SLAP, LHB, AC joint

Question 1

how can the labrum be torn?

Answer 1

-repetitve OH activities
-trauma
-sudden avulsion of biceps tendon
-entrapmnet
-hypermobility
-instability

has some potential to heal but doesnt typically on its own

Question 2

what does SLAP stand for

Answer 2

superior
labral
anterior to
posterior

Question 3

what is a type I SLAP tear

Answer 3

degenerative changers to labrum
fraying at edges
firmly attached to glenoid

Question 4

what is a type II SLAP tear

Answer 4

superior labrum detached completely
-lifted by biceps tendon
-unstable biceps tendon insertion

Question 5

what is a type III SLAP tear

Answer 5

-superior labrum displaced into joint (bucket handle)
-labral attachment to glenoid rim and biceps tendon intact
-stable biceps tendon insertion

Question 6

what is a type IV SLAP tear

Answer 6

bucket handle type III with splitting of biceps tendon

Question 7

what are the exam findings of a SLAP tear

Answer 7

-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

Question 8

what are the special tests of a SLAP tear

Answer 8

-active compression
-anterior slide
-biceps load I and II

Question 9

what is PT for a SLAP tear

Answer 9

-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

Question 10

what is the surgical treatment of a SLAP tear

Answer 10

-resection
-repair
-biceps tenodesis

Question 11

what is post-op PT labral repair

Answer 11

-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

Question 12

what is the LHB function

Answer 12

-ligamentous role in OH lifting
-dynamic and static restraint in throwing
-may be primary stabilization

Question 13

what does bicipital tenosynovitis look like

Answer 13

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

Question 14

what is the PT interventino for bicipital tenosynovitis

Answer 14

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

Question 15

what is the medical management of bicipital groove pathology “chondromalacia”

Answer 15

-anti inflamm meds
-Cortisone inject
-PRP
-surgical reattachment

Question 16

what are the post op tenodesis protocols

Answer 16

-no resisted elbow or shoulder flexion 6-8 weeks
-take strengthening slowly
-early shoulder ROM to full IF no concominant pathology

Question 17

what are the tenotomty post op protocols

Answer 17

-no precautions but respect the tissue
-delay resistive activity

Question 18

what is the cause of an AC Joint sprain

Answer 18

-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

Question 19

what is a grade 1 AC joint sprain

Answer 19

point tenderness and pain w movement
-no disruption of AC joint or laxity

heals well

Question 20

what is a grade 2 AC joint sprain

Answer 20

tear or rupture of AC lig
-partial displacement of lateral clavicle
-pain, tenderness and decreased ROM

heals well

Question 21

what is a grade 3 AC joint sprain

Answer 21

rupture of AC and CC ligaments
-strain deltoid and trap

majority dont need surgery

Question 22

what is a grade 4 AC joint sprain

Answer 22

posterior dislocation of clavicle

Question 23

what is a grade 5 AC joint sprain

Answer 23

loss of AC and CC ligaments
-tearing of deltoid and trap attachment
-gross deformity
-severe pain

WORST TYPE

Question 24

what is a grade 6 AC joint sprain

Answer 24

displacemnet of clavicle behind coracobrachialis

Question 25

what are the signs and symptoms of an AC joint sprain

Answer 25

-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

Question 26

how do you treat types I and II AC joint instability

Answer 26

-sling for 2 weeks

Question 27

how do you treat type III AC joint instability

Answer 27

-surgical treatment may be advocated in certain athletes and occupations

Question 28

how do you treat types IV, V, VI AC joint instability

Answer 28

surgery
-AC fixation with pins and plates
-coracoclavicular fixation or removal of distal end of clavicler

Question 29

what is PT treatment for grades I-III AC joint sprain

Answer 29

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