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S3- Musculoskeletal > Shoulder Interventions > Flashcards

Shoulder Interventions Flashcards

1
Q

INTRO

A

INTRO

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2
Q

When treating, we want to assess whether we are looking for _______ or ________. This can have some overlap, as well as changes at a given point along a diseases progression.

A

Mobility or Stability

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3
Q

What are some examples of “Mobility-type” presentations?

A
  • Osteoarthropathy

- Frozen Shoulder

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4
Q

What are some examples of “Stability-type” presentations?

A
  • Hypermobile Shoulder
  • SLAP
  • Scapular Dyskinesia
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5
Q

Fractures pending type/location, may be managed with ___________ or ___________________.

A
  • immobilization

- surgical fixation

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6
Q

In regards to fractures, we need to consider appropriate time frames for tissue _______ via communication with medical providers and following medical guidelines.

A

loading

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7
Q

Patients with RA go through periods of _______ and _________.

A

remission and progression

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8
Q

What is a good question to ask patients with RA.

A

What has flared you up before?

-Can give a good indication to amount of stress you can place without causing a flare-up.

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9
Q

When patients with RA are having a flare-up, we are generally working on things such as _____ management and _________ of ROM rather than gain of ROM. What are some ways to do this?

A

Pain Management and Maintance of ROM

  • electrotherapeutic modalities
  • cryotherapy/thermal modalities
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10
Q

When patients with RA are not in a flare-up, what can we work on?

A
  • Conservative strengthening/mobility exercises

- Conservative manual therapy

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11
Q

SC joint sprains can be divided into 3 degrees. How are 1st and 2nd degrees managed differently from a 3rd degree SC joint sprain?

A

1st and 2nd

  • Typically managed conservatively
  • 3-4 days immobilization

3rd
-shoulder sling or figure 8 strap for 2-3 weeks f/b continued protection 2 additional weeks

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12
Q

ROTATOR CUFF TENDINOPATHY

A

ROTATOR CUFF TENDINOPATHY

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13
Q

Tendinopathy can refer to ________ or ________.

A

tendonitis or tendinosis

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14
Q

With tendonitis, we want to work on things that reduce what?

A

Inflammation

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15
Q

Tendinosis involves a failed ________ response and is ________.

A
  • healing

- chronic

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16
Q

When appropriate with tendinopathy, we want to start to reintroduce _______ to the tissue. This involves what law?

A
  • loading

- Wolff’s law

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17
Q

Is eccentric or concentric better for tendinosis?

A

eccentric

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18
Q

With tendinopathy, what factors may we want to address?

A
  • posterior and/or inferior capsule hypomobility
  • scapulothoracic coordination impairments
  • AC/SC joint hypomobility
  • muscle-tendon unit “tightness”
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19
Q

What are some exercises to target the supraspinatus?

A
  • Full can

- Prone full can

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20
Q

What are some exercises to target the infraspinatus and teres minor?

A
  • Side lying ER
  • Prone ER at 90° abduction
  • ER with towel roll
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21
Q

What are some exercises to target the subscapularis?

A
  • IR at 0° abduction
  • IR at 90° abduction
  • IR diagonal exercise (PNF)
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22
Q

What are some exercises to target the serratus anterior?

A
  • Push-up with plus
  • Dynamic hug
  • Serratus punch 120°
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23
Q

What is a sleeper stretch? When is it used?

A
  • Side lying and patient applies overpressure to their hand into IR.
  • If there is subacromial compression or any hypomobility at the GH joint in the posterior aspect.
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24
Q

What are some conservative interventions for subacromial pain syndrome?

A
  • PATIENT EDUCATION
  • joint mobilization
  • stretching
  • promote tissue healing/remodeling
  • coordination training
  • strengthening
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25
Q

What are some common things to educate patients about when talking about subacromial impingement?

A
  • Sleeping Position
  • Ergonomic Training
  • Activity modification/avoidance
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26
Q

What muscles should we up-train in subacromial impingment?

A
  • Inferior Trapezius
  • Serratus Anterior
  • Subscapularis
  • Infraspinatus and Teres Minor
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27
Q

What muscles should we down-train in subacromial impingement?

A
  • Upper Trapezius
  • Pec Major
  • Posterior Deltoid
28
Q

ADHESIVE CAPSULITIS

A

ADHESIVE CAPSULITIS

29
Q

With adhesive capsulitis, motion is normally regained in what time period?

A

2 years

30
Q

Adhesive capsulitis is likely co-managed with ________ interventions.

A

medical

31
Q

Corticosteroid injections for adhesive capsulitis help with what?

