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therex test 2

210: Shoulder

relationship of humeral head to glenoid Golf ball on a tee
_____ positions of motion are available at the shoulder 1000's of
mobility of the shoulder gives up ____ stability
what structures provide static stability for the shoulder joint? Joint capsule; Synovial fluid and negative joint pressure; Glenoid labrum deepens fossa
what structures provide dynamic stability for the shoulder joint? Rotator cuff; Deltoid; Long head of biceps brachii
____ and ____ stabilizers must be coordinated static and dynamic
muscles of rotator cuff supraspinatus, infraspinatus, teres minor, subscap
what mm ER the shoulder teres minor; infraspinatus
what mm IR the shoulder subscap
The combined effect of the short rotator muscles (infraspinatus, teres minor, and subscapularis) produces stabilizing _____ and _____ translation of the humerus in the glenoid compression and downward
the head of humerus must glide ____ for the shoulder to flex/ abduct inferior
The supraspinatus muscle has a significant ____, ____ and _____translation effect on the humerus during arm elevation. stabilizing, compressive, and slight upward
supraspinatus functions with the ____ in humeral elevation deltoid
AC joint has a weak ____ capsule
what ligaments reinforce AC joint capsule Superior and inferior AC jt ligaments
what supports the AC ligaments? coracoclavicular ligament
the AC joint slides in the ____ direction the scapula moves same
SC joint articulation of the medial end of clavicle with sternum, has a disk
what ligaments make up the SC joint SC ligaments and interclavicular and costoclavicular ligaments
what causes movement on the SC joint? scapular movements
____ is an accessory motion in the SC joint rotation
what stabilizes the SC joint ligaments—no muscles cross joint for dynamic stability
motions of the scapula elevation, depression, protraction, retraction, upward rotation, downward rotation, winging and tipping
elevation, depression, protraction, and retraction of scapula are ____ motions of the humerus component
upward/downward rotation of scapula is a _____ motion of the humerus concurrent
winging of scapula medial borer lifts (horizontal add)
when does tipping of the scapula occur? with internal rotation and extension
•MM of scapula function in _____to control scapular position synchrony
Position of scapula important for _____ _____ relationship of scapulo-humeral mm length-tension
scapula is _____ for rotator cuff mm home base
how many degrees of GH motion for every degree of scapular motion 2
how does faulty posture affect the shoulder? Decreased flexibility in pec minor, scalenes and lev scap; Position of scapula changes position of humerus in glenoid; Internal rotators tight; ER stretch weakness
what makes up the coracoacromial arch Arch is acromion and coracoacromial ligament
what is found in the subacromial space under the coracoacromial arch ▫Sub deltoid bursa, Supraspinatus tendon, Long head of biceps
supraspinatus tendon has an attachment into ___ ____ superior labrum
scapular plane 30˚ anterior of the frontal plane; motion in this plane called scaption
benefits of movment in scapular plane Less tension on the capsule, Greater elevation is possible, Functional position, No IR or ER necessary to prevent greater tubercle impingement
The deltoid causes ____ translation of humerus upward
if no force opposes the deltoid, what can it cause impingement in subacromial space; need rotator cuffs to oppose
MM imbalance or timing causes _____ microtrauma
what can cause GH hypomobility? RA and OA, traumatic arthritis, post immobilization, idiopathic frozen shoulder
stage 1 frozen shoulder Gradual onset of pain that increases with movement and is present at night, Loss of external rotation motion with intact rotator cuff strength is common.
duration of frozen shoulder phase 1 less than 3 months
stage 2 of frozen shoulder (freezing) Intense pain, even at rest, Limited motion from 2-3 wks after onset
duration of stage 2 frozen shoulder (freezing) Acute symptoms may last 10-36 wks
stage 3 frozen shoulder (frozen) Pain with movement, Significant adhesions, Limited GH motion, increased substitutions, Atrophy of RC, deltoid, biceps, triceps
duration of stage 3 frozen shoulder (frozen) 4-12 months
stage 4 frozen shoulder (thawing) No pain and no synovitis, significant capsular restriction
duration of stage 4 frozen shoulder (thawing) ▫Lasts 2 - 24 months
frozen shoulder can be ____ _____ with spontaneous recovery BUT, Some patients never regain full motion self limiting
treatment of hypomobility in protection phase ▫PROM with progression to AAROM, AROM ▫**Must ensure quality motion over quantity** ▫ GH mobs Grade I and II in pain free position ▫Pendulum exercises for joint distraction ▫Isometrics
what should exercises should you do after shoulder immobilization to guard against RSD or CRPS Hand, wrist, elbow exercises
treatment of shoulder hypomobility in controlled motion phase ▫Increase time out of sling ▫Progress ROM up to point of pain ▫Instruct in self assisted ROM techniques ▫Increase joint and soft tissue mobility ▫GH mobs grade III and IV with stretching at end range motion ▫Strengthening to address mm imbalances
**Must have adequate____ ROM before stretching OH ** ER
treatment of shoulder hypomobility in return to function phase ▫Stretching and strengthening exercises progress ▫Aggressive ROM techniques at this stage ▫Functional activities
what joint mob may be needed if pt lacks ER? posterior glide of humerus in ER
shoulder manipulatio pt goes under anesthesia for surgeon to break up adhesions by moving the shoulder
when does AC joint arthritic changes often start? after 3rd decade
what causes AC joint arthritic changes Repetitive use at waist level, Repetitive diagonal extension, add, IR
what causes AC joint subluxation or dislocation Land on top of shoulder, Also termed sprains or separation
what can cause hypomobility of the clavicle faulty posture
tx for AC or SC joint dysfunction •Use of sling •Cross fiber FM ROM to shoulder to prevent decreased ROM of GH joint
anterior approach total shoulder uses ____ inscision deltopectoral
anterior total shoulder procedure release of subscap, anterior capsulotomy, exposure of humeral head and debridement of glenoid; may include repair of deficient RC, re-attach subscap, acromioplasty, bone graft
TSA rehab precautions No ER stretching, resisted IR, avoid excess extension
shoulder hemi-arthroplasty Humeral component is prosthesis; No joint capsule
what is left relatively intact with shoulder hemi-arthroplasty? glenoid fossa
what needs to heal shoulder hemi-arthroplasty tuberosities
shoulder hemi-arthroplasty precautions no ER first 6 weeks
what TSA procedure takes longer to heal? shoulder hemi-arthroplasty: bone healing must occur
reverse TSA No joint capsule, no rotator cuff
what allows for ER with reverse TSA posterior fibers of deltoid
reverse TSA precautions Need bone ingrowth into glenoid, no motion for 6 wks.
