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MSK 2 Summer 2024 > W2 > Flashcards

W2 Flashcards

1
Q

Rotator Cuff Tear Cluster

A
  • Age >65
  • Night pain
  • Weakness in ER
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2
Q

Rotator Cuff Full Thickness Tear Cluster

A
    • drop arm test
    • painful arc test
    • Infraspinatus test
  • Age >60
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3
Q

Impingement Cluster

A

+ Hawkins Kennedy
+ Painful arc
+ Infraspinatus weakness MMT

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4
Q

Anterior Instability Test Cluster

A

+ Apprehension
+ Relocation

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5
Q

Labral Tear Cluster

A

+ Relocation test
+ O’Brien’s/ active compression test

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6
Q

Acromioclavicular Joint Pathology Cluster

A

+ Crossbody Adduction Test
+ AC resisted extension test
+ O’Brien’s

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7
Q

What are all the tests for : Subacromial Impingement/Pain Syndrome

A
  1. Hawkins Kennedy–> (+) pain or motion limitation
  2. Painful Arc –> (+) Pain or compensation : 60-120 degrees: pain at end range is ACJ
  3. Neer’s–> (+) pain or limitation in motion
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8
Q

What are the Special Tests for: Scapula

A
  1. Scapular Assistance–> (alleviating) (+) relief of symptoms
  2. Scapular Repositioning–> (+) if patient no longer exhibits pain or weakness after repositioning
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9
Q

What are the Special Tests for: Muscle/Tendon Dysfunction

A
  1. Full/Empty Can Test ( Supraspinatus)–> (+) if the patient can’t hold position or pain
  2. Drop Arm Test (Supraspinatus: especially good for tears)–> (+) If patient isn’t able to slowly lower arm down
  3. IR Liftoff/ IR Lag Sign (Subscapularis)–> (+) if patient isn’t able to hold and slowly bring hand off of back
  4. 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
  5. Speeds Test (Tendinitis/ Labral Tear)–> (+) deep pain in bicipital groove = biceps / Deep pain in the shoulder = labrum
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10
Q

What are the special tests for: Shoulder (GH) Instability and Posterior Impingement

A
  1. Apprehension Sign/ Jobe Relocation –> (+) apprehension test = apprehension/ (+) relocation test= reduction of pain or an increase in ROM
  2. Jerk Test ( Posterior-inferior instability/Labral) –> (+) pain with possible click or clunk
  3. Load Shift Test–> (+) depends on where the hypermobility is either anterior or posterior and you compare sides
  4. Posterior Shoulder Impingement/ Modified and Relocation Test
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11
Q

What are the special tests for: Labral Lesions

A
  1. Active Compression/Obrien’s Test (Labral/AC)–> (+) pain at the shoulder = Labral / Pain at the AC = ACJ issues
  2. Biceps Load 1 ( Labral/SLAP/ shoulder is at 90 degrees abduction)–> (+) deep pain in shoulder
  3. Biceps Load 2 (Labral/SLAP/ shoulder is at 120 degrees of shoulder abduction) –> (+) deep shoulder pain
  4. Anterior Slide Test (SLAP) –> (+) Pain localized to anterosuperior aspect of the shoulder, pop, click, clunk in the anterosuperior region, or reproduction of symptoms
  5. Crank Test (Labrum) –> (+) deep pain in shoulder, click, clunk, and reproduction of symptoms
  6. Speeds Test ( Biceps Tendonitis/ Labral)–> (+) deep pain
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12
Q

What are the special tests for : AC joint Pathology

A
  1. Crossbody Adduction Test ( can help with subacromial impingement diagnosis)–> (+) pain depending on location
  2. AC Resisted Extension –> (+) pain in the AC joint
  3. Active Compression/O’Brien’s Test –> (+) Pain at the AC joint
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13
Q

What Muscles of the shoulder do Flexion

A
  1. Anterior Delts
  2. Pec Major
  3. Coracobrachialis
  4. biceps
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14
Q

What muscles of the shoulder do Extension

A
  1. Posterior delt
  2. Teres Major
  3. Teres Minor
  4. Lats
  5. Pec Major
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15
Q

What muscles of the shoulder do Horizontal Adduction

A
  1. pec Major
  2. Deltoid
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16
Q

What muscles of the shoulder do Horizontal Abduction

A
  1. Posterior Delt
  2. Teres major
  3. Teres Minor
  4. Infraspinatus
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17
Q

What muscles of the shoulder do Abduction

A
  1. Middle Delt
  2. Supraspinatus
  3. Infraspinatus
  4. Subscapularis
  5. Teres Minor
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18
Q

What muscles of the shoulder do Adduction

A
  1. Pec major
  2. Lats
  3. Teres Major
  4. Subscapularis
  5. Coracobrachialis
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19
Q

What muscles of the shoulder do IR

A
  1. Pec Major
  2. Subscapularis
  3. Lats
  4. teres Major
  5. Anterior Delt
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20
Q

What muscles of the shoulder do ER

A
  1. Infraspinatus
  2. Teres minor
  3. Posterior Delt
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21
Q

What muscles do scapular elevation?

