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therex test 2
210: Shoulder
| Question | Answer |
|---|---|
| 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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