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MSPT > The Shoulder > Flashcards

The Shoulder Flashcards

1
Q

What 6 areas can shoulder pain be referred to?

A
  1. Lung
  2. Gallbladder
  3. Pancreas
  4. Heart
  5. Diaphragm muscle
  6. Some lesions in the shoulder refer pain to the area of the deltoid tubercle
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2
Q

What 3 things should be observed when examining the shoulder?

A
  1. Posture
  2. Scapular Winging
  3. Step deformity
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3
Q

What area is most likely to experience pain as a result of poor posture?

A

Low back (63%)

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4
Q

What position is the supraspinatus tendon most easily palpated in?

A

Shoulder in 20 degrees of extension

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5
Q

What position is optimal for palpating the infraspinatus and teres minor tendons?

A

Prone on elbows

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6
Q

What 3 components/actions should be included when assessing ROM at the shoulder?

A
  1. Functional range of motion by asking the patient to bring the arms over the head
  2. Scapulohumeral rhythm
  3. Whether the patient has a painful arc
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7
Q

How should scapulohumeral rhythm be assessed?

A
  1. Instruct the patient to elevate both arms simultaneously in the scapular plane.
  2. Palpate the inferior border of the scapula during this movement.
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8
Q

Assessing scapulohumeral rhythm is a variation of the ______ test.

A

Lateral Scapular Slide test

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9
Q

What finding indicates abnormal scapulohumeral rhythm or a positive lateral scapular slide test?

A

Difference between medial border or left vs right scapula and the spine is more than 1.5 cm

difference in the distance between the medial border of the left vs. right scapula and the spine should be no more than 1 ½ cm

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10
Q

True or False: Asymmetrical scapular position indicated dysfunction.

A

FALSE

Asymmetry is common and often asymptomatic

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11
Q

True or False: Intrarater reliability for resisted isometric testing at the shoulder is poor.

A

FALSE

Intrarater reliability is good for RI of the shoulder

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12
Q

True or False: Interrater reliability for resisted isometric testing at the shoulder is poor.

A

TRUE

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13
Q

Where does the C4 nerve root refer pain to? (1)

A

AC joint

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14
Q

What 3 areas does the C5 nerve root refer pain to?

A
  1. GH joint capsule
  2. Supraspinatus muscle
  3. Area surrounding the deltoid tubercle
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15
Q

What 5 areas does the C6 nerve root refer pain to?

A
  1. Infraspinatus
  2. Teres minor
  3. Subscapularis
  4. Deltoid tubercle
  5. Lateral elbow
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16
Q

The diagnostic accuracy of the physical examination improves when ______.

A

Shoulder tests are evaluated in combination

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17
Q

True or False: When used in isolation, the majority special tests have the ability to rule in or rule out the pathology in question.

A

FALSE

Majority lack ability to rule in or rule out when used in isolation

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18
Q

What 3 signs/sxs form the test cluster for a rotator cuff tear?

A
  1. Age > 64
  2. Weakness in external rotation
  3. Night pain
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19
Q

What 4 signs/sxs form the test cluster for a FULL thickness rotator cuff tear?

A
  1. Age ≥ 60 and
    • painful arc test
    • drop arm test
    • infraspinatus test
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20
Q

What 3 signs/sxs form the test cluster for impingement?

A
    • Hawkins–Kennedy
    • painful arc test
    • infraspinatus test
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21
Q

What 2 signs/sxs form the test cluster for anterior instability (traumatic)?

A
    • apprehension test and

2. + relocation test

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22
Q

What 2 signs/sxs form the test cluster for a labral tear?

A
    • relocation test

2. + active compression test

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23
Q

What is a standard shoulder arthroplasty?

A

Conventional shoulder replacement device mimics the normal anatomy of the shoulder

A plastic cup” is fitted into the glenoid and a metal “ball” is attached to the humerus

24
Q

What is reverse shoulder arthroplasty?

A

In a reverse total shoulder replacement, the socket and metal ball are switched.

The metal ball is fixed to the glenoid and the plastic cup is fixed to the upper end of the humerus

25
Q

What muscle does a reverse shoulder arthroplasty rely on to power and position the arm?

A

Deltoid muscle

26
Q

What patient population does a revers shoulder arthroplasty work best for?

A

People with cuff tear arthroplasty

27
Q

What is another term for frozen shoulder?

A

Adhesive capsulitis

28
Q

Adhesive capsulitis: Age? Gender? Etiology?

A
  1. Most common in women
  2. Ages 40-50
  3. Etiology is unknown
29
Q

What 2 pathologies are thought to be common precursors to adhesive capsulitis?

A
  1. Rotator cuff tendinopathy

2. Impingement Syndromes

30
Q

Some clinicians believe adhesive capsulitis is _______.

A

self-limiting (resolves by itself)

31
Q

How long does it take for adhesive capsulitis to resolve on its own?

