Shoulder Interventions Flashcards
INTRO
INTRO
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.
Mobility or Stability
What are some examples of “Mobility-type” presentations?
- Osteoarthropathy
- Frozen Shoulder
What are some examples of “Stability-type” presentations?
- Hypermobile Shoulder
- SLAP
- Scapular Dyskinesia
Fractures pending type/location, may be managed with ___________ or ___________________.
- immobilization
- surgical fixation
In regards to fractures, we need to consider appropriate time frames for tissue _______ via communication with medical providers and following medical guidelines.
loading
Patients with RA go through periods of _______ and _________.
remission and progression
What is a good question to ask patients with RA.
What has flared you up before?
-Can give a good indication to amount of stress you can place without causing a flare-up.
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?
Pain Management and Maintance of ROM
- electrotherapeutic modalities
- cryotherapy/thermal modalities
When patients with RA are not in a flare-up, what can we work on?
- Conservative strengthening/mobility exercises
- Conservative manual therapy
SC joint sprains can be divided into 3 degrees. How are 1st and 2nd degrees managed differently from a 3rd degree SC joint sprain?
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
ROTATOR CUFF TENDINOPATHY
ROTATOR CUFF TENDINOPATHY
Tendinopathy can refer to ________ or ________.
tendonitis or tendinosis
With tendonitis, we want to work on things that reduce what?
Inflammation
Tendinosis involves a failed ________ response and is ________.
- healing
- chronic
When appropriate with tendinopathy, we want to start to reintroduce _______ to the tissue. This involves what law?
- loading
- Wolff’s law
Is eccentric or concentric better for tendinosis?
eccentric
With tendinopathy, what factors may we want to address?
- posterior and/or inferior capsule hypomobility
- scapulothoracic coordination impairments
- AC/SC joint hypomobility
- muscle-tendon unit “tightness”
What are some exercises to target the supraspinatus?
- Full can
- Prone full can
What are some exercises to target the infraspinatus and teres minor?
- Side lying ER
- Prone ER at 90° abduction
- ER with towel roll
What are some exercises to target the subscapularis?
- IR at 0° abduction
- IR at 90° abduction
- IR diagonal exercise (PNF)
What are some exercises to target the serratus anterior?
- Push-up with plus
- Dynamic hug
- Serratus punch 120°
What is a sleeper stretch? When is it used?
- 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.
What are some conservative interventions for subacromial pain syndrome?
- PATIENT EDUCATION
- joint mobilization
- stretching
- promote tissue healing/remodeling
- coordination training
- strengthening
What are some common things to educate patients about when talking about subacromial impingement?
- Sleeping Position
- Ergonomic Training
- Activity modification/avoidance
What muscles should we up-train in subacromial impingment?
- Inferior Trapezius
- Serratus Anterior
- Subscapularis
- Infraspinatus and Teres Minor
What muscles should we down-train in subacromial impingement?
- Upper Trapezius
- Pec Major
- Posterior Deltoid
ADHESIVE CAPSULITIS
ADHESIVE CAPSULITIS
With adhesive capsulitis, motion is normally regained in what time period?
2 years
Adhesive capsulitis is likely co-managed with ________ interventions.
medical
Corticosteroid injections for adhesive capsulitis help with what?
Limit fibrotic changes/extent of inflammation/fibrosis
How many stages of adhesive capsulitis are there?
4
What is our goal in Stage I of adhesive capsulitis?
ROM maintenance and pain management
What is our goal is Stage II and III of adhesive capsulitis?
- 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)
What is our goal in Stage IV of adhesive capsulitis?
Improve ROM and muscle performance
Patient education for adhesive capsulitis involves activity __________ and ___________ as well as the progression of the pathology.
modification and avoidance
Pain modulation for adhesive capsulitis can be done through __________ mobilizations as well as thermal modalities.
oscillation
There is _____ evidence on the use of joint mobilizations, translational manipulation under anesthesia, and modalities for adhesive capsulitis.
weak
There is _____ evidence for corticosteroid injections use in adhesive capsulitis.
strong
What are some common things to educate patients about when talking about adhesive capsulitis?
- Sleeping position
- Activity modification
- Lifting/carrying techniques
- Ergonomics
- Contrbuting factors
There is _________ evidence for stretching exercises in adhesive capsulitis.
moderate
What muscles would we want to stretch in adhesive capsulitis?
- Upper trap
- Pec major and minor
- Levator scap
- SCM
- Posterior joint capsule
INSTABILITY AND SLAP
INSTABILITY AND SLAP
In the acute stage of shoulder instability we should focus more on _____ and _________ management.
pain and inflammatory
When looking at shoulder instability, it is important to consider what type of instability, ________ vs ______.
AMBRI vs TUBS
- What does AMBRI stand for?
- AMBRI involves _____________ instability.
- Atraumatic Multidirectional Bilateral Rehabilitation with Inferior capsule shift
- multidirectional
- What does TUBS stand for?
- With TUBS we want to consider any other __________ that were damaged.
- Traumatic Unidirectional instability and Bankart lesion which often require Surgery
- structures
AMBRI
- Rotator cuff ________/________/________
- Peri-scapular coordination/ muscle performance
- Dynamic __________ and _________ training
- Activity modification as appropriate
- Muscular stability especially in extreme functional ranges
- coordination/strength/endurance
- stabilization and proprioceptive
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)
- muscle
- hypomobility
If seeing a SLAP lesion conservatively, we want to address _____________.
impairments
SLAP lesion common intervention strategies:
- _____ management interventions
- ____________ coordination/ strength/ endurance
- Peri-scapular coordination/ muscle performance
- Dynamic _____________ and ___________ training
- pain
- rotator cuff
- stabilization and proprioceptive
What are the surgical treatment for each of the 4 types of SLAP lesions?
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
GENERAL INTERVENTION CONCEPTS AND MANUAL THERAPY
GENERAL INTERVENTION CONCEPTS AND MANUAL THERAPY
Generally speaking, evidence for manual therapy procedures regarding shoulder conditions is ______.
weak
What are some areas we may focus on with soft tissue mobilization of patients with shoulder pathologies?
- Pec major and minor
- Subscapularis
- Upper trap
- Levator scap
- Teres major
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EXERCISE INTERVENTIONS
EXERCISE INTERVENTIONS
What are our goals with coordination training?
-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)