Repair of RC or deficient RC progressed ____; Intact RC progressed more _____ slowly, rapidly
what are ROM goals for shoulder based on? based on what was available under anesthesia post operatively
TSA tx in protection phase •PROM - AAROM within limitations; No end range stretching; Do not stress anterior capsule •Have patient face pulley if used •Modalities for pain control Maintain mobility of adjacent joints
how to avoid stressing anterior capsule after TSA Towel roll under arm (keeps them out of extension); No horizontal abd or hyper extension; No reaching behind back (towel stretch)
when should pt wear sling after TSA Wear sling in crowded areas/ outside and sleeping. No lifting—waist level only, eating, brushing teeth okay.
when does controlled motion phase begin with TSA? 4-12 weeks
how long does controlled motion phase of TSA last? 12 to 16 weeks or longer
TSA tx in controlled motion phase •90˚ of shoulder elevation, 45˚ of ER; Begin low intensity pain free stretching; Gentle mobilization techniques; Table slides; Door or dowel ER stretch; Towel stretch for IR; Cross body horiz add stretch
strengthening for TSA in controlled motion phase AROM but no anti-gravity abd; Scapular and GH stabilization ex; Progress to dynamic scapular and GH exercises with t-band or light weights below 90˚; Emphasize RC mm; UE UBE
scapular and GH stabilization exercises Alternating isometrics; Rhythmic stabilizations; Submaximal isometrics
TSA tx in return to function phase Full AROM for function is goal (or goal set by surgeon); Pain free strengthening progressed; HEP continues after D/C
criteria for return to function phase in TSA Full PROM or 130-140 ˚shoulder flex, 120˚abd; ER 60˚ in plane of scapula; 4/5 strength for RC and deltoid
impingement syndrome can be ____ or ____ structural or mechanical
primary impingement syndrome Mechanical Wear and Tear against acromion in subacromial space
intrinsic factors that can contribute to impingement syndrome Acromion types I, II and III
what type of acromion in impingement can do well with conservative PT types 1 and 2
what type of acromion in impingement likely needs surgery type 3
extrinsic factors that contribute to impingement syndrome ▫Tight posterior capsule; Poor RC control; Faulty scapulo-thoracic posture; Weak peri-scapular mm; Weak serratus
Excessive ____ ____ engagement and ____ ____ is linked to impingement syndrome upper trap, anterior deltoid
what areas do you need to target to help with impingement syndrome strengthen scapular mm and relax the upper trap, strengthen lower trap, stretch chest mm, thoracic spine exercises
upper crossed syndrome a muscle imbalance pattern located at the head and shoulder regions. It is most often found in individuals who work at a desk or who sit for a majority of the day and continuously exhibit poor posture
what mm are overactive/tight in upper crossed syndrome upper trapezius, levator scapulae, sternocleidomastoid and pectoralis muscles, and reciprocal weakness of the deep cervical flexors, lower trapezius & serratus anterior
what will cause pain with supra and infra spinatus tendinitis OH activity
what head of biceps is involved in biceps tendonitis long head
when will biceps tendonitis have pain? ▫Pain with Speed's test ▫Pain can radiate down into mm belly
types of shoulder instabilities Multi directional, Unidirectional, Dislocation
what needs to be strengthened in shoulder instabilities Need strong dynamic stabilizers (RC and scap stabilizers) - closed chain ext is good
ROM restrictions for TSA with intact rotator cuff 0-4 weeks no elevation of arm (up to 120 degrees), no ER (up to 30 deg)
ROM restrictions for TSA with intact rotator cuff 4-6 weeks no GH extension past neutral
ROM restrictions for TSA with intact rotator cuff 6-12 weeks combined ADD, IR, and extension allowed
revers shoulder arthroplasty precautions/ROM restrictions *limit for 12 weeks or more*: no GH extension or IR, no combined GH extension, ADD, or IR
rotator cuff tears can be ____ or ____ partial or full thickness
what is typically cause of rotator cuff tear? repetitive microtrauma
does rotator cuff always need surgery? •No surgery if asymptomatic
rotator cuff surgery Repairs can be arthroscopic, mini open, open subacromial decompression performed
Created by: bdavis53102
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