Week 2: Quiz 4 Flashcards
What is the recommended direction for the dynamic warm-up for UE before starting TERT?
Retro-cycling
What are three reasons for dynamic warm up?
- Inc tissue temperature
- Postural muscular endurance training for posterior RTC and scapulothoracic muscles
- Cardiovascular training for some patients
What postural deformity is counter-acted by retro-cycling warm-up?
Kyphotic posture
What is the prescriptive formula for TERT based on?
Intensity X duration X frequency
What is the prescriptive formula for TERT used for?
To create plastic deformation
What limits the amount of force that can be applied when utilizing the prescriptive TERT formula and how do you know the appropriate amount?
The patient’s pain tolerance - look in their eyes and watch for indication of pain
What is the desired TERT duration?
20 minutes with tissue in stretched position
What is the daily frequency when using the TERT formula?
3X per day
What is the weekly frequency when using the TERT formula?
Daily
Why do we need to exercise patients daily when using the TERT formula?
To prevent the cross-bonds, that were denatured between collagen fibers as a result of stretching exercises, from reestablishing over the course of the next 24 hours
What is the optimum TERT time per day?
60 minutes
Which scapulothoracic MMT’s can be done in sitting: 3
- Upper traps & Levator scap
- Serratus anterior
Which scapulothoracic MMT’s should be done in prone? 3
- Middle trap
- Lower trap
- Rhomboids
Which glenohumeral MMTs should be done in sitting? 3
- Flexion
- Abduction
- Scaption
Which glenohumeral MMTs should be done in supine? 1
- Horizontal adduction
Which glenohumeral MMTs should be done in prone? 4
- Extension
- Horizontal Extension
- IR
- ER (use only 2 fingers)
Describe the difference between the position for the original sleep stretch and the modified sleep stretch
Original Sleeper:
- Side-lying on side to be stretched
- 90*90* and then apply IR
Modified Sleeper:
- Side-lying on side to be stretched
- 30* scaption
- 45* GH elevation
- Apply IR (with strap ideally, to avoid fatigue)
Which sleep stretch position is optimal and why?
- Modified sleeper is optimal - avoids creating iatrogenic impingement
What is an additional stretch that can be done to stretch posterior capsule?
Cross-body horizontal flexion
What are the three limiting factors causing motion limitation in selective hypomobility?
- Osseous (checked with CT, MRI)
- Non-contractile (checked with passive mobility testing)
- Contractile
Which selective hypomobility limitation can be addressed in rehab?
- Noncontractile and contractile
- (Osseous cannot be changed with rehab)
Give an example of each type of selective hypomobility
-
Osseous- Example: retroverted humerus in GIRD/ERG (not sure about this one)
- Possibly also acromion morphology
- Non contractile- Example: superior capsule tightness (also not sure about this one)
-
Contractile (Process of elimination bc muscle flexibility tests are not well recorded in the literature)
- Example: muscle tendon unit in should
What is thixotropy?
- Tissue becoming less viscous when subjected to shearing forces
What MOI causes Thixotrophy?
Eccentric deceleration
With Thixotrophy, when the MTU is involved, what two ways can we address it?
- By doing static positional stretching and/or
- Contract-relax PNF
How long should stretches be held for younger vs older adults (> 60) for the contractile unit?
- Younger - 30 seconds
- Older - 60 seconds (double the time!)
What does GIRD/ERG stand for?
Glenohumeral IR deficit, ER gain.
What population is GIRD/ERG commonly seen in?
- Children who start throwing sports early, due to an anatomical change in the humerus (“[using] both MRI and CT scans, it is now well documented that the humerus of the throwing arm is more retroverted than the nondominant arm.”)
What is the total arc of motion for GIRD/ERG?
1600
What makes GIRD the appropriate diagnosis?
Total arc in one arm must be less than the other arm for GIRD to be the diagnosis
Other teatment techniques that can be used to try to stretch the collagen tissue and create the plastic deformation?
- Manual Therapy
- Mobilizations
- Myofascial Techniques
- Myotherapy
- Muscle Energy Techniques
- ART
- Graston
- Strain Counterstrain Techniques
Describe the arthroscopic lavage surgery.
Washout of the joint with an inflow and outflow canula to flush out inflammatory mediators and floating pieces of articular cartilage. Only effective in individuals with incomplete lesions
According the Moseley et. al Level I RCT study (comparing lavage and arthroscopic surgery to placebo surgery), what was found regarding this surgery?
No difference in pain or function between intervention and placebo group
Name 3 of the 4 things that can help to create plastic deformation of soft tissues.
- Temperature (heat)
- Temperature (cooling)
- Intensity
- Duration
- Frequency
Which one of the requirements to create plastic deformation can we not control?
Intensity (based on patient’s tolerance)
What is the optimum amount of time (duration) for soft tissue elongation?
60 minutes per day
How many times per week (frequency) would be optimal for patients to acheive true arthrofibrotic changes?
Everyday
Never manipulate on a Friday/ always manipulate at the beginning of the week to achieve greater maintained ROM
At what point of GH elevation is the subacromial space the smallest?
Between 60-120 degrees elevation (painful arc syndrome)1
What are the two surgical options for a LHB detachment/injury?
- Tenotomy
- Tenodesis
Which surgery has been shown to be more effective Tenotomy or Tenodesis?
No difference in outcomes
Describe how to perform the lateral scapular slide test.
- Make a body mark at level of T7 (inferior angle) on spine
- Measure from mark to inferior angle BL for all positions
- Position 1- Arms at sides
- Position 2- Hands on hips, thumbs posteriorly
- Position 3- Arms 90 deg abduction, thumbs down
- Position 4- Arms 120 deg abduction, thumbs up
- Position 5- Arms 150 deg abduction, thumbs up
- Normal: <1 – 1.5 cm difference bilateral
- Pathological/athlete: >1.5 cm difference bilaterally
- Roughly a 0.5 – 1cm increase in each position
Name 3 treatment options for pain and inflammation:
- Cryotherapy
- Iontophoresis
- Modalities
- Manual therapy
- Placebo effect
What is the most common reason for failure of a subacromial decompression surgery?
- If the pt also has AC DJD that does not get addressed in the surgery
What procedure can be done to address the AC DJD?
Mumford procedure: distal clavicular excision
What percentage of RTC repairs fail?
75%
What percentage of pts with an atraumatic full thickness tear were successfully treated with PT and able to avoid surgery/RTC repair?
74-75%
