W2 Flashcards
1
Q
Rotator Cuff Tear Cluster
A
- Age >65
- Night pain
- Weakness in ER
2
Q
Rotator Cuff Full Thickness Tear Cluster
A
- drop arm test
- painful arc test
- Infraspinatus test
- Age >60
3
Q
Impingement Cluster
A
+ Hawkins Kennedy
+ Painful arc
+ Infraspinatus weakness MMT
4
Q
Anterior Instability Test Cluster
A
+ Apprehension
+ Relocation
5
Q
Labral Tear Cluster
A
+ Relocation test
+ O’Brien’s/ active compression test
6
Q
Acromioclavicular Joint Pathology Cluster
A
+ Crossbody Adduction Test
+ AC resisted extension test
+ O’Brien’s
7
Q
What are all the tests for : Subacromial Impingement/Pain Syndrome
A
- Hawkins Kennedy–> (+) pain or motion limitation
- Painful Arc –> (+) Pain or compensation : 60-120 degrees: pain at end range is ACJ
- Neer’s–> (+) pain or limitation in motion
8
Q
What are the Special Tests for: Scapula
A
- Scapular Assistance–> (alleviating) (+) relief of symptoms
- Scapular Repositioning–> (+) if patient no longer exhibits pain or weakness after repositioning
9
Q
What are the Special Tests for: Muscle/Tendon Dysfunction
A
- Full/Empty Can Test ( Supraspinatus)–> (+) if the patient can’t hold position or pain
- Drop Arm Test (Supraspinatus: especially good for tears)–> (+) If patient isn’t able to slowly lower arm down
- IR Liftoff/ IR Lag Sign (Subscapularis)–> (+) if patient isn’t able to hold and slowly bring hand off of back
- ER Lag Sign ( Infraspinatus shoulder is abducted 20 degrees and elbow 90)/Horn blowers (Teres minor and shoulder is 90 and so is elbow in 90 )–> (+) if patient isn’t able to hold position
- Speeds Test (Tendinitis/ Labral Tear)–> (+) deep pain in bicipital groove = biceps / Deep pain in the shoulder = labrum
10
Q
What are the special tests for: Shoulder (GH) Instability and Posterior Impingement
A
- Apprehension Sign/ Jobe Relocation –> (+) apprehension test = apprehension/ (+) relocation test= reduction of pain or an increase in ROM
- Jerk Test ( Posterior-inferior instability/Labral) –> (+) pain with possible click or clunk
- Load Shift Test–> (+) depends on where the hypermobility is either anterior or posterior and you compare sides
- Posterior Shoulder Impingement/ Modified and Relocation Test
11
Q
What are the special tests for: Labral Lesions
A
- Active Compression/Obrien’s Test (Labral/AC)–> (+) pain at the shoulder = Labral / Pain at the AC = ACJ issues
- Biceps Load 1 ( Labral/SLAP/ shoulder is at 90 degrees abduction)–> (+) deep pain in shoulder
- Biceps Load 2 (Labral/SLAP/ shoulder is at 120 degrees of shoulder abduction) –> (+) deep shoulder pain
- Anterior Slide Test (SLAP) –> (+) Pain localized to anterosuperior aspect of the shoulder, pop, click, clunk in the anterosuperior region, or reproduction of symptoms
- Crank Test (Labrum) –> (+) deep pain in shoulder, click, clunk, and reproduction of symptoms
- Speeds Test ( Biceps Tendonitis/ Labral)–> (+) deep pain
12
Q
What are the special tests for : AC joint Pathology
A
- Crossbody Adduction Test ( can help with subacromial impingement diagnosis)–> (+) pain depending on location
- AC Resisted Extension –> (+) pain in the AC joint
- Active Compression/O’Brien’s Test –> (+) Pain at the AC joint
13
Q
What Muscles of the shoulder do Flexion
A
- Anterior Delts
- Pec Major
- Coracobrachialis
- biceps
14
Q
What muscles of the shoulder do Extension
A
- Posterior delt
- Teres Major
- Teres Minor
- Lats
- Pec Major
15
Q
What muscles of the shoulder do Horizontal Adduction
A
- pec Major
- Deltoid
16
Q
What muscles of the shoulder do Horizontal Abduction
A
- Posterior Delt
- Teres major
- Teres Minor
- Infraspinatus
17
Q
What muscles of the shoulder do Abduction
A
- Middle Delt
- Supraspinatus
- Infraspinatus
- Subscapularis
- Teres Minor
18
Q
What muscles of the shoulder do Adduction
A
- Pec major
- Lats
- Teres Major
- Subscapularis
- Coracobrachialis
19
Q
What muscles of the shoulder do IR
A
- Pec Major
- Subscapularis
- Lats
- teres Major
- Anterior Delt
20
Q
What muscles of the shoulder do ER
A
- Infraspinatus
- Teres minor
- Posterior Delt
21
Q
What muscles do scapular elevation?