A

12 months

32
Q

List 4 interventions that treat adhesive capsulitis.

A
  1. Short term PT
  2. Stretching of GH joint and surrounding musculature
  3. Minimize atrophy
  4. Increase strength
33
Q

True or False: The most improvement in function during recovery from adhesive capsulitis occurs in the late stages.

A

FALSE

Occurs early

34
Q

What 6 interventions are recommended by the JOSPT 2013 CPG for treating adhesive capsulitis?

A
  1. Corticoid Injections
  2. Patient education
  3. Modalities
  4. Joint Mobilizations
  5. Translational manipulations
  6. Stretching exercises
35
Q

Corticosteroid injections should be given inconjuction to what 2 treatments to provide short term pain relief?

A
  1. Shoulder Mobility

2. Stretching

36
Q

What 3 goals should be targeted when providing patient education?

A
  1. Describes the natural course of the disease
  2. Promotes activity modification to encourage functional, pain-free ROM
  3. Matches the intensity of stretching to the patient’s current level of irritability
37
Q

What 3 modalities, combined with mobility and strengthening, are may be used to treat adhesive capsulitis?

A
  1. Short wave diathermy
  2. Ultrasound
  3. Electrical Stimulation
38
Q

When is it permitted to use translational manipulation in pts with adhesive capsulitis?

A

When the patient is not responding to conservative treatment.

39
Q

What causes impingement?

A

Caused by anything that decreases the space in the subacromial area, causing the subacromial structures to be impinged between the acromium and humerus

40
Q

What are 8 possible causes of impingement syndrome?

A
  1. Impaired Posture
  2. Rotator cuff/biceps tendinopathy
  3. Subacromial bursitis
  4. Calcium deposits in GH joint or rotator cuff tendons
  5. Hook shaped acromion (type III)
  6. Shoulder Instability
  7. Adhesions in inferior/posterior capsule
  8. Weakness in rotator cuff muscles
41
Q

What happens to the GH joint with kyphosis/protracted scapulae?

A

GH joint becomes positioned into flexion and abduction making it difficult to hold the humerus in the glenoid.

42
Q

What happens to the acromion with poor posture?

A

Acromion jams against the biceps and/or subscapularis muscle with overhead activities.

43
Q

What occurs at the humeral head as a result of adhesions in the inferior and posterior joint capsule?

A

Causes the humeral head to jam against the acromion with movement into shoulder elevation

44
Q

What muscles contribute to the force couple generated with shoulder elevation?

A
  1. The middle deltoid and supraspinatus muscles contract to abduct the shoulder.
  2. The infraspinatus, teres minor and subscapularis muscles contract to counteract the tendency of the deltoid and supraspinatus muscles to elevate the humeral head in the glenoid, setting the humerus in the glenoid.
45
Q

What 6 interventions can be used to treat impingement?

A
  1. Exercise
  2. Tape
  3. ECSWT
  4. Laser
  5. Manual Therapy
  6. NSAIDs/corticosteroids
46
Q

True or False: PT is better than surgery in treating rotator cuff injuries.

A

FALSE

Insufficient evidence to support one intervention over the other

47
Q

What 2 interventions are primarily used in treating GH instability?

A
  1. Instruction in activities and positions to avoid

2. Strengthening exercises to shoulder musculature

48
Q

What is the most common type of shoulder instability?

A

Anterior joint instability

49
Q

What position does anterior GH injuries usually occur?

A

Abduction and ER

Weakest position of the GH joint biomechanically

50
Q

What positions should be avoided with anterior joint instability?

A

Abduction to 90 degrees of full ER

51
Q

What 3 muscles should be strengthened to provide a buttress against further anterior subluxations?

A
  1. Biceps
  2. Coracobrachialis
  3. Subscapularis
52
Q

What 4 muscles should be strengthened to control osteokinematic movement into abduction and external rotation?

A
  1. Pectoralis major
  2. Latissimus
  3. Teres major
  4. Subscapularis
53
Q

What 2 muscles should be strengthened to prevent the arthrokinematic motion of anterior movement of the humeral head in the glenoid?

A
  1. Infraspinatus

2. Teres Minor

54
Q

Intervention is most effective if the patient continues _______ beyond PT episode of care/

A

Prescribed exercise regimen

55
Q

What happens to the labrum if it is treated surgically following a labrum tear?

A

The labrum is clipped or sutured back in place

56
Q

What should the surgeon evaluate at the shoulder prior to surgery?

A
  1. Shoulder Instability
  2. If the shoulder is unstable then the instability must also be addressed during the surgery, otherwise the tear is likely to reoccur
57
Q

True or False: Therapeutic exercise and joint mobilization is superior to therapeutic exercise alone for treating shoulder dysfunction.

A

FALSE

No consensus

MSPT (12 decks)

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