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Shoulder Intervention Flashcards

1
Q

Where does a ligament sprain have pain

A

End range

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2
Q

True or False:

The capsule and ligament of the shoulder are so deeply intertwined that they can’t be separated

A

True

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3
Q

What intervention do you do if you suspect impingement

A

Joint play

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4
Q

How does the shoulder get some stability

A

Rely on ligaments, capsule, and tendons

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5
Q

What are the broad things you are looking to address in the shoulder (3)

A
  1. Pain
  2. Mobility
  3. Muscle performance
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6
Q

What is pain due to

A

Load intolerance

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7
Q

What are the 3 load intolerance

A
  1. Tensile
  2. Compression
  3. Shear
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8
Q

What are the 2 types of mobility

A
  1. Hypermobility

2. Hypomobility

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9
Q

What are the 4 things addressed under muscle performance

A
  1. Strength
  2. Power
  3. Endurance
  4. Motor control
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10
Q

What are causes of compression load intolerance (5)

A
  1. Degradation of articular cartilage
  2. Tight muscle
  3. Muscle spasm
  4. Restricted capsule
  5. Shortened GH ligaments
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11
Q

What tissues are implicated in compression load intolerance (3)

A
  1. Tendon
  2. Muscle
  3. Bursae
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12
Q

How do you address compression load intolerance (5)

A
  1. Static stretch
  2. PNF techniques
  3. Creep
  4. Stress relaxation
  5. Non thrust manipulation
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13
Q

How long do you stretch muscles for

A

30-60 seconds 3-5 sets

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14
Q

What is creep a constant of

A

Load

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15
Q

What is stress relaxation a constant of

A

Deformation

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16
Q

What do creep and stress relaxation stretch

A

DCT (capsule and ligament)

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17
Q

How long do you have to do creep and stress relaxation

A

5-40 minutes as tolerated (doesn’t have to all be at once

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18
Q

What causes tensile load intolerance (3)

A
  1. Abnormal load to normal tissue
  2. Normal load to abnormal tissue
  3. Abnormal load to abnormal tissue
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19
Q

How do you address tensile load intolerance

A

Reduce load

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20
Q

What do you do to reduce the load for tensile intolernce

A

AAROM

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21
Q

What tissues are implicated with tensile load intolerance (3)

A
  1. Tendon
  2. Muscle
  3. Ligament
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22
Q

What are the 2 muscle contractile tissue inadequecies

A
  1. Decreased muscular contractility

2. Tissue reactivity

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23
Q

What muscular contractility is decreased (2)

A
  1. Intensity

2. Duration

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24
Q

How do you address decreased contraction intensity

A

3-5 sets 8-12 reps

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25
Q

How do you address decreased contraction duration

A

3-5 sets 20-30 reps

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26
Q

What are the types of tissue reactivity (2)

A
  1. Compression load intolerance

2. Tensile load intolerance

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27
Q

How do you address compression/tensile load intolerance (2)

A
  1. High load avoidance

2. Cyclic low loading

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28
Q

What causes hypomobility (4)

A
  1. Tight muscle
  2. Muscle spasm
  3. Restricted capsule
  4. Shortened GH ligaments
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29
Q

What are the 2 types of tissue length inadequacy

A
  1. Decreased capsule, ligament, fascia inextensibility

2. Decreased muscle flexibility

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30
Q

How do you address decreased capsuloligament inextensibility using long duration stretches (2)

A
  1. Creep

2. Stress Relaxation

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31
Q

How do you address decreased capsuloligament inextensibility not using long duration stretches

A

Non-thrust manipulation

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32
Q

How do you address decreased muscle flexibility (2)

A
  1. Short duration stretch

2. PNF techniques

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33
Q

What are the 2 PNF techniques you can do

A
  1. Hold relax

2. Hold relax with agonist contraction

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34
Q

What causes hypermobility (3)

A
  1. Ligamentous integrity compromise
  2. Muscle performance issue (instability)
  3. Motor control issue
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35
Q

What cause ligamentous integrity compromise (2)

A
  1. Sprain

2. Tear

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36
Q

What cause muscle performance issues (2)

A
  1. Weakness

2. Poor endurance

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37
Q

What cause motor control issues (2)

A
  1. Poor timing

2. Poor sequencing

38
Q

True or False:

Motor control issues are secondary to ligamentous integrity compromise and muscle performance issues

39
Q

What are 3 ways to address decreased capsuloligamentous restraint

A
  1. Avoidance of provocative position
  2. Improve muscle performance
  3. Orthotics, splinting, taping
40
Q

What does improving muscle performance improve (3)

A
  1. Force duration
  2. Force magnitude
  3. Improving timing
41
Q

What do the improvements from muscle performance improvement cause (3)

A
  1. Improved joint compression
  2. Decreased arthrokinematic slide
  3. Increased osteokinematic control
42
Q

True or False:

With hypomobile people you have to be very careful not to overmobilize them

43
Q

What are causes of decreased muscle performance (3)

A
  1. Muscle weakness
  2. Decreased endurance
  3. Motor control
44
Q

What cause muscle weakness (3)

A
  1. Strength
  2. Power
  3. Reactivity issue
45
Q

Parameters for strength

A

3-5 sets 6-12 reps

46
Q

Parameters for endurance

A

3-5 sets 20-30 reps

47
Q

Parameters for tendon

A

3-5 sets 30-40 reps

48
Q

Parameters for ligament

A

1000s of reps

49
Q

Parameters for cartilage

A

Hours of reps

50
Q

What are the stabilizers of the scapula (3)

A
  1. Serratus anterior
  2. Rhomboids
  3. Trapezius
51
Q

True or False:

Impingement is a diagnosis

52
Q

What pathologies can shoulder impingement lead to (3)

