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PTRS 745 Exam 1 > The Shoulder > Flashcards

The Shoulder Flashcards

1
Q

Diagram: Identify the 4 joints

A

Left to Right, Top to Bottom

  1. Sternoclavicular
  2. Acromioclavicular
  3. Scapulothoracic
  4. Glenohumeral
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2
Q

Content: Passive/static glenohumeral stability (5)

A
  1. Bones
  2. Cartilage
  3. Capsule
  4. Labrum
  5. Ligaments
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3
Q

Content: Active/dynamic glenohumeral stability (2)

A
  1. Deep muscles (rotator cuff)
  2. Neuromuscular balance between deep and superficial muscles
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4
Q

Diagram: Ligaments

A

Top to bottom

  • Conoid
  • Trapezoid (with conoid = coracoclavicular
  • Acromioclavicular
  • Coraco-acromial
  • Coraco-humeral
  • Transverse humeral
  • Superior GHL
  • Middle GHL
  • Inferior GHL
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5
Q

Content: Superficial muscles (6)

A
  1. Deltoid
  2. Pectoralis
  3. Biceps
  4. Trapezius
  5. Latissimus dorsi
  6. Serratus anterior
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6
Q

Content: Deep muscles/rotator cuff (4)

A
  1. Supraspinatus
  2. Infraspinatus
  3. Teres minor
  4. Subscapularis
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7
Q

Q: What is the ratio for glenohumeral/scapulothoracic movement?

A

5:4

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8
Q

Q: What is the ratio for humeral/scapular movement?

A

2:1

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9
Q

Q: When does scapulohumeral rhythm begin?

A

After 30 degrees of abduction

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10
Q

Q: What 3 movements occur at the clavicle?

A
  1. Protraction/Retraction
  2. Elevation/Depression
  3. Posterior rotation/Anterior rotation
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11
Q

Q: What movements occur at the ST joint?

A
  1. IR/ER
  2. Upward/lateral rotation/Downard/medial rotation
  3. Posterior tilting/Anterior tilting
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12
Q

Q: What is roll and glide for humeral flexion?

A

R = ant

G = post

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13
Q

Q: What is roll and glide for humeral horizontal adduction?

A

R = ant

G = post

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14
Q

Q: What is roll and glide for humeral IR?

A

R = ant

G = Post

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15
Q

Q: What is roll and glide for humeral extension?

A

R = post

G = ant

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16
Q

Q: What is roll and glide for humeral horizontal abduction?

A

R = post

G = ant

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17
Q

Q: What is roll and glide for humeral ER?

A

R = post

G = ant

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18
Q

Q: What is roll and glide for humeral abduction?

A

R = superior

G = inferior

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19
Q

Q: For what degrees of motion does elevation through abduction occur?

A

170-180

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20
Q

Q: For what degrees of motion does elevation through forward flexion occur?

A

160-180

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21
Q

Q: For what degrees of motion does elevation through the plan of the scapula occur?

A

170-180

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22
Q

Q: For what degrees of motion does ER occur?

A

80-90

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23
Q

Q: For what degrees of motion does IR occur?

A

60-100

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24
Q

Q: For what degrees of motion does extension occur?

A

50-60

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25
Q

Q: For what degrees of motion does adduction occur?

A

50-75

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26
Q

Term: A mechanical impingement of the subacromial structure, esp. the rotator cuff tendons, beneath the atnerior-inferior poriotn of the acromion

A

Impingement syndrome

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27
Q

Defn: Shoulder impingement syndrome

A

Term: A mechanical impingement of the subacromial structure, esp. the rotator cuff tendons, beneath the atnerior-inferior portion of the acromion

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28
Q

Q: What are the symptoms of shoulder impingement syndrome? (2)

A
  1. Pain in the anterosuperior part of the shoulder
  2. weakness and stiffness
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29
Q

Q: What is outlet impingement syndrome?

A

Occurs when the coracoarcomial arch encroaches on the supraspinatus outlet

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30
Q

Q: What is non-outlet impingement syndrome?

A

Occurs secondary to thickening or hypertrophy of the bursa or the rotator cuff tendons

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31
Q

Content: Intrinsic classification of impingement syndrome (4)

A
  1. Primary or secondary
  2. Rotator cuff weakness
  3. Overuse of the shoulder
  4. Degerenative tendinopathy
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32
Q

Q: Why can a pt. not hold up there arm when you perform a drop test?

A

If the supraspinatus is ruptured, it can not compress the shoulder joint/engage it to allow the deltoid to due it’s job.

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33
Q

Content: Extrinsic classifcation of impingement syndrome (6)

A
  1. Primary or secondary
  2. Shape of the acromion
  3. Instability (classic)
  4. Degeneration of the AC joint
  5. Impingement by the coracoacromial ligament or coracoid process
  6. Os acromiale (3 types)
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34
Q

Diagram: types of os acromiale

A
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35
Q

Q: If your scapula is anteriorly tilted you stretch ____________ and strengthen ___________.