A
- Upper traps
- Levator Scapulae
- Rhomboids maj/min
22
Q
What muscles do scapular depression
A
- Lats
- Lower traps
- Pec Major/Minor
- Serratus Anterior
23
Q
What muscles do scapular protraction
A
- Serratus anterior
- Pec major/minor
- Lats
24
Q
What muscles do scapular retraction
A
- Traps
- Rhomboids Major/Minor
25
What muscles do scapular Upward Rotation
1. Traps
2. Serratus Anterior
26
What muscles do scapular downward Rotation
1. Levator Scapulae
2. Rhomboid Major/Minor
3. Pec Minor
27
Axillary Nerve:
C5-C6
Innervates --> Delts/Teres minor
28
If you have a lesion of the axillary nerves what might you see?
Teres Minor and Delts would be affected:
Potentially see:
- could see delt and teres minor atrophy
- patients inability to raise arm correctly
- Weak to little ER/abduction
29
Long Thoracic Nerve
C5-C7
Innervates Serratus Anterior
30
If there was a lesion at the Long thoracic nerve what might you see?
- Scapular movement issues including lack of upward rotation/protraction/depression
31
Suprascapular Nerve
C5-C6
Innervates Supraspinatus and infraspinatus
32
Supraclavicular Nerve
C3-C4
33
Musculocutaneous Nerve
C5-C7
Innervates Brachialis, biceps, coracobrachialis
34
Radial Nerve
C5-T1
Innervates Extensors of wrist, fingers, brachioradialis, supinator
35
Median Nerve
C5-T1
Innervates Pronator teres, Flexors of the forearm, wrist and hand
36
Ulnar Nerve
C8-T1
Innervates flexor carpi ulnaris, adductor pollicis, flexor digitit minimi brevis, hypothenar
37
Joint Mobs: Shoulder Flexion
Humeral Head spins anterior
Posterior glide
38
Joint mobs: Shoulder abduction
Humerus rolls superior and slides inferior
Inferior Glide
39
Joint Mobs: Shoulder Extension
Humeral head spins posterior
Anterior Glide
40
Joint mobs: Shoulder ER
Posterior roll and anterior slide
Anterior Glide
41
Joint mobs: Shoulder IR
Anterior roll and posterior slide
Posterior glide
42
Joint Mobs: Scapular Thoracic Elevation
Superior glide
43
Joint Mobs: Scapular Thoracic Depression
Inferior Glide
44
Joint Mobs: Scapular Thoracic Flexion
Upward rotation
45
Joint Mobs: Scapular Thoracic Adduction
Medial Glide
46
Joint Mobs: Scapular Thoracic Abduction
Lateral Glide
47
Thoracic Mobility:
Exam Findings
Proposed Interventions
Exam Findings:
- Restricted AROM
- Restricted PIVM thoracic spine and robs
- No UE radicular symptoms
- Postural deviations
- Muscle imbalances
Proposed Interventions:
- Mobility exercises
- Thoracic spine and rib mobs/manips.
- Self mobilization techn.
- Postural Exercises
48
Thoracic Hypomobility with UE Referred Pain
Exam Findings:
Proposed Interventions:
Exam Findings:
- Restricted AROM
-Restricted PIVM upper thoracic spine and robs
- UE symptoms
- Positive ULTT
- Muscle Imbalances
- Postural Deviations
Proposed Interventions:
- Mobility exercises
- Thoracic spine and rib mobs/manips.
- UE neural mobs/exercises
- Self mobs
- Postural Exercises
49
Thoracic Hypomobility with Neck Pain
Exam Findings:
Proposed Interventions:
Exam Findings:
- Symptoms <30 days
- No symptoms distal to shoulder
- No aggravation of symptoms w/looking up
- FABQPA score <12
- Decreased up thoracic visual
- Cervical extension ROM <30 degrees
Proposed Interventions:
- Thoracic spine and rib mobs/manip
- Mobility exercises
- Self mobs
- Postural exercises
- treatment of cervical impairments
50
Thoracic Hypomobility with Shoulder Impairments
Exam Findings:
Proposed Interventions:
Exam Findings:
- Stiff thoracic spine with shoulder AROM
- Restricted PIVM upper thoracic spine and ribs
- Shoulder impingement/rotator cuff signs
- Muscles imbalances
- Postural deviation
Proposed Interventions
- Mobility exercises
- thoracic spine and rib mobs/manip.
