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Active Care Exam 2 > UE Rehab > Flashcards

UE Rehab Flashcards

1
Q

What is the stability of the shoulder girdle like?

A

Great mobility but tendency to instability.

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2
Q

What three bones make up the shoulder girdle?

A

Humerus, clavicle, scapula

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3
Q

What are the three anatomical joints of the shoulder girdle?

A

Glenohumeral

Acromialclavicular

Sternoclavicular

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4
Q

What are the two functional joints?

A

Scapulothoracic

Suprahumeral

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5
Q 
• Base of the Upper Extremity
• Multiple attachments
• Links trunk to upper extremity
• Mobile base for humerus
• Distal function compromised without
proximal stability
• Transfers energy through kinetic chain
A

Scapula

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6
Q

T/F You must be able to understand normal
movement pattern before identifying and
treating abnormal scapular patterns

A

True

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7
Q

Scapulo-humeral rhythm

A

• 180 degrees total abduction
– 120 degrees Glenohumeral motion
– 60 degrees Scapulothoracic motion
– 2:1 GH:ST

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8
Q

First ~30-60 degrees GlenoHumeral (GH)

A

Setting Phase

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9
Q

Scapula must rotate _______(upward/downward), tilt ________ (post/ant) and rotate ________ (ext/int).

A

upward, posteriorly, externally

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10
Q

Why does the scapula have to move in this pattern?

A

To clear the acromion from the moving arm

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11
Q

T/F Scapula must also rotate internally and externally to maintain the glenoid as a congruent socket for the moving arm?

A

True

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12
Q

In what position must the scapula be stabilized in during arm movements?

A

Relative retraction

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13
Q

Altered scapula position and motion changes

joint loads which can cause what?

A

Shoulder injury

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14
Q

T/F In the shoulder active stabilizers contract and tighten the
passive stabilizers?

A

True

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15
Q

T/F Individual muscle actions our the primary concern with the shoulder?

A

False, Functional movement in general is the primary concern

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16
Q

Impairment of voluntary movement

resulting in fragmentary movements

A

Scapular Dyskinesis

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17
Q

This is frequently involved with glenohumeral derangement.

A

Scapular Dyskinesis

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18
Q

Scapular dyskinesis occurs in 64% of _________ cases.

A

Instability

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19
Q

Scapular dyskinesis occurs in 100% of _________ cases.

A

Impingement

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20
Q

What causes scapular dyskinesis?

A

Age
– Decreased posterior tilt and upward rotation
• Posture
• Fatigue
– Decreases force production
– Altered resting position of scapula
– May decrease subacromial space available

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21
Q

Lesser scapula upward rotation and posterior tilt.

A

Inadequate serratus anterior

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22
Q

Greater clavicle elevation

A

Excess upper trap activation

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23
Q

Greater scapula internal rotation and anterior tilt

A
  • Posterior GH joint soft tissue tightness

- Pec minor tightness

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24
Q

What is the shoulder abduction motor pattern?

A 
• Abduct the arms fully
• Observe from front
and back
• Watch for smooth,
symmetrical motion
with equal mm tone
• Ask for symptoms
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25
Q

What is the lateral scapular slide test?

A

• Three positions measured in cm from spine to
inferior angle of scapula
– Arms at side—very little muscle activity
– Hands on hip—SA and LT working at low levels
– 90 degrees abduction with full IR—Upper and lower traps,
rhomboids, and SA working at 40% MVC

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26
Q

Lateral Scapular Slide Test:
– A difference greater than ___ cm between sides is a
positive finding. Long standing cases may be larger
– (+) Test indicates deficit in dynamic stabilization or
postural adaptations that produce differences in scapular
-__________.

A

1.5 cm

Positioning

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27
Q

Should be able to depress and retract scapula
and hold for 15-20 seconds without burning or
obvious signs of muscle weakness

A

Isometric Pinch or Squeeze Test for Scapula

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28
Q

Lower Trapezius Activation

A

Prone Depression/Retraction of Scapulae

**Keep the wrists in the same plane as
elbows parallel to the floor.
Holds until fatigued then repeat

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29
Q

Great test/exercise for the lower trapezius
– Lower trap weakness is associated with poor
scapular control and faulty postures

A

Reach, Roll and Lift (Scapula)

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30
Q

T/F Slouched posture decreases shoulder elevation

as much as 25%

A

True

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31
Q

Choose exercises with a low Upper Trap to

high Lower Trap ratio

A

S-T rhythm exercises

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32
Q

Side-lying eliminates gravity and takes away

postural support of _____ _____.

