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PTMMD > Shoulder Mobility Deficit > Flashcards

Shoulder Mobility Deficit Flashcards

1
Q

What will you typically hear in the History, with a patient with a Shoulder Mobility Deficit?

A
  • It was an Insidious Onset
  • “Stiffness” and pain; worsens over time
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2
Q

What are the Agg and Ease Factors?

A

Agg:
- Prolonged Positioning
- End-Range shoulder motions

Ease:
- Movement

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3
Q

What is the 24hr behavior?

A

Pain is the worse in the morning

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4
Q

During the Physical Examination, what may you find in shoulder ROM?

A

AROM and PROM are limited; Potential capsular pattern

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5
Q

During the Physical Examination, what may you find in the Joint Integrity and Mobility Assessment?

A

Hypomobility

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6
Q

During the Physical Examination, what may you find in the Muscle Performance Testing?

A

Potential Decreased Muscle Length

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7
Q

With the shoulder, what are 4 condition that may cause shoulder mobility deficit?

A
  • Adhesive Capsulitis
  • Calcific Tendinopathy
  • Acromioclavicular Joint Pathology
  • Glenohumeral Osteoarthritis
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8
Q

What are Primary and Secondary causes of Adhesive Capsulitis?

A

Primary: Etiology unknown (Idopathic)

Secondary: Trauma, surgery, associated with an underlying condtion such as Clacific teninosis or RC pathology, or prolonged immobilization

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9
Q

What is Adhesive Capsulitis?

A

Synovial inflammation with subsequent reactive capsular fibrosis

Making this both an inflammatory and a fibrosis condition, depending on the stage of the disease

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10
Q

What may you find in the Hx of those patients with Adhesive Capsulitis? What are the risk factors

A
  • Typically female
  • >40 years old (40-65)
  • Has Endocrine disorder:Diabetes, Thyroid disease
  • Had Adhesive Capsulitis on contralateral arm
  • Low BMI
  • Presence of immune disease
  • CVA or MI
  • Certain psychiatric disorders

The ones in bold are also RISK FACTORS

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11
Q

What are the 3 stages of Adhesive Capsulitis?

A

Freezing, Frozen, Thawing

Initially (before the 3 stages), Adhesive Capsulitis present with mild s/s often mimic impingment syndrome and are characterized by progressive stiffness, restriction of ROM and pain generally becomes severe and disabling

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12
Q

What are common exam finding with Adhesive Capsulitis?

A
  • Motion is loss is a capsular pattern in all planes
  • Painful and limited AROM and PROM of shoulder elevation usually <120°
  • Passive ER of 50% or <30°
  • No definitive diagnostic tests
  • Decreased joint mobility
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13
Q

Adhesive Capsulitis (Frozen Shoulder Contracture Syndrome)

How is FSCS characterized in the Freezing stage?

A
  • Persistent and more intense pain, even at rest
  • Night pain and disturbed sleep occur during acute flares
  • Loss of ROM in all planes and there is pain throughout the range
  • Typically demonstrate an inability to reach overhead, behind the head, and behind the back. This results in difficulty with dressing, self-grooming, bringing eating utensils to mouth and reaching the hand into the back pockets

The motion loss in this stage reflects loss of capsular volume and a response to painful synovitis

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14
Q

Patient with Adhesive Capsulities, what will you find with AROM/PROM

A
  • There is normally decreased joint play associated with limited ER and Abduction, some some IR limitatons.
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15
Q

Adhesive Capsulitis (Frozen Shoulder Contracture Syndrome)

How is FSCS characterized in the Thawing stage?

A
  • Slow, steady recovery of some of the lost ROM resulting from capsular remodeling in response to the use of the arm and shoulder
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16
Q

What are the objective finding when FSCS is in the Thawing stage?

A
  • Stiff shoulder
  • Marked alteration of scapulohumeral mechanics
  • limited arm use during ADLs

Tissue resistance in the form of a capsular EF is felt before pain is reached as the GH joint is taken through ROM

17
Q

What is the Prognosis for Adhesive Capsulitis?

A

Adhesive capsulitis occurs as a continuum of pathology characterized by a staged progression of pain and mobility deficits and that, at 12 to 18 months, mild to
moderate mobility deficits and pain may persist, though many patients report minimal to no disability

However the gradual return to full mobility occurs within 18 months to 3 years, even without specific intervention

18
Q

What should you do for Interventions with patients with Adhesive Capsulitis for short term relief and function?