A

Pectoralis minor, lower trap

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36
Q

Content: Stage 1 of impingement syndrome (2)

A
  1. Characterized by edema and hemorrhage of the bursa and cuff
  2. Pts. < 25 yo
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37
Q

Content: Stage 2 of impingement syndrome (2)

A
  1. Represents irreversible changes (fibrosis/teninitis) of the rotator cuff
  2. pts. 25-40 yo
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38
Q

Content: Stage 3 of impingement syndrome (2)

A
  1. Marked by more chronic changes (partial/complete tear) of rotator cuff
  2. Pts. > 40 yo
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39
Q

Content: Shoulder impingement differential diagnoses (6)

A
  1. Instability (secondary impingement)
  2. Adhesive capsulitis
  3. Glenohumeral arthritis
  4. Biceps tendonosis
  5. Labral pathology
  6. Cervical radiculopathy
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40
Q

Content: MOI for shoulder impingement (8)

A
  1. Age
  2. Position of the arm during activites
  3. Repetitive overhead
  4. Muscle imbalances
  5. Capsular tightness
  6. Postural imbalance
  7. Structural asymmetry
  8. Impaired scapular kinematics
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41
Q

Q: What is the diagnosis for a pt. > 40 yo with overuse and painful arc symptoms?

A

Primary impingement

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42
Q

Q: What is the diagnosis for a pt who is young with repetitive overhead/athletic activity with painful arc symptoms?

A

Secondary impingement

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43
Q

Q: In what ROM does the glenohumeral painful arc occur?

A

45-60 to 120 and beyond 170 degrees

44
Q

Q: What 4 tests can be done during a OE to confirm/refute a shoulder impingement diagnosis?

A
  1. Painful arc
  2. Neer’s test
  3. Hawkin’s test
  4. “Empty can” test
45
Q

Q: What is an education plan for a pt. with a shoulder impingement?

A

Avoid overhead activities and postitions of shoulder impingement

46
Q

Q: What is a modalities plan for a pt. with a shoulder impingement? (3)

A
  1. Ice
  2. Ultrasound
  3. Electrical currents
47
Q

Q: What is a therapeutic exercise plan for a pt. with a shoulder impingement? (3)

A
  1. Postural corrections
  2. ROM/stretching
  3. Strengthening
48
Q

Q: What is a manual therapy plan for a pt. with a shoulder impingement?

A

Inferior and posterior glides

49
Q

Q: What is an assistvie device plan for a pt. with a shoulder impingement?

A

sling when acute

50
Q

Q: What is a HEP plan for a pt. with a shoulder impingement?

A

Pendulum exercises and others based on the TherEx program

51
Q

Q: What is name of a traumatic shoulder instabiltiy lesion?

52
Q

Q: What ligaments are injuried in a non-traumtic shoulder instability injury?

A

IGHL and AGHL

53
Q

Q: What are the symtpoms for traumatic shoulder instability?

A

Recurrent shoulder dislocation (chronic phase)

54
Q

T/F: With traumatic shoulder instability a apprehension test is negative.

A

False: positive

55
Q

Q: What are the symptoms of non-traumatic shoulder instabiltiy?

A
  1. Tendinitis
  2. Sensation of instability and laxity
56
Q

T/F: With non-traumatic shoulder instabiltiy an apprehension test will be negative.

57
Q

Q: What is an education plan for shoulder instability?

A

Avoid MOI and overhead activities

58
Q

Q: What is a modalities plan for shoulder instability? (3)

A
  1. Ice,
  2. Electrical currents
  3. Diathermy (SWD)
59
Q

Q: What is a therapeutic exercise plan for shoulder instability? (2)

A
  1. Scapular stabilization exercises
  2. Rotator cuff strengthening
60
Q

Q: What is an manual therapy plan for shoulder instability?

A

Depends on exam findings, may not be applicable

61
Q

Q: What is an assistvie device plan for shoulder instability?

A

Sling when acute

62
Q

Q: What is a HEP plan for shoulder instability?

A

Follow the presribed TherEx

63
Q

Q: What is SLAP lesion?

A

Injury to the glenoid labrum

64
Q

Q: What does SLAP stand for?

A

Superior Labral tear from Anterior to Posterior

65
Q

Diagram: SLAP lesions classificaiton

66
Q

Content: MOI for SLAP lesions (2)

A
  1. Sudden eccentric biceps contraction as in trying to grap an object while falling from a height or a FOOSH
  2. Repetitive overhead activity (overhead athletes) - esp. baseball players
67
Q

Q: What deficits are seen in baseball players with SLAP lesions?

A

IR with should in 90 degrees of abduction, which predisposes excessive ER

68
Q

Content: Symptoms of a SLAP lesion (2)

A
  1. Pain
  2. Feeling of instability/lack of control (when overhead/abd ER)
69
Q

Q: What is an education plan for SLAP lesions?

A

Avoid MOI and overhead activites

70
Q

Q: What is a modality plan for SLAP lesions?

A

Diathermy (SWD)

71
Q

Q: What is a therapeutic exercise plan for SLAP lesions? (2)

A
  1. Scapular stabilization exercises
  2. Posterior capsular stretching
72
Q

Q: What is a manual therapy plan for SLAP lesions?