- Self mobs
- Postural exercises
- Rotator cuff exercises
51
Thoracic Hypomobility with LBP
Exam Findings
Proposed Interventions
Exam Findings:
- Stiff thoracic spine with thoracolumbar AROM
- Restricted PIVM testing
- Lumbar Impairment
- Muscle imbalances
- Postural deviations
Proposed Interventions:
- Mobility exercises
- Thoracic spine and rib mobs/manips.
- Lumbar rehab
- Self mobs
- Postural Exercises
52
Thoracic Clinical Instability
Exam Findings:
Proposed Interventions:
Exam Findings:
- History of trauma or thoracic surgery
- Provocation with sustained WB posture
- Relief with sustained WB posture
- relief with NWB posture
- Hypermobility with loose end feel with PIVM
- Poor strength (2/5) of thoracic multifidi's, erector spinae, and parascapular muscles
- Aberrant movement (shaking/poor control) with thoracic AROM
53
Subacromial Debridement
- Arthroscopic--> clean up shave down and remove part of the acromion potentially
- NO PRECAUTIONS AS TOLERATED
- Control pain edema, preserve ROM
- Stretching and neuromuscular control
- Optimize posture
- Strengthening
54
RTC Repair General Post Op Guidelines****
1. 4-6 weeks continuous use of brace
2. 4-6 weeks NO AROM
3. 4-6 weeks NO UE WB
4. 2-4 weeks NO PROM
55
What is the RTC Protocol for Immediate Phase of 2-4 weeks
- Scapular, cervical ROM and isometrics
- Elbow, wrist, hand AROM and resisted exercise
- GH PROM- manual pendulums
56
What is the RTC Protocol for Protective Phase 4-10 weeks
- Ween brace
- pain free PROM--> AAROM
- Joint Mobs
- RTC isometrics
- GH AROM
57
What is the RTC protocol for Intermediate phase 10-14 weeks
- Dynamic stabilization
- strengthening
58
RTC Protocol days 1-6
- Abduction brace/sling
- sleep in brace/sling
- begin scapula musculature isometrics/ cervical ROM
- Patient education, posture, joint protection, positioning, hygiene
- cryotherapy for pain and inflammation
days 1-2 as much as possible / days 3-6 post activity or for pain
59
What are the Precautions for Immediate Post Op surgical phase of RTC tear weeks 1-4
- NO ACTIVE RANGE OF MOTION OF SHOULDER
- Maintain arm in sling, remove only for exercise
- No lifting objects
- No shoulder motion behind the back
- No excessive stretching or sudden movements
- No supporting body weight with hands
- Keep incision clean and dry
60
What is the protocol for Post- surgical rehab of a SLAP repair weeks 1-2
- Limited ER/IR motion
- No biceps activation (elbow flexion, supination)
- AROM scapula, cervical, elbow, hand, wrist
- Submax isometrics to GH, periscapular musculature
- THEY DONT WANT IR/ER MOTION BECAUSE THE BICEPS TENDON RUNS THROUGH THE BICIPITAL GROOVE IN THAT LITTLE TUNNEL AND WHEN YOU DO THOSE MOTIONS IT ADDS TENSION TO THE BICEPS TNEDON AND THE BICEPS TENDON ATTACHES TO THE LABRUM
61
What is the protocol for Post- surgical rehab of a SLAP repair weeks 3-4
- Rhythmic stabilization
- Proprioceptive training
- Progressive isometrics
62
What is the protocol for Post- surgical rehab of a SLAP repair weeks 5-8
- Progress preriscap strengthening
- Manual resistance PNF
- Shoulder AROM
-Progress to full PROM
63
TSA/Hemi-TSA
- joint degeneration with INTACT ROTATOR CUFF and deltoid, adequate bone quality, stable joint
- Gentle progression of ROM
- NO EXTENSION > neutral (patient always has to be able to see their own elbow)
- NO IR + ADD (shift tuck/hygiene)
- NO WB
64
rTSA
- Arthritis with inoperable RC tear, complex fractures, or revision of failed TSA
- Joint protection ( higher dislocation risk/ Ext, IR + Add x 10-12 weeks )
- Dependents on deltoid and periscapular muscles
65
What is the best exercise for lower trap to achieve max recruitment with the least amount of upper trap recruitment?
Modified cobra
- retracts, depresses and extends
- if patient cant do this yet they may want to do seated depressions
66
T/F thumb up prone T's are not safe for patients with anterior instability
True - not safe
67
What are some good Serratus Anterior exercises with the best activation and not a lot of UT activation?
