Upper extremity injuries Flashcards
What is shoulder impingement
compression of structures found in the subacromial space
What is the cause of impingement
repetitive or sustained elevation above 90 degrees
What is a positive impingement test
Hawkins test
shoulder and elbow are flexed to 90 degrees followed by forced IR
What is stage 1 of impingement
Tendons and bursa are inflamed
symptoms can be resolved
focus is on activity modification
Treatment: Meds, stretching, progressive strengthening, taping, posture, thoracic spine mobility exercises
What is stage 2 of impingement
Bursa and tendons become thick and fibrotic
treatment is conservative (Same as stage 1) (Recovery is longer)
What is stage 3 in impingement
bone spurs and partial or full thickness tears in muscles
surgery to remove bone spurs or repair muscle tear
What are causes of rotator cuff tears
trauma, progression of impingement syndrome, degenerative changes of tendon
What are symptoms of rotator cuff tear
Overhead and rotational movt’s are difficult and painful
compensate by hiking shoulder
Treatment for rotator cuff tear
recommended 3 months of conservative therapy before surgery
activity mod, strengthening of scapular and rotator cuff
What are tests for rotator cuff tears
Neer impingement sign hawkins test empty can test drop arm test biceps speed test
When does early tendon healing take place
1st 4-6 weeks
What happens in the early phase following rotator cuff surgery
Wear shoulder immobilizer PROM and AAROM Ice use Codmans pendulum uninvolved arm supplies power one handed techniques
What happens after 4-6 weeks of healing
no immobilizer AROM shoulder ext and ir avoid compensatory movt's strengthening through isometric exercise
what happens in 8-12 weeks following surgery
isotonic exercises using theraband and free weights
encourage adl’s above shoulder level
What can OT’s teach for rotator cuff tears
dressing and bathing one-handed
how to transfer in/out of shower
What is adhesive capsulitis characterized by
stiffness and pain in the shoulder joint
What is adhesive capsulitis caused by
differential diagnosis post menopausal stress post mastectomy stroke arm fractures
What is stage 1 of adhesive capsulitis
what happens in this stage
Painful stage
pain w/ movt, limited shoulder range
treatment; nsaids, steroid injection, postural correction, active exercise, isometric strengthening w/in pain limits, modalities
Who do you see adhesive capsulitis in more
women after age 40
What is stage 2 of adhesive capsulitis
what happens in this stage
Frozen stage
more stiffness than pain
treatment: jt mobilization (compression/distraction), stretches, steroids, joints mobs under anesthesia, modalities
What is stage 3 of adhesive capsulitis
what happens in this stage
Thawing stage
Joint presents w/ increased ROM and decreased pain
What is treatment of adhesive capsulitis
Passive exercise: use dowel stick (to help lift and assist affected side)
Active stretch exercise: finger walk up wall, side hand up wall of shower
Active ROM: no resistance then progress to resistive exercises
Resistive exercise: weights, theraband
How to stretch the anterior capsule
place arms against ope door or corner and sep back and lean forward
How to stretch posterior capsule
grasp impaired arm under the elbow and pull upper arm across chest under the chin
