Spring ICP Exam 2 Flashcards by Kadin Ribble

Influencing Factors on the Shoulder

Stability (Static and Dynamic)
Scapular Muscles
Force Couples
Trunk and Hip
Posture
Cervical and T-Spine

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2 mobs to increase extension

PA glide and PA Spring

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4 joints of the shoulder

Sternoclavicular
Acromioclavicular
Scapulothoracic
Glenohumeral

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How does the shoulder match up in relation to mobility and stability?

Great mobility w/ limited stability

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What does the humeral head articulate with?

Glenoid (Flat)

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Ability of the rotator cuff and long head of biceps provide what?

Dynamic Stability

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During overhead motion, The supraspinatus does what to the head of the humerus while the other rotator cuff muscles do what?

Compress, Depress

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Movement of scapula relative to the humerus?

1:2 scapula to humeral movement

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Initial 30 degrees of glenohumeral abduction does…..

Does not incorporate scapular motion

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30 to 90 degrees

The scapula abducts upwardly rotates 1 degree for every 2 degrees of humeral elevation

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Above 90 degrees

The scapula and humerus move in 1:1 ratio

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SICK Shoulder

Scapular malposition
Inferior medial winging
Coracoid tenderness
Scapular dyskinesia

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When is the SICK shoulder visable?

Elbow Flexion 90
Abduction 90
ER

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Scapular Dyskinesis Stats

64% instability
100% impingement
72% in healthy population

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Why do we care about Scapular Dysfunction?

Scapular motion is critical for normal motion of the UE
The critical link between trunk and UE
The site of multiple muscular attachment
Provide a mobile base for the humerus to maintain GH stability

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Posterior displacement of medial border and/or inferior angle away from thorax

Scapular Dyskinesis

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Premature or excessive elevation or protraction, non-smooth/stuttering motion, or rapid downward rotation during arm lowering

Dysrhythmia

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Causes of Scapular Dyskinesis

Poor Posture
Soft Tissue Changes
Reduced GH mobility
Lower Scap weakness
Upper Trap hyperactivity
Acute injury

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Limited IR when compared to ER
20 degree deficit in IR from side to side
Limited by posterior musculature and capsule tightness
Morphological changes in bone also occur

Glenohumeral internal rotation deficit (GIRD)

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Scap dyskinesis rehab

Re-establish coordinated UE movement
Increase endurance
Scap stabilization exercises that minimize upper trap and levator scap and normalize upward rotation of scapula

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TUBS

Traumatic Onset, Unidirectional anterior with a Bankart lesion responding to Surgery

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AMBRI

Atraumatic cause, Multidirectional with Bilateral shoulder findings with Rehabilitation as an appropriate treatment and, rarely, Inferior capsular shift surgery

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Permanent anterior defect of labrum

Bankart lesion

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Compression of cancellous bone against anterior glenoid rim creating a divot in the humeral head

Hill Sachs lesion

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3 types of repair for Bankart lesion

Arthroscopic - most common, not good for younger age, hyper lax, male, contact sports Open Capsular Shift - lower recurrence, results in motion loss and can be used in contact athletes Bony - creates a bony block to instability

SLAP tear

Not usually associated with instability Onset in sport Type II most common Mechanical, posterior/deep pain, decreased force production Surgery = 30% return to baseball at former level

Initial management of SLAP lesion

Overhead: Non-operative route first Decrease pain/Improve function/RTP Guided injection + rest 3-6 months non-op management before surgery

Adolescents and Throwing

Tensile forces on medial elbow Medial elbow p! = Little League Elbow in skeletally immature athletes

Presents as a gradual onset of discomfort during the throwing motion with aching following activity. Can lead to avulsion. Accompanied by increased volume and intensity. May have slowed throwing velocity and diminished accuracy.

Apophysitis

Apophysitis treatment

Rest for 4-6 weeks, start RTT program after another 6 weeks of rehab

If Apophysitis leads to avulsion, treatment plan?

