SLAP, LHB, AC joint Flashcards
how can the labrum be torn?
-repetitve OH activities
-trauma
-sudden avulsion of biceps tendon
-entrapmnet
-hypermobility
-instability
has some potential to heal but doesnt typically on its own
what does SLAP stand for
superior
labral
anterior to
posterior
what is a type I SLAP tear
degenerative changers to labrum
fraying at edges
firmly attached to glenoid
what is a type II SLAP tear
superior labrum detached completely
-lifted by biceps tendon
-unstable biceps tendon insertion
what is a type III SLAP tear
-superior labrum displaced into joint (bucket handle)
-labral attachment to glenoid rim and biceps tendon intact
-stable biceps tendon insertion
what is a type IV SLAP tear
bucket handle type III with splitting of biceps tendon
what are the exam findings of a SLAP tear
-complaints of deep pain, history of overuse or trauma, instability/click/pop/catch
-AROM: may have painful click
-PROM: may feel palpable click wtith motion
-resistive: usually negative
-mobility: hypermobility or functional instability
-palpation: deep pain, cant palpate
what are the special tests of a SLAP tear
-active compression
-anterior slide
-biceps load I and II
what is PT for a SLAP tear
-treat the instability
-be aware of the type of lesion
goals:
-reduce pain and inflammation
-restore ROM
-strengthen ST and GH muscles
-avoid exercises that stress biceps tendon
up to 85% success with non operative care
what is the surgical treatment of a SLAP tear
-resection
-repair
-biceps tenodesis
what is post-op PT labral repair
-treat inflammation
-start isometrics/low level co-contraction
-progress ROM/strengtheinng at 3-4 weeks
-avoid aggressive early exercise and ROM
NO forceful stretching into ABD/ER
NO resistance with biceps in SLAP
what is the LHB function
-ligamentous role in OH lifting
-dynamic and static restraint in throwing
-may be primary stabilization
what does bicipital tenosynovitis look like
like RC tendinopathy
AROM: may have full ROM but painful arc occurs more in flexion than abduction
-may have full pain free PROM
-may have pain with elbow and shoulder flexion
-pain over biceps tendon
what is the PT interventino for bicipital tenosynovitis
intra-articular so same avascularity as RTC
-similar treatment to RTC tendonopathy
-transverse friction massage MAY be helpful
-dry needling combined with eccentrics and stretching may be beneficial in some cohorts
what is the medical management of bicipital groove pathology “chondromalacia”
-anti inflamm meds
-Cortisone inject
-PRP
-surgical reattachment
what are the post op tenodesis protocols
-no resisted elbow or shoulder flexion 6-8 weeks
-take strengthening slowly
-early shoulder ROM to full IF no concominant pathology
what are the tenotomty post op protocols
-no precautions but respect the tissue
-delay resistive activity
what is the cause of an AC Joint sprain
-fall on tip of shoulder or FOOSH
-repetivei reaching overhead or across chest
-results in sprain to AC ligaments and join capsule
-meniscus may be torn
what is a grade 1 AC joint sprain
point tenderness and pain w movement
-no disruption of AC joint or laxity
heals well
what is a grade 2 AC joint sprain
tear or rupture of AC lig
-partial displacement of lateral clavicle
-pain, tenderness and decreased ROM
heals well
what is a grade 3 AC joint sprain
rupture of AC and CC ligaments
-strain deltoid and trap
majority dont need surgery
what is a grade 4 AC joint sprain
posterior dislocation of clavicle
what is a grade 5 AC joint sprain
loss of AC and CC ligaments
-tearing of deltoid and trap attachment
-gross deformity
-severe pain
WORST TYPE
what is a grade 6 AC joint sprain
displacemnet of clavicle behind coracobrachialis
what are the signs and symptoms of an AC joint sprain
-local pain at AC joint
-swelling, tenderness to palpation
-painful arc
-step down deformity
-grade II seperations are more painful than G3 due to partial tearing
how do you treat types I and II AC joint instability
-sling for 2 weeks
how do you treat type III AC joint instability
-surgical treatment may be advocated in certain athletes and occupations
how do you treat types IV, V, VI AC joint instability
surgery
-AC fixation with pins and plates
-coracoclavicular fixation or removal of distal end of clavicler
what is PT treatment for grades I-III AC joint sprain
goal is to reduce pressure and traction at the AC joint to allow the ligaments to heal
-restrict reaching and direct pressure over shoulder
-limit lifting to 10-20 lb held close to body
-immobilization initiallly for healing
-ice to control swelling and pain
-avoid sleeping on either side
-general shoulder conditioning
-full PROM by 2-3 weeks
