Upper Extremity - Management/Evaluation Flashcards
Subacromial Pain Syndrome
44-65% of all conditions that cause shoulder pain
- relative overuse (sports, manual labor)
- anterior/lateral shoulder pain worse at night
- painful arc or pain with motions at or above shoulder height
- limited GHJ mobility
- Kyphotic posture
- decreased pec minor length
- scapular weakness or motor control deficits
tests for subacromial pain syndrome
Hawkins sign, neer sign, jobe test, painful arc, weakness in ER
Grade of mobilizations for Subacromial pain syndrome
Gr III-IV (at end ROM if low irritability)
Manual therapy for Subacromial pain syndrome
GHJ mobilizations, ST/SC/AC mobilizations, cross-friction, hold/relax
High irritability Therapeutic exercise for SPS
isometrics in neutral
scapular setting exercises
table slides
moderate irritability Therapeutic exercise for SPS
resistive exercises (band, isotonics, eccentrics <90)
pec stretching (low)
low rows, scap retraction
thoracic mobility exercises into extension/rotation
low irritability Therapeutic exercise for SPS
Inc. load and ROM of above exercises
Pec stretching with arms abd/ER
Prone scap strengthening
Primary impingement is
a structural problem
- narrowing of subacromial space
* osteophytes
* hooked acromion
* bursitis
* tendinopathy of RTC and biceps
Secondary impingement is
a functional problem
- shoulder muscle imbalance
- laxity/instability
- scapular dyskinesis
- postural dysfunctions
Full Thickness Rotator Cuff Tear MOI and Associated impairments
traumatic (imaging/referral possible) vs atraumatic (degenerative)
Impairments: pain with movement, point tenderness, “sling position”, atrophy, ROM restriction
Long Head of Biceps Tendinopathy or Tendon Rupture MOI and Associated impairments
MOI: continuous/repetitive shoulder motions, excessive abduction with ER
For rupture: heavy lift, FOOSH
Impairments: overhead activities, pain with resisted flexion, tenderness of bicipital groove, possible popping, possible instability
Therapeutic Exercise for Biceps tendinopathy
scapular setting isometric holds to scapular resistance exercises (mid, low traps, serratus)
RTC isometric
thoracic extension and rotation exercises
Adhesive Capsulitis MOI and Associated impairments
Frozen Shoulder
MOI: synovial inflammation with adhesions
- primary = insidious onset
- secondary = trauma, immobilization, CRPS
Four stages: prefreezing>freezing>frozen>thawing
*loss of active and passive movements
septic arthritis, malignancy, PMR
Therapeutic exercise for Acute Adhesive capsulitis
- exercises to restore ROM (wand, pulleys)
- isometrics
- pendulums
Therapeutic exercise for Chronic Adhesive capsulitis
Self-stretching of the capsule
wall climbing
PNF patterns for functional ROM
Glenohumeral Instability MOI and impairments
90% of dislocations are anterior
MOI: traumatic vs atraumatic
Impairments: GIRD, posterior shoulder tightness, Weakness
Therapeutic exercise for glenohumeral instability
Early: RTC and scap MM activation, address proprioception
middle: resistive exercises <90, controlled AROM
Late: strengthening exercises in provocative positions
Labral Lesions MOI and Impairments
MOI: repetitive OH activity, trauma
Impairments: pain, popping with rotational movements, weakness, posterior shoulder tightness
SLAP tear is “10-2 o’clock”
Bankart Lesion is “3-6 o’clock”
exercise for labral lesions
stabilization, strengthening starting in midrange, ER/IR strength, thoracic extension, rotation, stretching
Proximal humeral fracture MOI and Impairments
3rd most common type of fracture in adults
traumatic!
MOI: FOOSH, direct blow to the shoulder
Impairments: pain severe/sharp and radiate down upper arm
- very limited ROM
Exercise for proximal humeral fracture
depends on type and grade
AROM gripping, wrist, forearm, elbow, scap pro/retraction
progress from PROM to AAROM
Acromioclavicular Injury MOI and Impairments
MOI: force to top of the shoulder, FOOSH, Primary or secondary OA
- graded by ligamentous disruption and radiographic changes
Impairments: scapular depression in case of ligament injury, pain in superior shoulder, ROM limitations secondary to pain
Exercises for AC joint injury
Passive to active ROM as tolerated
RTC and scapular strengthening
Deltoid/trapezius strengthening in midrange may enhance stability
Posterior Internal Impingement MOI and Impairments
betweenn glenoid and humeral head
MOI: repetitive overhead activity, younger, active individuals
Impairments: pain in posterior shoulder, joint hypermobility, posterior capsule, soft tissue restriction, GIRD
Posterior Internal Impingement manual therapy and exercises
mobilizations, soft tissue
stretching of tight structures, strengthening of scapular retractors and RTC muscles
Glenohumeral OA MOI and Impairments
MOI: degenerative changes over time (heavy labor, prior trauma)
impairments: progressive stiffness and loss of ROM, CREPITUS, pain worse at night, joint compression
patients > 60 years old
Manual therapy glenohumeral OA
gentle ROM
Gr I-II for pain
Gr III-IV for mobility
RS for stability and hold/relax for mobility
Exercise for mild Glenohumeral OA
gentle stretching and self-mobilization
RTC/scap strengthening > isometrics to theraband and isotonic
thoracic ext/rot exercises