A
  1. Tendinitis
  2. RC tear (full or partial)
  3. Bursitis
53
Q

What is the primary focus of addressing shoulder impingement (2)

A
  1. Address maladaptive posture patterns

2. Restore normal biomechanics

54
Q

What do you do to restore normal biomechanics

A

Decrease compressive load

55
Q

What is the secondary focus of addressing shoulder impingement (3)

A
  1. Improve tensile load tolerance
  2. Improve muscle performance
  3. Improve motor control
56
Q

What are 2 causes of long head of the biceps tendinitis

A
  1. Impingement

2. Repetition or overload

57
Q

How do you address long head of the biceps tendinitis caused by repetition or overload (2)

A
  1. PROM to AAROM to AROM

2. Muscle performance

58
Q

What is the progression of muscle performance through the stages of healing for long head of the biceps tendinitis

A

Inflammatory: Submaximal isometrics
Proliferation: Multiangle isometrics
Maturation: PRE program

59
Q

What does PRE stand for

A

Progressive Exercise Program

60
Q

What is the progression of ROM through the stages of healing for long head of the biceps tendinitis

A

Inflammatory: PROM
Proliferation: AAROM
Maturation: AROM

61
Q

What are the causes of RC tendinitis (2)

A
  1. Impingement

2. Repetition or overload

62
Q

How do you address RC tendinitis caused by repetition or overload (3)

A
  1. PROM-AAROM-AROM
  2. Muscle performance
  3. Neuromuscular retraining
63
Q

What is the progression of muscle performance through the stages of healing for RC tendinitis

A

Inflammatory: Submaximal isometrics
Proliferation: Multiangle isometrics
Maturation: PRE program

64
Q

What is the progression of ROM through the stages of healing for RC tendinitis

A

Inflammatory: PROM
Proliferation: AAROM
Maturation: AROM

65
Q

What should you consider with RC tendinitis

A

Return to function (work/sport)

66
Q

What are the intervention goals for partial RC tear (3)

A
  1. Same as management of RC tendinitis
  2. Consider stage of healing
  3. Potentially seeing pt post operative
67
Q

What are the intervention goals for full RC tear if not a surgical candidate (5)

A
  1. Same as RC tendinitis
  2. Consider stage of healing
  3. PRE for accessory muscle that assist with motion
  4. Postural exercises
  5. PRE for scapular muscles
68
Q

True of False:

Everyone who has a RC tear will get surgery

69
Q

Who are not surgical candidates

A

The elderly risk is too high for the return

70
Q

What are the intervention goals of adhesive capsulitis (4)

A
  1. Postural exercises
  2. Increased AROM/PROM
  3. Increased strength/endurance
  4. Improve joint arthrokinematics
71
Q

What do you do for someone with adhesive capsulitis by increasing AROM/PROM

A

Improve extensibility of capsule/ligaments

72
Q

What muscles do you increase the strength of for adhesive capsulitis patients (2)

A
  1. RC muscles

2. Scapular stabilizers

73
Q

What joint arthorkinematics do you improve for people with adhesive capsulitis (4)

A
  1. GH
  2. SC
  3. AC
  4. Thoracic spine
74
Q

When do you start working with people with adhesive capsulitis

A

The thawing stage

75
Q

How long can adhesive capsulitis take to resolve

A

1 year-1.5 years

76
Q

What are the intervention goals of uni/multidirectional instability (4)

A
  1. Pt education
  2. Increase AAROM/AROM
  3. Increase strength
  4. Improve motor control
77
Q

True or False:

You should always start with CKC then progress to OKC

78
Q

What are the grades of AC sprain

79
Q

What are the intervention goals of type I-III AC sprain (6)

A
  1. Reduce pain
  2. Increase pain free AROM/PROM/AAROM
  3. Strengthen muscles that attach to the AC joint to assist with stabilitiy
  4. Improve AC joint mobility
  5. Restore normal mechanics/timing of shoulder complex movement
  6. Incorporate return to function activities
80
Q

What muscles do you work on for AC sprain (2)

A
  1. Deltoid

2. Trapezius

81
Q

How long should someone with a type I-III AC sprain avoid heavy lifting and contact sports

A

8-12 weeks

82
Q

What do types IV and V AC sprains require

A

Surgical intervention

83
Q

What are the intervention goals for SC sprain (6)

A
  1. Reduce pain
  2. Increase painfree AROM/PROM/AAROM
  3. Strengthen muscles that attach to the SC joint to assist with stability
  4. Improve SC joint mobility
  5. Restore mechanics/timing of shoulder complex movement
  6. Incorporate return to function activities
84
Q

What muscles do you strengthen with SC sprain (3)

A
  1. Pec major (sternal head)
  2. Pec minor
  3. Upper trapezius
85
Q

What are the intervention goals of clavicle fracture (4)

A
  1. Increase AROM/PROM/AAROM
  2. Improve arthrokinematics secondary to immobilization
  3. Increase strength/endurance
  4. Return to function activities
86
Q

What muscles do you strengthen for clavicle fracture (2)

A
  1. RC muscles

2. Scapular stabilizers

87
Q

What are the surgical repairs of the shoulder (5)

A
  1. RC repair
  2. LHB repair
  3. SLAP repair
  4. Bankart repair
  5. Capsular shift
88
Q

True or False:

With surgery patients you should always follow the surgeon protocol provided

89
Q

What the interventions to improve ROM (3)

A
  1. PROM/AAROM/AROM
  2. Non thrust manipulation techniques
  3. Static stretching
90
Q

What are the static stretches for noncontracile tissue (2)

A
  1. Creep

2. Stress relaxation

91
Q

What are the static stretches for contractile tissue

Musculo (18 decks)

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