UE Rehab Flashcards
1
Q
What is the stability of the shoulder girdle like?
A
Great mobility but tendency to instability.
2
Q
What three bones make up the shoulder girdle?
A
Humerus, clavicle, scapula
3
Q
What are the three anatomical joints of the shoulder girdle?
A
Glenohumeral
Acromialclavicular
Sternoclavicular
4
Q
What are the two functional joints?
A
Scapulothoracic
Suprahumeral
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
6
Q
T/F You must be able to understand normal
movement pattern before identifying and
treating abnormal scapular patterns
A
True
7
Q
Scapulo-humeral rhythm
A
• 180 degrees total abduction
– 120 degrees Glenohumeral motion
– 60 degrees Scapulothoracic motion
– 2:1 GH:ST
8
Q
First ~30-60 degrees GlenoHumeral (GH)
A
Setting Phase
9
Q
Scapula must rotate _______(upward/downward), tilt ________ (post/ant) and rotate ________ (ext/int).
A
upward, posteriorly, externally
10
Q
Why does the scapula have to move in this pattern?
A
To clear the acromion from the moving arm
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
12
Q
In what position must the scapula be stabilized in during arm movements?
A
Relative retraction
13
Q
Altered scapula position and motion changes
joint loads which can cause what?
A
Shoulder injury
14
Q
T/F In the shoulder active stabilizers contract and tighten the
passive stabilizers?
A
True
15
Q
T/F Individual muscle actions our the primary concern with the shoulder?
A
False, Functional movement in general is the primary concern
16
Q
Impairment of voluntary movement
resulting in fragmentary movements
A
Scapular Dyskinesis
17
Q
This is frequently involved with glenohumeral derangement.
A
Scapular Dyskinesis
18
Q
Scapular dyskinesis occurs in 64% of _________ cases.
A
Instability
19
Q
Scapular dyskinesis occurs in 100% of _________ cases.
A
Impingement
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
21
Q
Lesser scapula upward rotation and posterior tilt.
A
Inadequate serratus anterior
22
Q
Greater clavicle elevation
A
Excess upper trap activation
23
Q
Greater scapula internal rotation and anterior tilt
A
- Posterior GH joint soft tissue tightness
- Pec minor tightness
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
25
What is the lateral scapular slide test?
• 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
26
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
-__________.
1.5 cm
Positioning
27
Should be able to depress and retract scapula
and hold for 15-20 seconds without burning or
obvious signs of muscle weakness
Isometric Pinch or Squeeze Test for Scapula
28
Lower Trapezius Activation
Prone Depression/Retraction of Scapulae
**Keep the wrists in the same plane as
elbows parallel to the floor.
Holds until fatigued then repeat
29
Great test/exercise for the lower trapezius
– Lower trap weakness is associated with poor
scapular control and faulty postures
Reach, Roll and Lift (Scapula)
30
T/F Slouched posture decreases shoulder elevation
| as much as 25%
True
31
Choose exercises with a low Upper Trap to
| high Lower Trap ratio
S-T rhythm exercises
32
Side-lying eliminates gravity and takes away
| postural support of _____ _____.
Upper Trap
33
Push-up plus is performed by this muscle: _____ ______.
Serratus Anterior
34
Seated Press Ups are performed by the ______ ______.
Lower Trap
35
Stabilizes the scapula and ribcage.
Serratus Anterior
36
Superior rotation during arm abduction and important in pushing activities
Serratus Anterior
37
Elevation of the humerus through the plane of the scapula is called ________.
Scaption
38
Scaption is performed ___ to ____ degrees anterior to the frontal plane.
30 - 45
39
What muscles make up the rotator cuff?
Supraspinatus, Infraspinatus, Teres Minor, Subscapularis
40
The Labrum increases ________.
Stability
41
What is in the subacromial space?
Subacromial bursa and supraspinatus tendon
42
What is the function of the rotator cuff?
• 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
43
What are additional functions of the rotator cuff?
```
Compress the
humerus into the
glenoid
• Downward depress
humerus during
abduction
• Dynamic stability
```
44
What causes rotator cuff dysfunction?
