective phase considerations for reverse total shoulder replacement
Phase 1 - 0 to 6 weeks
PROM/AAROM
Flex <90 (0-2wks) –> progress to 120 by 4-6 wks
ER 0-20 (0-2wks) –> progress to max of 45 by 4-6 wks
protection phase considerations for labral repair
no PROM into ER / AB, no rotation with arm above 60 abduction for 2 weeks
sling (including sleep), no bicep contraction or AAROM for 4 weeks
no ER in 90/90 for 6 weeks
no extension past trunk