A

Depending on exam findings - inferior/anterior glides

73
Q

Q: What is an assistive device plan for SLAP lesions?

A

Sling when acute

74
Q

Q: What is a HEP plan for SLAP lesions?

A

Follow prescribed TherEx

75
Q

Term: a condition difficult to define, treat, and explain from the point of view of pathology

A

Adhesive capsulitis/frozen shoulder

76
Q

Term: Inflammed and fibrotic condition of capsuloligamentous tissue

A

Adhesive capsulitis/frozen shoulder

77
Q

Defn: Adhesive capsulitis or frozen shoulder

A

Inflammed and fibrotic condition of capsuloligamentous tissue

78
Q

Diagram: Classification of frozen shoulder

79
Q

Q: What is an education plan for frozen shoulder?

A

Explain the nature of the disease and prepare pt. for extended recovery

80
Q

Q: What is a modality plan for frozen shoulder? (2)

A
  1. Hotpacks
  2. TENS
81
Q

Q: What is a therapeutic exercise plan for frozen shoulder?

A

Stretching: progressive in the amount of stress and time (according with stage) - Hold/relax and LLLD

82
Q

Q: What is a manual therapy plan for frozen shoulder? (2)

A
  1. ER with inferior glide (rotator cuff interval - RIC)
  2. Posterior glide and maneuvers for general mobility
83
Q

Q: What is an assistive device plan for frozen shoulder?

A

Low load prolonged stress equipment

84
Q

Q: What is a HEP plan for frozen shoulder?

A

Pendulum and AA exercise 3x/day

85
Q

Q: What are 4 suggested modalities for shoulder pathologies?

A
  1. Ultrasound
  2. Diathermy
  3. Laser
  4. Eletrical currents
86
Q

Q: What is ultrasound good for?

A

Decrease pain and speed healing process

87
Q

Q: What effects does diathermy have?

A

Effects similar to subacromial corticosteroid injecitons

88
Q

Q: What is laser good for?

A

Decrease pain and speed the healing process

89
Q

Q: What is electrical currents good for?

A

Decrease pain

90
Q

Term: In degenerate shoulders where there is fraying and roughening of the biceps anchor area

A

SLAP type 1

91
Q

Term: Biceps anchor peels off from the supraglenoid tubercle with the associated detachment of the labrum extending for a variable distance anteriorly and/or posteriorly

A

SLAP type 2

92
Q

Q: Which SLAP classification is most common?

93
Q

Term: Bucket handle tear ofthe superior labrum without involvement of the biceps anchor

A

SLAP type 3

94
Q

Term: The labral tear extends into the biceps anchor na dtendon for a variable distance

A

SLAP type 4

95
Q

Term: SLAP with a bankart lesion

A

SLAP type 5

96
Q

Term: Flap tear of anterior labrum with detrachment of biceps anchor

A

SLAP type 6

97
Q

Term: SLAP tear associated with anteriocapsuloligamentous tear involving the middle glenohumeral ligament (MGHL)

A

SLAP type 7

98
Q

Content: Stages of Adhesive Capsulitis - Duration of Symptoms (4)

A

1: 0-3 mo
2: 3-9 mo
3: 9-15 mo
4: 15-24 mo

99
Q

Content: Stages of Adhesive Capsulitis - Pain (4)

A

1: w/AROM & PROM
2: Chronic pain w/AROM & PROM
3: Min pain except at end ROM
4: Min pain

100
Q

Content: Stages of Adhesive Capsulitis - Limitations (4)

A

1: Forward flexion, abduction, IR, ER
2: Significant limitation of forward flexion, abduction, IR, ER
3: Significant limitation of ROM with rigid end feel
4: Progressive inprovement in ROM

101
Q

Content: Stages of Adhesive Capsulitis - Examination (4)

A

1: Pt. under anesthesia - norm/min loss of ROM
2: Pt. under anesthesia - ROM essentially identical to ROM when pt. is awake
3: Pt. under anesthesia - ROM identical to ROM when pt. is awake
4: Data not available

102
Q

Content: Stages of Adhesive Capsulitis - Pathologic changes (3)

A

1: Hypertrophic, hypervascular synovitis, rare inflammatory cell infiltrates, normal underlying capsule
2: Hypertrophic, hypervascular synovitis with perivascular and subsynovial scar, fibroplasias and scar formation in the underlying capsule
3: “Burned-out” synovitis without significant hypertrophy or hypervascularity. Underlying capsule shows dense scar formation

103
Q

Defn: Intrinsic Impingement

A

Intratendinous

104
Q

Defn: Extrinsic Impingement

A

Extratendinous

105
Q

Defn: Primary Impingement (2)

A
  1. Structures that occupy the subacromial space
  2. Causes the impingement
106
Q

Defn: Secondary impingement (2)

A
  1. Structures that DO NOT occupy the subacromial space
  2. Instability or neurological disease
107
Q

Defn: Subacromial space

A

Coracoacromial arch: coracoacromial ligament or coracoid process and greater tuberosity of the humerus

PTRS 745 Exam 1 (9 decks)

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