1. Supine punches 50-80% MVIC of the SA and only 7% UT activation
2. Push up Plus 73-80% MVIC SA and only 8-19% UT MVIC
Advanced exercises are standing upper cut with a 100% MVIC SA but a 66% MVIC of UT
or
Scaption of 120 degrees w/96% MVIC but a 79% MVIC of UT
68
Resistance training Dosage for
1. Power
2. Strength
3. Hypertrophy
4. Endurance
1. Power
Intensity= 75-90 1RM
Sets= 3-5
Reps= 1-5
Rest 2-5 minutes
2. Strength
Intensity= >85% 1RM
Sets= 2-6
Reps= <6
Rest 2-5 minutes
3. Hypertrophy
Intensity = 67-85% 1RM
Sets = 3-6 sets
Reps = 6-12
Rest= 30-90 seconds
4. Endurance
Intensity= <67% 1RM
Sets= 2-3
Reps= >12
Rest = 30 seconds
69
What are some Subscapularis EMG Common Exercises for rehab
1. Push Up plus 122+
2. Flexion above 90 degrees with 120 degrees of ER 99+
3. Standing extension from 90-0
4. D2 extension
5. Standing row at 90 degrees
6. Standing IR at 0
7. Standing IR at 90 degrees
70
Based off of EMG what is the best Serratus Anterior scapular stabilization prescription?
Wall slide
71
Based off of EMG what is the best Middle trap scapular stabilization prescription exercises?
1. prone row
2. prone horizontal abduction with ER
72
Based off of EMG what is the best Lower trap scapular stabilization prescription exercises?
- Prone full can scaption (Y's)
- Bilateral ER in neutral (W's)
73
Based off of EMG what is the best Rhomboids scapular stabilization prescription exercises?
1. Prone row
2. Prone extension with ER
74
What is the UE kinesthetic Awarness Progression
1. Static kinesthetic awareness
2. Dynamic Stability
3. Reactive stabilization
4. Plyometric progression
75
What is the critical zone of the spinal canal?
T4-T9 is where the spinal cord narrow
- T6 is the spinal cord tension point
- mobility in these regions may be associated with altered neural dynamics
T4 SYNDROME
76
Pes Carinatum
- Pigeon Chest
- Sternum projects forward and downward
- Congenital deformity
77
Pes Excavatum
- Sternum pushed posteriorly into the thoracic cavity by overgrowth of ribs
- Shrinks AP diameter
- Decreases the space and can even displace the heart
78
What are the neurovascular special tests for the thoracic
1. Slump test
2. First thoracic nerve root stretch
3. Roos test
4. Provocation elevation test
5. Wrights Test (Allens)
6. Shoulder girdle passive elevation test
7. Adson test
79
C7-T1 and T1-T2 hypomobility is a predictor of
Neck and shoulder pain and hand weakness
80
C7-T1 and T3-T4 hypomobility predicts
Headache
81
TOS Scalene Syndrome
- Compression (arterial (subclavian) and or neural) between ANTERIOR and MIDDLE scalene
- NOT VENOUS
Etiology=
- Scalene tightness
- fibrous bands - congenital or scar
- Accessory Scalene Muscle
- Enlarged C7 TP
- Cervical rib syndrome (extra bone?)
82
TOS: Costoclavicular Syndrome
- Compression of neurovascular bundle between 1st rib and clavicle
- Possible vein, artery, nerve
- results from elevated first rib, clavicle fracture/callus, subclavius muscle disorder or morphological abnormality
83
TOS: Hyperabduction Syndrome
- Compression of neurovascular bundle underneath pec minor
- Possible vein, artery, nerve
- Results from tight pec minor, expansion of fascia, prolonged arm elevation
84
What are good Special tests for TOS
Costoclavicular
Hyperabduction test
Adson test
85
Red Flags for Thrust Techniques
- Myelopathy
- cancer
- upper cervical ligamentous instability
- vertebral artery insufficiency
- Inflammation or systemic disease
86
What test is good to perform to show serratus anterior weakness and / long thoracic nerve weakness?
Wall push up test
87
Biceps Tests
- Yergasons
-Bicipital tendonitis
88
What must be present for it to be considered a tendinopathy?
1. Tendon pathology
2. Pain system changes
3. Motor system impairments
89
What are the Subscapularis Tests ??? ( These are from the notes)
1. Belly press test
2. Lift off test
3. Bear hug test
- if its + belly press and bear hug = 30% torn
- if its + lift off: its 75 % torn ( this test will be negative until its at least 75% torn)
90
What is the different types of SLAP tears
Type 1= labrum and biceps strain, anchor still intact
Type 2= Labral strain with a detached biceps anchor
Type 3= bucket handle tear intact biceps anchor
Type 4= bucket handle tear with a detached biceps anchor
91
Bankhart tear isssss
Avulsion of the anterior inferior labrum from the glenoid rim
92
Hill-Sachs Lesion issss
Compression fracture of the posterior humeral head at the site where the humeral head impacted the inferior glenoid rim
93