Treat non-op with 2-4 weeks immobilized to hinged elbow brace for another 6-8 weeks then follow with rehab

If there are compressive forces on lateral elbow with lateral elbow pain, what do we want to rule out

OCD

Often presents with more severe pain and limitations. Disruption in subchondral blood to capitellum. Radial head can be involved as progresses and loose bodies may be present

OCD

How to treat stable OCD lesions of the capitellum

Non-op with activity restriction and close observation. Surgical management is diverse and may include open/arthroscopic debridement, loose body removal, microfracture, or drilling. Average RTS is 6 months

Lateral Epicondylitis

Kinetic Chain Theory = Dual rehab for scapula and elbow Good evidence for proximal and radioulnar joint mobs

An intervention aimed at affecting the neural structures or surrounding tissue directly or indirectly through exercise or manual techniques. Normally divided into "sliders" and "tensioners"

Neural Mobilization

Actions that elongate the nerve bed through movement at one joint while moving another to relieve tension in the nerve. Also known as "neural flossing"

Sliders

Joints are moved in such a way that the nerve bed is elongated and the tension in nerves is increased

Tensioners

Before doing neurodynamics

Ensure tissue mobility is good by working on pain, swelling, joint motion, fascial movement, and tissue extensibility/length

Why use slider?

Don't increase tension/compression, decrease pain, increase excursion of nerve

Why use tensioner?

More progressive, makes viscoelastic and physiological changes to nerve tissue

Parameters for Neurodynamics

Low Reps/Sets 10-15 slow reps (3-5 sec), 3-5 times per day

Manual and Exercise technique, uses maximum facilitation of neural input to produce maximum output response. Uses dermal receptors, muscle spindles/GTOs, and visual/auditory/tactile stimulation.

Proprioceptive Neuromuscular Facilitation (PNF)

The body naturally moves in functional patterns that are multi-joint and involve

Diagonals and spiral motions

PNF Techniques

Rhythmic Stabilization Rhythmic Initiation Slow Reversal Slow reversal-hold Agonist Reversal

Place extremity into any part of the D1 or D2 movement pattern and have the pt hold the position isometrically with perturbations

Rhythmic Stabilization

Rhythmic motion of the limb or body through the desired range, starting with passive motion and progressing to active resisted movement

Rhythmic Initiation

Have pt move through pattern (both flexion and extension) and using an isotonic concentric contraction

Slow Reversal

Same as Slow reversal but hold isometrically at end ROM for 6-10 seconds

Slow reversal-hold

Have pt move through pattern using an isotonic concentric contraction in one direction and then “reverse” the agonist role into an eccentric contraction to resist moving back to the starting position

Agonist Reversal

D1 pattern

Buckle your seat belt

D2 pattern

Drawing your sword

UCL provides how much support

54%, able to resist 32 NM of strain Youth - 28 NM HS pitchers - 48 NM College pitchers - 55 NM Pro pitchers - 64 NM

Osseous provides how much support

33%, lateral compression at radiocapitellar joint

Soft tissue provides how much support

13%, FCU + FCR = 15%, Pronator Teres = 7%

Risk of elbow pain increased by 6% for every _ pitches and _ % over 75 pitches

10 pitches, 50%

Deficit of what increases risk of UCL injury

UCL Rehab Considerations

Type of repair/reconstruction Position/Level of Play Elbow position and exercise Underlying factors Rotator cuff and forearm conditioning Proprioception LE and lumbopelvic strength and stability

Traumatic anterior shoulder dislocations have been reported in how much of Gen Pop?

1.7%

Anterior dislocations make up how much of all shoulder dislocations

90%

Highest rates of shoulder dislocations are found in?

Contact sports

In 45% of injured athletes due to shoulder dislocation, how much time did they miss

Greater than 10 days

Recurrence rates of shoulder dislocation based on age

52% if 1st SD was under 23 y/o 18% if 1st SD was over 30 y/o

Common pathology related to SD

Hills-Sachs lesion Glenoid bone loss Alpsa lesion (non-acute) Prolonged instability HAGL (Humeral avulsion of GH ligament)

AMBRI vs TUBS

"Born Loose" vs "Torn Loose"

3 purposes of Glenoid Labrum

Increase surface contact area Buttress Attachment site for GH ligament

Risk factors for impingement

Pathomechanics Acquired instability overuse syndrome (AIOS) IR deficit and implications Scapular dyskinesis

2 primary causes of Internal Impingement

Excessive Humeral Head translations (leads to microinstability and IR deficit) Abnormal scapular patterns (leads to dyskinesis and retractor deficiency)