```
• Failure of some of the
fibers inserting into
bone
• Can be weakened by
age, disuse, smoking,
spurs
• Tears due to trauma,
instability, aging
```
45
What type of trauma usually causes rotator cuff tears?
Traction force (either sudden load or such traction force)
Heavy weight from shelf
or
Pulling and sudden stop
46
2 most commonly cited cause of tears of rotator cuff
Subacromial impingement (MC)
and
Tendon degeneration
47
What causes subacromial impingement?
Cuff compression, irritation and tearing
48
What causes tendon degeneration of the rotator cuff?
* Poor vascularity
| * Failure of collagen matrix
49
What are the structures of the subacromial space that may be compromised?
– Supraspinatus
– Long head of biceps
– Infraspinatus
– Subacromial bursa
50
Impingement risk factors
• 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
51
Symptoms of impingement?
– Pain from deltoid insertion to under AC joint
– Abduction and internal rotation cause pain
– Overuse
– Previous shoulder problems-instability
– Middle deltoid pain
52
• Impingement usually begins at 30-70 degrees
| – maximal at 70-120 of abduction called ___________.
Neer's Painful Arc
53
What test is: Extreme passive flexion of arm-pronated forearm?
Neer's Test, Seated
54
Rotator Cuff Extreme Weakness
TEAR
55
Rotator Cuff Extreme Decrease of Motion
Adhesive Capsulitis
56
What are the ortho exams for shoulder impingement?
Neer sign, Hawkings Impingement Test, Supraspinatis Press Test, Empty Can test
57
What are the preventative techniques for impingement?
```
• 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
Tendon continuity intact
Partial thickness tear
59
Tendon continuity disrupted
Full thickness tear
60
0-1 cm tear
small
61
1-3 cm tear
medium
62
3-5 cm tear
large
63
>5 cm tear
massive
64
What tendon is most commonly torn with a rotator cuff tear?
Supraspinatus
65
On X-Ray you will see displacement of what bony structure?
Humeral Head will move superiorly
66
What are five reasons against early surgical repair of rotator cuff?
• 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
T/F Adequate rest combined with scapular and
rotator cuff strengthening resulted in 40-82%
satisfaction of non-operated shoulders
True
68
What is the treatment for rotator cuff tears?
```
• 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
Series of rigid segments linked by moveable joints
Kinetic chain
70
Distal end of the extremity is free (Open/Closed Chain)?
Open
71
One Joint involvement (Open/Closed Chain)?
Open
72
Forces Perpendicular to the joint (Open/Closed Chain)?
Open
73
Increased shear stress (Open/Closed Chain)?
Open
74
Typically non-weight bearing (Open/Closed Chain)?
Open
75
Open Chain Examples?
Bench Press
Biceps Curl
Leg Extensions
Straight Leg Raises
Back Extension Exercises
Curl Up
76
Distal End of the Extremity is fixed (Open/Closed Chain)?
Closed
77
Multiple Joint Involvement (Open/Closed Chain)?
Closed
78
Forces parallel to the joint (compression) (Open/Closed Chain)?
Closed
79
Decreased shear stress (Open/Closed Chain)?
Closed
80
Typically weight bearing (Open/Closed Chain)?
Closed
81
Closed chain examples?
```
Pushups
• Handstands, pushups
• Pull-ups
• Squats
• Lunges
• Pelvic tilts
```
82
```
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.
```
Codman's Exercise (Codman's Pendulum)
83
Lean against ball with one or two hands.
Closed Chain
84
Exercise ball pushups
Closed Chain
85
Rotator Cuff - body blade
PNF fast reversal
86
Frozen Shoulder
Adhesive Capsulitis
87
Adhesive Capsulitis is most commonly due to what?
Idiopathic
less commonly post traumatic
88
What are the risk factors for adhesive capsulitis?
```
Risk factors:
– Age 40 to 60
– Women:Men = 2:1
– Diabetes and Thyroid dysfunction
– Trauma & Surgery, esp. with immobilization
```
89
What are the motion limitations with adhesive capsulitis?