A

Upper Trap

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33
Q

Push-up plus is performed by this muscle: _____ ______.

A

Serratus Anterior

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34
Q

Seated Press Ups are performed by the ______ ______.

A

Lower Trap

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35
Q

Stabilizes the scapula and ribcage.

A

Serratus Anterior

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36
Q

Superior rotation during arm abduction and important in pushing activities

A

Serratus Anterior

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37
Q

Elevation of the humerus through the plane of the scapula is called ________.

A

Scaption

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38
Q

Scaption is performed ___ to ____ degrees anterior to the frontal plane.

A

30 - 45

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39
Q

What muscles make up the rotator cuff?

A

Supraspinatus, Infraspinatus, Teres Minor, Subscapularis

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40
Q

The Labrum increases ________.

A

Stability

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41
Q

What is in the subacromial space?

A

Subacromial bursa and supraspinatus tendon

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42
Q

What is the function of the rotator cuff?

A

• 3 well recognized
– Stabilization of humeral head in glenoid
– Provide muscular balance
• Stabilize GH when other larger muscles crossing the
joint activate. Force couple with deltoid
– Rotation of humeral head

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43
Q

What are additional functions of the rotator cuff?

A 
Compress the
humerus into the
glenoid
• Downward depress
humerus during
abduction
• Dynamic stability
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44
Q

What causes rotator cuff dysfunction?

A 
• Failure of some of the
fibers inserting into
bone
• Can be weakened by
age, disuse, smoking,
spurs
• Tears due to trauma,
instability, aging
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45
Q

What type of trauma usually causes rotator cuff tears?

A

Traction force (either sudden load or such traction force)

Heavy weight from shelf

or

Pulling and sudden stop

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46
Q

2 most commonly cited cause of tears of rotator cuff

A

Subacromial impingement (MC)

and

Tendon degeneration

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47
Q

What causes subacromial impingement?

A

Cuff compression, irritation and tearing

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48
Q

What causes tendon degeneration of the rotator cuff?

A
  • Poor vascularity

* Failure of collagen matrix

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49
Q

What are the structures of the subacromial space that may be compromised?

A

– Supraspinatus
– Long head of biceps
– Infraspinatus
– Subacromial bursa

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50
Q

Impingement risk factors

A

• Anatomic reductions in the available space
beneath the coracoacromial arch or within the
supraspinatus outlet area
• Intrinsic tendon degeneration from eccentric
overload, ischemia, aging, or inferior tissue
properties
• Scapular or humeral movement alterations
compromising the RC tissues

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51
Q

Symptoms of impingement?

A

– Pain from deltoid insertion to under AC joint
– Abduction and internal rotation cause pain
– Overuse
– Previous shoulder problems-instability
– Middle deltoid pain

52
Q

• Impingement usually begins at 30-70 degrees

– maximal at 70-120 of abduction called ___________.

A

Neer’s Painful Arc

53
Q

What test is: Extreme passive flexion of arm-pronated forearm?

A

Neer’s Test, Seated

54
Q

Rotator Cuff Extreme Weakness

A

TEAR

55
Q

Rotator Cuff Extreme Decrease of Motion

A

Adhesive Capsulitis

56
Q

What are the ortho exams for shoulder impingement?

A

Neer sign, Hawkings Impingement Test, Supraspinatis Press Test, Empty Can test

57
Q

What are the preventative techniques for impingement?

A 
• Sleep patterns-arm under
head, etc.
• Perform activities at chest
level instead of overhead
• Keep activities close to
body
• Posture position of
scapula, thoracic spine,
cervical spine
• Breathing
58
Q

Tendon continuity intact

A

Partial thickness tear

59
Q

Tendon continuity disrupted

A

Full thickness tear

60
Q

0-1 cm tear

A

small

61
Q

1-3 cm tear

A

medium

62
Q

3-5 cm tear

A

large

63
Q

> 5 cm tear

A

massive

64
Q

What tendon is most commonly torn with a rotator cuff tear?

A

Supraspinatus

65
Q

On X-Ray you will see displacement of what bony structure?

A

Humeral Head will move superiorly

66
Q

What are five reasons against early surgical repair of rotator cuff?

