Shoulder Intervention Flashcards by Owen Honroth

proliferation is also known as _______
what does this stage entail?

regeneration
revascularization / rebuilding tissue

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

what is balanced during the remodeling phase

tissue synthesis and degradation

How well did you know this?

Not at all

Perfectly

protein synthesis allows for ______? this is seen in ________?

generation of contractile proteins and increase the density of the myofiber

remodeling phase

How well did you know this?

Not at all

Perfectly

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 well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

what increases likelihood for pain behavior and disability

passive approaches

How well did you know this?

Not at all

Perfectly

MCID for PSFS

0.8-3.0

How well did you know this?

Not at all

Perfectly

MCID for QUICK-Dash

8.0-15.9

How well did you know this?

Not at all

Perfectly

MCID for Penn Shoulder Scale

11.4

How well did you know this?

Not at all

Perfectly

MCID for SPADI
- RTC
- Arthroplasty
- Adhesive Capsulitis
- Shoulder Disorders

15.4

21.5

How well did you know this?

Not at all

Perfectly

modalities indicated for high irritability/acute shoulder treatment

heat and Estim
- pain

How well did you know this?

Not at all

Perfectly

self-care indication for high irritability/acute shoulder treatment

pt education
- position of comfort
- activity modification to limit tissue inflammation/pain

How well did you know this?

Not at all

Perfectly

pain management indication for high irritability/acute shoulder treatment

joint manipulation @ area / surrounding region and segments

general aerobic exercise

How well did you know this?

Not at all

Perfectly

manual therapy indication for high irritability/acute shoulder treatment

low intensity joint mobilization in pain free accessory ranges

How well did you know this?

Not at all

Perfectly

mobility exercise indication for high irritability/acute shoulder treatment

pain free:
PROM
AAROM

How well did you know this?

Not at all

Perfectly

neuromuscular re-education indication for high irritability/acute shoulder treatment

biofeedback for muscle activation

How well did you know this?

Not at all

Perfectly

muscle performance indication for high irritability/acute shoulder treatment

pain free isometrics

AROM through available range

encourage use of unaffected regions

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

early rehab submaximal exercise indication

somewhere between 5-50% of max
- increases blood flow during exercise
- hyperemia after

How well did you know this?

Not at all

Perfectly

modality indication for moderate irritability/proliferative phase of shoulder treatment

heat and estim
- for pain as needed

How well did you know this?

Not at all

Perfectly

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