1. ) External Rotation
2. ) Abduction
3. ) Internal Rotation
90
What is the treatment for adhesive capsulitis?
```
• 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
What other treatments are offered for adhesive capsulitis?
```
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
Physeal stress injury at the shoulder
• Stress causes widened growth plate
• Pain and swelling of the shoulder
Little Leaguer's Shoulder
93
What are the risk factors for little leaguer's shoulder?
– Repeated overhead / overhand throwing without proper rest
– Pitching and throwing with poor mechanics
– Lack of muscle strength of the shoulder and upper back
94
Other prominent sites of physeal stress include:
Elbow, Wrist, and Lower Leg
95
What are the recommendations for little leaguer's shoulder?
```
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
What are the passive techniques to approaching elbow, forearm and wrist conditions?
• Adjusting, Ice, Friction Massage, Active Release
97
What are the active techniques to approaching elbow, forearm and wrist conditions?
Passive, Active Assisted, Active, Active Resisted
98
The Flexor Carpi Radialis tendon causes this problem.
Medial Epicondylitis
99
What activities cause medial epicondylitis?
Golf, throwing activities
100
What work related physical and psychosocial factors are
associated with increased risk of developing medial
epicondylitis?
– > 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
How quickly does medial epicondylitis improve?
Few months, less disabling than lateral epicondylitis
102
Rehab exercises for medial epicondylitis?
Hang wrist over table edge holding light weight
straighten/extend/supinate then reverse
– Flexbar, eccentric loading
103
Tennis elbow, rower's elbow, common insertion of wrist extensor tendons
Lateral Epicondylitis
104
In lateral epicondylitis the dominant arm is more common in what percentage of people?
70%
105
What are the risk factors for lateral epicondylitis?
– Sports or occupational activities requiring
repetitive wrist extension
– Tennis associated with condition in only 5% of
patients
106
What conditions are associated with lateral epicondylitis?
– Carpal tunnel
– Cervical neuropathy
– Shoulder impingement
– Osteoarthritis of elbow
107
How long does lateral epicondylitis last?
6-24 months
108
How many patient's have absence from work due to lateral epicondylitis?
10-30%
109
T/F Recurrences were more common with injection for lateral epicondylitis than with manipulation and wait and see methods.
True
110
T/F Static extensor brace may reduce pain and
| improve function
False, Dynamic Extensor Brace may reduce pain and improve function
111
T/F Elbow strap and sleeve orthosis associated with
| improved pain-free grip strength
True
112
What order are stretches performed for the wrist/forearm?
```
• Passive ROM 1st
• Active
– Self Stretches
• Active Assisted
• Active Resisted
```
113
Treatment for Carpal Tunnel Syndrome
– Exercises
– Splints
– Corticosteriods
– Surgery
114
T/F Splints are considered the first line of care for carpal tunnel.
True
115
What are the two predictors of success for carpal tunnel syndrome?
Less than 1 year duration
Score of 6/10 or less for severity of nocturnal parasthesia
116
How is the wrist splinted?
At zero degrees flex/ext/rot.
117
Splints with magnets are worn how long?
24 hours/day
118
T/F Yoga is a useful treatment for CTS.
True
119
What are pro/cons to surgery for CTS?
Decrease in symptoms immediately
Still decrease present in strength and sensation, risk of infection and rehab lasts months following
120
What are the hand positions for CTS?
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
What can lead to failed CTS surgery outcomes?
Double Crush Syndrome
122
Thickening of the sheath of the flexor
| tendons at the A1 pulley
Trigger Finger
123
Extension of MCP and DIP,
| flexion of the PIP
Boutonniere Deformity
124
Flexion of the MCP and DIP,
| hyperextension of the PIP
Swan Neck Deformity
125
Rupture of extensor digitorum tendon at
| the instertion on distal phalanx
Mallet Finger
126
Avulsion of flexor profundus, forced
| hyperextension, loss of DIP flexion
Jersey Finger