A

• 25% of cadavers have torn cuff
• 50% of patients recover spontaneously
• Diagnosis difficult in acute phase
• Results of early vs. delayed repair are the same
• Immediate repair offers no real advantage due to the
degenerated, avascular and fibrosed tendon

67
Q

T/F Adequate rest combined with scapular and
rotator cuff strengthening resulted in 40-82%
satisfaction of non-operated shoulders

A

True

68
Q

What is the treatment for rotator cuff tears?

A 
• Decrease the inflammatory
process—Passive care
measures
• Maintain or restore joint
mobility—posture
• Regain or improve strength
• Restore normal neuromuscular
control
• Functional ADL training
– Try to achieve within 3-6
months or referral for
surgical intervention
69
Q

Series of rigid segments linked by moveable joints

A

Kinetic chain

70
Q

Distal end of the extremity is free (Open/Closed Chain)?

A

Open

71
Q

One Joint involvement (Open/Closed Chain)?

A

Open

72
Q

Forces Perpendicular to the joint (Open/Closed Chain)?

A

Open

73
Q

Increased shear stress (Open/Closed Chain)?

A

Open

74
Q

Typically non-weight bearing (Open/Closed Chain)?

A

Open

75
Q

Open Chain Examples?

A

Bench Press

Biceps Curl

Leg Extensions

Straight Leg Raises

Back Extension Exercises

Curl Up

76
Q

Distal End of the Extremity is fixed (Open/Closed Chain)?

A

Closed

77
Q

Multiple Joint Involvement (Open/Closed Chain)?

A

Closed

78
Q

Forces parallel to the joint (compression) (Open/Closed Chain)?

A

Closed

79
Q

Decreased shear stress (Open/Closed Chain)?

A

Closed

80
Q

Typically weight bearing (Open/Closed Chain)?

A

Closed

81
Q

Closed chain examples?

A 
Pushups
• Handstands, pushups
• Pull-ups
• Squats
• Lunges
• Pelvic tilts
82
Q 
What is being described?
• Shoulder mobilization and
strengthening.
• Lean on counter or chair
• Swing arm gently forward
and backward, side to side,
and in circles.
• Gravity distracts the head of
the humerus
• Progress to holding weights
(1-2 lb at first).
• Tendonitis, adhesive
capsulitis, frozen shoulder,
post surgical rehab, etc.
A

Codman’s Exercise (Codman’s Pendulum)

83
Q

Lean against ball with one or two hands.

A

Closed Chain

84
Q

Exercise ball pushups

A

Closed Chain

85
Q

Rotator Cuff - body blade

A

PNF fast reversal

86
Q

Frozen Shoulder

A

Adhesive Capsulitis

87
Q

Adhesive Capsulitis is most commonly due to what?

A

Idiopathic

less commonly post traumatic

88
Q

What are the risk factors for adhesive capsulitis?

A 
Risk factors:
– Age 40 to 60
– Women:Men = 2:1
– Diabetes and Thyroid dysfunction
– Trauma & Surgery, esp. with immobilization
89
Q

What are the motion limitations with adhesive capsulitis?

A
  1. ) External Rotation
  2. ) Abduction
  3. ) Internal Rotation
90
Q

What is the treatment for adhesive capsulitis?

A 
• Moist Hot packs 10–15 min
• Ultrasound
• Supine ext. rotation with 1–2 LB wt 45 min
• Replace hot pack every 10-15 min
• Ice for final 10-15 min
• Home
stretches
91
Q

What other treatments are offered for adhesive capsulitis?

A 
Conservative Rehab
– Adjusting / Joint mobilization
– Heat and stretch
• Watson and Jones found 5% failed to regain satisfactory motion
after 6 months of stretching
• Manipulation under
Anesthesia (MUA)
– Last resort to break up
adhesions
92
Q

Physeal stress injury at the shoulder
• Stress causes widened growth plate
• Pain and swelling of the shoulder

A

Little Leaguer’s Shoulder

93
Q

What are the risk factors for little leaguer’s shoulder?

A

– Repeated overhead / overhand throwing without proper rest
– Pitching and throwing with poor mechanics
– Lack of muscle strength of the shoulder and upper back

94
Q

Other prominent sites of physeal stress include:

A

Elbow, Wrist, and Lower Leg

95
Q

What are the recommendations for little leaguer’s shoulder?