A
  1. Upper traps
  2. Levator Scapulae
  3. Rhomboids maj/min
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22
Q

What muscles do scapular depression

A
  1. Lats
  2. Lower traps
  3. Pec Major/Minor
  4. Serratus Anterior
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23
Q

What muscles do scapular protraction

A
  1. Serratus anterior
  2. Pec major/minor
  3. Lats
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24
Q

What muscles do scapular retraction

A
  1. Traps
  2. Rhomboids Major/Minor
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25
Q

What muscles do scapular Upward Rotation

A
  1. Traps
  2. Serratus Anterior
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26
Q

What muscles do scapular downward Rotation

A
  1. Levator Scapulae
  2. Rhomboid Major/Minor
  3. Pec Minor
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27
Q

Axillary Nerve:

A

C5-C6
Innervates –> Delts/Teres minor

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28
Q

If you have a lesion of the axillary nerves what might you see?

A

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

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29
Q

Long Thoracic Nerve

A

C5-C7
Innervates Serratus Anterior

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30
Q

If there was a lesion at the Long thoracic nerve what might you see?

A
  • Scapular movement issues including lack of upward rotation/protraction/depression
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31
Q

Suprascapular Nerve

A

C5-C6
Innervates Supraspinatus and infraspinatus

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32
Q

Supraclavicular Nerve

A

C3-C4

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33
Q

Musculocutaneous Nerve

A

C5-C7
Innervates Brachialis, biceps, coracobrachialis

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34
Q

Radial Nerve

A

C5-T1
Innervates Extensors of wrist, fingers, brachioradialis, supinator

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35
Q

Median Nerve

A

C5-T1
Innervates Pronator teres, Flexors of the forearm, wrist and hand

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36
Q

Ulnar Nerve

A

C8-T1
Innervates flexor carpi ulnaris, adductor pollicis, flexor digitit minimi brevis, hypothenar

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37
Q

Joint Mobs: Shoulder Flexion

A

Humeral Head spins anterior
Posterior glide

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38
Q

Joint mobs: Shoulder abduction

A

Humerus rolls superior and slides inferior
Inferior Glide

39
Q

Joint Mobs: Shoulder Extension

A

Humeral head spins posterior
Anterior Glide

40
Q

Joint mobs: Shoulder ER

A

Posterior roll and anterior slide
Anterior Glide

41
Q

Joint mobs: Shoulder IR

A

Anterior roll and posterior slide
Posterior glide

42
Q

Joint Mobs: Scapular Thoracic Elevation

A

Superior glide

43
Q

Joint Mobs: Scapular Thoracic Depression

A

Inferior Glide

44
Q

Joint Mobs: Scapular Thoracic Flexion

A

Upward rotation

45
Q

Joint Mobs: Scapular Thoracic Adduction

A

Medial Glide

46
Q

Joint Mobs: Scapular Thoracic Abduction

A

Lateral Glide

47
Q

Thoracic Mobility:
Exam Findings
Proposed Interventions

A

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
Q

Thoracic Hypomobility with UE Referred Pain
Exam Findings:
Proposed Interventions:

A

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
Q

Thoracic Hypomobility with Neck Pain
Exam Findings:
Proposed Interventions:

A

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
Q

Thoracic Hypomobility with Shoulder Impairments
Exam Findings:
Proposed Interventions:

A

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
Q

Thoracic Hypomobility with LBP
Exam Findings
Proposed Interventions

A

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
Q

Thoracic Clinical Instability
Exam Findings:
Proposed Interventions:

A

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
Q

Subacromial Debridement

A
  • 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
Q

RTC Repair General Post Op Guidelines**

A
  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
Q

What is the RTC Protocol for Immediate Phase of 2-4 weeks

A
  • Scapular, cervical ROM and isometrics
  • Elbow, wrist, hand AROM and resisted exercise
  • GH PROM- manual pendulums
56
Q