A

Limit fibrotic changes/extent of inflammation/fibrosis

32
Q

How many stages of adhesive capsulitis are there?

A

4

33
Q

What is our goal in Stage I of adhesive capsulitis?

A

ROM maintenance and pain management

34
Q

What is our goal is Stage II and III of adhesive capsulitis?

A
  • ROM maintenance and pain management
  • Compensation training
  • Muscle performance
  • Manage impairments following medical intervention
  • Education on HEP (with instruction to return once in thawing stage)
35
Q

What is our goal in Stage IV of adhesive capsulitis?

A

Improve ROM and muscle performance

36
Q

Patient education for adhesive capsulitis involves activity __________ and ___________ as well as the progression of the pathology.

A

modification and avoidance

37
Q

Pain modulation for adhesive capsulitis can be done through __________ mobilizations as well as thermal modalities.

A

oscillation

38
Q

There is _____ evidence on the use of joint mobilizations, translational manipulation under anesthesia, and modalities for adhesive capsulitis.

A

weak

39
Q

There is _____ evidence for corticosteroid injections use in adhesive capsulitis.

A

strong

40
Q

What are some common things to educate patients about when talking about adhesive capsulitis?

A
  • Sleeping position
  • Activity modification
  • Lifting/carrying techniques
  • Ergonomics
  • Contrbuting factors
41
Q

There is _________ evidence for stretching exercises in adhesive capsulitis.

A

moderate

42
Q

What muscles would we want to stretch in adhesive capsulitis?

A
  • Upper trap
  • Pec major and minor
  • Levator scap
  • SCM
  • Posterior joint capsule
43
Q

INSTABILITY AND SLAP

A

INSTABILITY AND SLAP

44
Q

In the acute stage of shoulder instability we should focus more on _____ and _________ management.

A

pain and inflammatory

45
Q

When looking at shoulder instability, it is important to consider what type of instability, ________ vs ______.

A

AMBRI vs TUBS

46
Q
  • What does AMBRI stand for?

- AMBRI involves _____________ instability.

A
  • Atraumatic Multidirectional Bilateral Rehabilitation with Inferior capsule shift
  • multidirectional
47
Q
  • What does TUBS stand for?

- With TUBS we want to consider any other __________ that were damaged.

A
  • Traumatic Unidirectional instability and Bankart lesion which often require Surgery
  • structures
48
Q

AMBRI

  • Rotator cuff ________/________/________
  • Peri-scapular coordination/ muscle performance
  • Dynamic __________ and _________ training
  • Activity modification as appropriate
  • Muscular stability especially in extreme functional ranges
A
  • coordination/strength/endurance

- stabilization and proprioceptive

49
Q

TUBS

  • ________ performance
  • Address other tissue injuries as appropriate
  • Address ___________ following immobilization period
  • Address other hypomobility as appropriate (example; posterior G-H capsule with anterior instability)
A
  • muscle

- hypomobility

50
Q

If seeing a SLAP lesion conservatively, we want to address _____________.

A

impairments

51
Q

SLAP lesion common intervention strategies:

  • _____ management interventions
  • ____________ coordination/ strength/ endurance
  • Peri-scapular coordination/ muscle performance
  • Dynamic _____________ and ___________ training
A
  • pain
  • rotator cuff
  • stabilization and proprioceptive
52
Q

What are the surgical treatment for each of the 4 types of SLAP lesions?

A 
Type I
-debridement of frayed edges
Type II
-repair biceps anchor
Type III
-debridement of bucket-handle tear
Type IV
-debridement of bucket-handle tear, repair biceps anchor, biceps tenodesis, biceps tenotomy
53
Q

GENERAL INTERVENTION CONCEPTS AND MANUAL THERAPY

A

GENERAL INTERVENTION CONCEPTS AND MANUAL THERAPY

54
Q

Generally speaking, evidence for manual therapy procedures regarding shoulder conditions is ______.

A

weak

55
Q

What are some areas we may focus on with soft tissue mobilization of patients with shoulder pathologies?

A
  • Pec major and minor
  • Subscapularis
  • Upper trap
  • Levator scap
  • Teres major
56
Q

1

A

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57
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58
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59
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1

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60
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61
Q

1

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11

62
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1

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63
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64
Q

1

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1

65
Q

EXERCISE INTERVENTIONS

A

EXERCISE INTERVENTIONS

66
Q

What are our goals with coordination training?

A

-Improve proprioceptive function of shoulder girdle
-Coactivation of agonists/antagonists for improved force couples
Improve force dispersion in GH joint
-Decreasing time for amortization phase (time between eccentric and concentric phases)

S3- Musculoskeletal (27 decks)

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