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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
How do you address decreased contraction duration
3-5 sets 20-30 reps
26
What are the types of tissue reactivity (2)
1. Compression load intolerance | 2. Tensile load intolerance
27
How do you address compression/tensile load intolerance (2)
1. High load avoidance | 2. Cyclic low loading
28
What causes hypomobility (4)
1. Tight muscle 2. Muscle spasm 3. Restricted capsule 4. Shortened GH ligaments
29
What are the 2 types of tissue length inadequacy
1. Decreased capsule, ligament, fascia inextensibility | 2. Decreased muscle flexibility
30
How do you address decreased capsuloligament inextensibility using long duration stretches (2)
1. Creep | 2. Stress Relaxation
31
How do you address decreased capsuloligament inextensibility not using long duration stretches
Non-thrust manipulation
32
How do you address decreased muscle flexibility (2)
1. Short duration stretch | 2. PNF techniques
33
What are the 2 PNF techniques you can do
1. Hold relax | 2. Hold relax with agonist contraction
34
What causes hypermobility (3)
1. Ligamentous integrity compromise 2. Muscle performance issue (instability) 3. Motor control issue
35
What cause ligamentous integrity compromise (2)
1. Sprain | 2. Tear
36
What cause muscle performance issues (2)
1. Weakness | 2. Poor endurance
37
What cause motor control issues (2)
1. Poor timing | 2. Poor sequencing
38
True or False: | Motor control issues are secondary to ligamentous integrity compromise and muscle performance issues
True
39
What are 3 ways to address decreased capsuloligamentous restraint
1. Avoidance of provocative position 2. Improve muscle performance 3. Orthotics, splinting, taping
40
What does improving muscle performance improve (3)
1. Force duration 2. Force magnitude 3. Improving timing
41
What do the improvements from muscle performance improvement cause (3)
1. Improved joint compression 2. Decreased arthrokinematic slide 3. Increased osteokinematic control
42
True or False: | With hypomobile people you have to be very careful not to overmobilize them
True
43
What are causes of decreased muscle performance (3)
1. Muscle weakness 2. Decreased endurance 3. Motor control
44
What cause muscle weakness (3)
1. Strength 2. Power 3. Reactivity issue
45
Parameters for strength
3-5 sets 6-12 reps
46
Parameters for endurance
3-5 sets 20-30 reps
47
Parameters for tendon
3-5 sets 30-40 reps
48
Parameters for ligament
1000s of reps
49
Parameters for cartilage
Hours of reps
50
What are the stabilizers of the scapula (3)
1. Serratus anterior 2. Rhomboids 3. Trapezius
51
True or False: | Impingement is a diagnosis
False
52
What pathologies can shoulder impingement lead to (3)
1. Tendinitis 2. RC tear (full or partial) 3. Bursitis
53
What is the primary focus of addressing shoulder impingement (2)
1. Address maladaptive posture patterns | 2. Restore normal biomechanics
54
What do you do to restore normal biomechanics
Decrease compressive load
55
What is the secondary focus of addressing shoulder impingement (3)
1. Improve tensile load tolerance 2. Improve muscle performance 3. Improve motor control
56
What are 2 causes of long head of the biceps tendinitis
1. Impingement | 2. Repetition or overload
57
How do you address long head of the biceps tendinitis caused by repetition or overload (2)
1. PROM to AAROM to AROM | 2. Muscle performance
58
What is the progression of muscle performance through the stages of healing for long head of the biceps tendinitis
Inflammatory: Submaximal isometrics Proliferation: Multiangle isometrics Maturation: PRE program
59
What does PRE stand for
Progressive Exercise Program
60
What is the progression of ROM through the stages of healing for long head of the biceps tendinitis
Inflammatory: PROM Proliferation: AAROM Maturation: AROM
61
What are the causes of RC tendinitis (2)
1. Impingement | 2. Repetition or overload
62
How do you address RC tendinitis caused by repetition or overload (3)
1. PROM-AAROM-AROM 2. Muscle performance 3. Neuromuscular retraining
63
What is the progression of muscle performance through the stages of healing for RC tendinitis
Inflammatory: Submaximal isometrics Proliferation: Multiangle isometrics Maturation: PRE program
64
What is the progression of ROM through the stages of healing for RC tendinitis
Inflammatory: PROM Proliferation: AAROM Maturation: AROM
65
What should you consider with RC tendinitis
Return to function (work/sport)
66
What are the intervention goals for partial RC tear (3)
1. Same as management of RC tendinitis 2. Consider stage of healing 3. Potentially seeing pt post operative
67
What are the intervention goals for full RC tear if not a surgical candidate (5)
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
True of False: | Everyone who has a RC tear will get surgery
False
69
Who are not surgical candidates
The elderly risk is too high for the return
70
What are the intervention goals of adhesive capsulitis (4)
1. Postural exercises 2. Increased AROM/PROM 3. Increased strength/endurance 4. Improve joint arthrokinematics
71
What do you do for someone with adhesive capsulitis by increasing AROM/PROM
Improve extensibility of capsule/ligaments
72
What muscles do you increase the strength of for adhesive capsulitis patients (2)
1. RC muscles | 2. Scapular stabilizers
73
What joint arthorkinematics do you improve for people with adhesive capsulitis (4)
1. GH 2. SC 3. AC 4. Thoracic spine
74
When do you start working with people with adhesive capsulitis
The thawing stage
75
How long can adhesive capsulitis take to resolve
1 year-1.5 years
76
What are the intervention goals of uni/multidirectional instability (4)
1. Pt education 2. Increase AAROM/AROM 3. Increase strength 4. Improve motor control
77
True or False: | You should always start with CKC then progress to OKC
True
78
What are the grades of AC sprain
I-V
79
What are the intervention goals of type I-III AC sprain (6)
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
What muscles do you work on for AC sprain (2)
1. Deltoid | 2. Trapezius
81
How long should someone with a type I-III AC sprain avoid heavy lifting and contact sports
8-12 weeks
82
What do types IV and V AC sprains require
Surgical intervention
83
What are the intervention goals for SC sprain (6)
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
What muscles do you strengthen with SC sprain (3)
1. Pec major (sternal head) 2. Pec minor 3. Upper trapezius
85
What are the intervention goals of clavicle fracture (4)
1. Increase AROM/PROM/AAROM 2. Improve arthrokinematics secondary to immobilization 3. Increase strength/endurance 4. Return to function activities
86
What muscles do you strengthen for clavicle fracture (2)
1. RC muscles | 2. Scapular stabilizers
87
What are the surgical repairs of the shoulder (5)
1. RC repair 2. LHB repair 3. SLAP repair 4. Bankart repair 5. Capsular shift
88
True or False: | With surgery patients you should always follow the surgeon protocol provided
True
89
What the interventions to improve ROM (3)
1. PROM/AAROM/AROM 2. Non thrust manipulation techniques 3. Static stretching
90
What are the static stretches for noncontracile tissue (2)
1. Creep | 2. Stress relaxation
91
What are the static stretches for contractile tissue
Stretch

Musculo (18 decks)

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