A 
When an overuse injury appears to have
symptoms near a growth plate, x-ray and/or get
opinion of orthopedic surgeon
– Limit cause of overuse symptoms
– Promote different activities
– Focus on proper movements/form etc.
96
Q

What are the passive techniques to approaching elbow, forearm and wrist conditions?

A

• Adjusting, Ice, Friction Massage, Active Release

97
Q

What are the active techniques to approaching elbow, forearm and wrist conditions?

A

Passive, Active Assisted, Active, Active Resisted

98
Q

The Flexor Carpi Radialis tendon causes this problem.

A

Medial Epicondylitis

99
Q

What activities cause medial epicondylitis?

A

Golf, throwing activities

100
Q

What work related physical and psychosocial factors are
associated with increased risk of developing medial
epicondylitis?

A

– > 5kg 2x/min at a min of 2 hrs/day
– > 20kg at least 10x day
– high grip forces for >1 hr. day.
– Vibrating tools >2 hrs. day

101
Q

How quickly does medial epicondylitis improve?

A

Few months, less disabling than lateral epicondylitis

102
Q

Rehab exercises for medial epicondylitis?

A

Hang wrist over table edge holding light weight
straighten/extend/supinate then reverse
– Flexbar, eccentric loading

103
Q

Tennis elbow, rower’s elbow, common insertion of wrist extensor tendons

A

Lateral Epicondylitis

104
Q

In lateral epicondylitis the dominant arm is more common in what percentage of people?

A

70%

105
Q

What are the risk factors for lateral epicondylitis?

A

– Sports or occupational activities requiring
repetitive wrist extension
– Tennis associated with condition in only 5% of
patients

106
Q

What conditions are associated with lateral epicondylitis?

A

– Carpal tunnel
– Cervical neuropathy
– Shoulder impingement
– Osteoarthritis of elbow

107
Q

How long does lateral epicondylitis last?

A

6-24 months

108
Q

How many patient’s have absence from work due to lateral epicondylitis?

A

10-30%

109
Q

T/F Recurrences were more common with injection for lateral epicondylitis than with manipulation and wait and see methods.

A

True

110
Q

T/F Static extensor brace may reduce pain and

improve function

A

False, Dynamic Extensor Brace may reduce pain and improve function

111
Q

T/F Elbow strap and sleeve orthosis associated with

improved pain-free grip strength

A

True

112
Q

What order are stretches performed for the wrist/forearm?

A 
• Passive ROM 1st
• Active
– Self Stretches
• Active Assisted
• Active Resisted
113
Q

Treatment for Carpal Tunnel Syndrome

A

– Exercises
– Splints
– Corticosteriods
– Surgery

114
Q

T/F Splints are considered the first line of care for carpal tunnel.

A

True

115
Q

What are the two predictors of success for carpal tunnel syndrome?

A

Less than 1 year duration

Score of 6/10 or less for severity of nocturnal parasthesia

116
Q

How is the wrist splinted?

A

At zero degrees flex/ext/rot.

117
Q

Splints with magnets are worn how long?

A

24 hours/day

118
Q

T/F Yoga is a useful treatment for CTS.

A

True

119
Q

What are pro/cons to surgery for CTS?

A

Decrease in symptoms immediately

Still decrease present in strength and sensation, risk of infection and rehab lasts months following

120
Q

What are the hand positions for CTS?

A
  1. wrist is neutral, fingers and thumb in flexion
  2. ) Wrist is neutral, fingers and thumb extended
  3. ) Thumb is neutral, wrist and fingers extended
  4. ) Wrist, fingers and thumb extended
  5. ) Same as in #4 with forearm in supination
  6. ) Same as #5 other hand gently stretching thumb
121
Q

What can lead to failed CTS surgery outcomes?

A

Double Crush Syndrome

122
Q

Thickening of the sheath of the flexor

tendons at the A1 pulley

A

Trigger Finger

123
Q

Extension of MCP and DIP,

flexion of the PIP

A

Boutonniere Deformity

124
Q

Flexion of the MCP and DIP,

hyperextension of the PIP

A

Swan Neck Deformity

125
Q

Rupture of extensor digitorum tendon at

the instertion on distal phalanx

A

Mallet Finger

126
Q

Avulsion of flexor profundus, forced

hyperextension, loss of DIP flexion

A

Jersey Finger

Active Care Exam 2 (7 decks)

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