What is the RTC Protocol for Protective Phase 4-10 weeks

A
  • Ween brace
  • pain free PROM–> AAROM
  • Joint Mobs
  • RTC isometrics
  • GH AROM
57
Q

What is the RTC protocol for Intermediate phase 10-14 weeks

A
  • Dynamic stabilization
  • strengthening
58
Q

RTC Protocol days 1-6

A
  • 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
Q

What are the Precautions for Immediate Post Op surgical phase of RTC tear weeks 1-4

A
  • 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
Q

What is the protocol for Post- surgical rehab of a SLAP repair weeks 1-2

A
  • 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
Q

What is the protocol for Post- surgical rehab of a SLAP repair weeks 3-4

A
  • Rhythmic stabilization
  • Proprioceptive training
  • Progressive isometrics
62
Q

What is the protocol for Post- surgical rehab of a SLAP repair weeks 5-8

A
  • Progress preriscap strengthening
  • Manual resistance PNF
  • Shoulder AROM
    -Progress to full PROM
63
Q

TSA/Hemi-TSA

A
  • 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
Q

rTSA

A
  • 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
Q

What is the best exercise for lower trap to achieve max recruitment with the least amount of upper trap recruitment?

A

Modified cobra
- retracts, depresses and extends
- if patient cant do this yet they may want to do seated depressions

66
Q

T/F thumb up prone T’s are not safe for patients with anterior instability

A

True - not safe

67
Q

What are some good Serratus Anterior exercises with the best activation and not a lot of UT activation?

A
  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
Q

Resistance training Dosage for
1. Power
2. Strength
3. Hypertrophy
4. Endurance

A
  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
Q

What are some Subscapularis EMG Common Exercises for rehab

A
  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
Q

Based off of EMG what is the best Serratus Anterior scapular stabilization prescription?

A

Wall slide

71
Q

Based off of EMG what is the best Middle trap scapular stabilization prescription exercises?

A
  1. prone row
  2. prone horizontal abduction with ER
72
Q

Based off of EMG what is the best Lower trap scapular stabilization prescription exercises?

A
  • Prone full can scaption (Y’s)
  • Bilateral ER in neutral (W’s)
73
Q

Based off of EMG what is the best Rhomboids scapular stabilization prescription exercises?

A
  1. Prone row
  2. Prone extension with ER
74
Q

What is the UE kinesthetic Awarness Progression

A
  1. Static kinesthetic awareness
  2. Dynamic Stability
  3. Reactive stabilization
  4. Plyometric progression
75
Q

What is the critical zone of the spinal canal?

A

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
Q

Pes Carinatum

A
  • Pigeon Chest
  • Sternum projects forward and downward
  • Congenital deformity
77
Q

Pes Excavatum

A
  • Sternum pushed posteriorly into the thoracic cavity by overgrowth of ribs
  • Shrinks AP diameter
  • Decreases the space and can even displace the heart
78
Q

What are the neurovascular special tests for the thoracic

A
  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
Q

C7-T1 and T1-T2 hypomobility is a predictor of

A

Neck and shoulder pain and hand weakness

80
Q

C7-T1 and T3-T4 hypomobility predicts

A

Headache

81
Q

TOS Scalene Syndrome

A
  • 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
Q

TOS: Costoclavicular Syndrome

A
  • 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
Q

TOS: Hyperabduction Syndrome

A
  • Compression of neurovascular bundle underneath pec minor
  • Possible vein, artery, nerve
  • Results from tight pec minor, expansion of fascia, prolonged arm elevation
84
Q

What are good Special tests for TOS

A

Costoclavicular
Hyperabduction test
Adson test

85
Q

Red Flags for Thrust Techniques

A
  • Myelopathy
  • cancer
  • upper cervical ligamentous instability
  • vertebral artery insufficiency
  • Inflammation or systemic disease
86
Q

What test is good to perform to show serratus anterior weakness and / long thoracic nerve weakness?

A

Wall push up test

87
Q

Biceps Tests

A
  • Yergasons
    -Bicipital tendonitis
88
Q

What must be present for it to be considered a tendinopathy?

A
  1. Tendon pathology
  2. Pain system changes
  3. Motor system impairments
89
Q

What are the Subscapularis Tests ??? ( These are from the notes)

A
  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
Q

What is the different types of SLAP tears

A

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
Q

Bankhart tear isssss

A

Avulsion of the anterior inferior labrum from the glenoid rim

92
Q

Hill-Sachs Lesion issss

A

Compression fracture of the posterior humeral head at the site where the humeral head impacted the inferior glenoid rim

93
Q
A

MSK 2 Summer 2024 (5 decks)

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