A

CSIs along with shoulder mobility and stretching exercises have been found to be effective in providing short term (4-6 weeks) pain relief and improved function

19
Q

Adhesive Capsulitis

As a general guideline, what interventions should you do
if the patient presents with capsular restriction and low irritibility compared if they had high irritability?

A

With low irritability they may require aggressive soft tissue and joint mobilization

With high irritability they may require pain-easing manual therapy techniques

20
Q

Adhesive Capsulitis

What can be done in the Acute stage for those patients with Adhesive Capsulitis?

A

Pendulum exercises and low grade joint mobilizations techniques are recommended to relieve pain and apply a gentle stretch to the capsule.
- Also the clinician can perform passive stretching of the Upper trap., and Levator Scap. then teach the patient a part of the HEP

21
Q

Adhesive Capsulitis

What can be done in the Subacute stage for those patients with Adhesive Capsulitis?

A

More aggresive ROM exercises can be incorporated using PNF techniques, wall climbing, and wall/corner stretches

22
Q

Adhesive Capsulitis

What can be done in the Chonic stage for those patients with Adhesive Capsulitis?

A

As ROM returns, strength becomes the focus, initiating isometric and then progressive strengthening of the shoulder complex

23
Q

What is Calcific Tendinopathy?

A

This is characterized by a reactive calcification that affects the RTC tendons with associated acute or chronic painful shoulder ROM restrictions impacting ADLs. (Typically affects the Suprasinatus)
- The course of the disease may be cyclic (occurs in cycles), with spontaneous resorption and and reconstitution of the tendon

24
Q

What population does Calcific Tendinopathy typically affect?

A

More common in caucasian females between 30-50 years of age

25
Q

How do you manage Calcific Tendinopathy?

A

Management is often conservative, consisting of ice applications and pendulum exercises to prevent the development of Adhesive Capsulitis

26
Q

What are interventions strategies for Calcific Tendinopathy?

A
  • Extracorporeal shockwave therapy combined with eccentric training. This helps in reducing pain and improving function
  • Invasive treatment if conservative care fails is needling, CSIs, surgical removal of deposits, needle aspiration, closed lavage with lidocaine
27
Q

What may you find in the Hx of a patient with AC Joint Pathology?

A
  • Commonly in middle-aged patients
  • It was degenerative or post-traumatic
28
Q

With AC Joint Pathology, what may you observe from the patient?

A

You may see a step/bump at the point of the shoulder

29
Q

With AC Joint Pathology, what may you find with AROM/PROM?

A

AROM: Limited abduction; Limited Horizontial Adduction

PROM: Limited Abduction; Painful with Horizontal Adduction

30
Q

What may you find in the Exam portion with a patient with an AC Joint Pathology

A
  • Its aggravated with overhead and/or crossbody activities (Horizontal Adduction); symptoms stay local to superior shoulder
  • Reproduced with direct palpation and accessory mobility testing of the AC joint
31
Q

What is the Test Item Cluster for AC joint Pathology?

A
  • Cross body Adduction
  • AC resistive Extension
  • Active Compression Test

2 or more: 81 Sn and 89 Sp

32
Q

What should be done in terms of Interventions for those with AC Joint Pathologies?

A
  • AC mobility exercises
  • AC Joint mobilizations
  • Periarticular Strengthening
33
Q

What may you typically find in the Hx with patients with Glenohumeral Osteoarthritis?

A
  • Typically occurs in individuals >45 years old
  • Can be primary or secondary due to trauma
34
Q

What may you find in the Exam portion with a patient with Glenohumeral Osteoarthritis?

A
  • Pain can refer into UE distally to the hand
  • Passive horizontal adduction tends to be the most limited and painful motion
35
Q

With Glenohumeral Osteoarthritis, what may you see with AROM/PROM?

A

AROM: Capsular Pattern (ER > Abduction > IR)

PROM: Pain

With a Capsular End-Feel

36
Q

With Glenohumeral Osteoarthritis, what may you find with resistive test?

A

Weakness of rotator cuff, rather than pain

PTMMD (33 decks)

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