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211 exam 2
Shoulder/Thoracic
| Question | Answer |
|---|---|
| joints of the shoulder | glenohumeral acromioclavicular sternoclavicular scapulothoracic |
| glenohumeral joint convex/concave | Humeral Head is convex and glenoid is concave |
| acromioclavicular joint convex/concave | Clavicle is convex and acromion is concave |
| SC joint convex/concave | Anterior/posterior: Clavicle is concave and sternum is convex. Cephalocaudal: Sternum is convex and clavicle is concave. |
| scapulothoracic convex/concave | Scapula is concave and ribs are convex |
| rotator cuff muscles | supraspinatus subscap infraspinatus teres minor |
| rotator cuff muscles purpose | provide compression and assist in translation of the humerus |
| supraspinatus function | upward translation |
| subscapularis function | downward translation and internal rotation |
| infraspinatus function | downward translation and external rotation |
| teres minor function | downward translation and external rotation |
| scapulothoracic muscles | trap serratus anterior levator scapulae pec minor |
| purpose of scapulothoracic muscles | function in synchrony to help control scapular position. Position of the scapula is critical to the length-tension relationships of scapulohumeral muscles. |
| for every degree of scapular motion, you gain ___ degrees of GH motion. | 2 |
| what provides dynamic stability for the GH joint | rotator cuff, biceps, triceps and deltoid muscles, along with supporting ligaments |
| what provides static stability for the GH joint | the joint capsule, depth within the fossa created by the glenoid labrum and negative pressure enabled by synovial fluid. |
| superior glenohumeral ligament function | stabilizes GH joint during abduction until 90 deg. |
| middle glenohumeral ligaments function | stabilizes GH joint anteriorly until 90 degrees. |
| inferior glenohumeral ligament function | stabilizes GH joint during abduction |
| anterior band of inferior GHL function | Anterior band stabilizes with ABD/EXT |
| when is anterior band of inferior GHL taught? | ER/ABD |
| when is posterior band of inferior GHL taught? | IR/ABD |
| posterior band of inferior GLH function | stabilizes with ABD/FLEX |
| brachial plexus review | |
| most commonly inflamed bursa | Subdeltoid/Subacromial -between the deltoid and glenohumeral capsule, extending under the acromion |
| where does pain radiate from inflamed subdeltoid bursa | down to the arm, not the neck. Abduction >60 degrees & flexion >90 degrees can be painful. |
| subscapular bursa | between the subscapularis and the neck of the scapula |
| where does pain radiate from inflamed subscapular bursa | behind the arm reaching the shoulder blade and/or down the back of the arm. |
| closed pack position of GH joint | full ABD, ER |
| resting position of GH joint | 55 deg ABD, 30 deg horizontal ADD |
| capsular pattern of GH joint | ER, ABD, IR |
| Some therapists believe, for every degree of ER you get, you’ll increase ___ degrees of humeral elevation (flexion, ABD) | 2 |
| phase 1 of scapulohumeral rhythm | The 1st 30 degrees of abduction is purely glenohumeral motion |
| phase 2 of scapulohumeral rhythm | next 150 degrees is a combination of GH and ST in a 2:1 ratio. (100 degrees GH + 50 degrees ST |
| For every 15 degrees of abduction, ___ degrees occur at glenohumeral joint & ___ degrees occurs at scapulothoracic joint | 10, 5 |
| organs that refer pain to the shoulder | Heart Liver Gallbladder Lung |
| items to look for on shoulder eval | MOI (fall, crash, blunt trauma) overuse (job-related, sports, hobbies or crafts) Imaging PLOF Pain levels; usually in brachial region except w/ AC joint injuries LOF w/ ADLs Social/Home environment Equipment required (slings, taping, etc |
| AC joint test | piano key sign = AC dislocation |
| what attaches to coracoid process | short head of the biceps, pec minor, coracobrachialis dysfunction |
| what attaches to greater tubercle of humerus | supraspinatus, infraspinatus, teres minor dysfunction |
| parsonage turner syndrome | pain and muscle weakness from brachial plexus damage |
| what attaches to inferior spine of scapula | lats |
| No more than ___ of humerus should be in front of the acromion | 1/3 |
| functional assessments for the shoulder | Bed mobility Reach overhead – comb hair, hand into cupboard Reach behind back Wall push-up – check for winging |
| examples of shoulder standardized tests | DASH: Disabilities of the Arm Shoulder & Hand (APTA website) SST: Simple Shoulder Test (Journal of Orthopedic and Sports PT) |
| yeryasons test | stability of bicep tendon |
| drop arm test | rotator cuff tear/ impingement |
| apprehension test | anterior dislocation/subluxation |
| apley's scratch test | ROM and potential rotator cuff tear |
| sulcus test | multidirectional dislocation/subluxation |
| anterior/posterior drawer test | multidirectional dislocation/subluxation |
| neers test | impingement |
| scaption/empty can test | rotator cuff tear |
| Adson maneuver | thoracic outlet syndrome |
| acute symptoms of shoulder bursitis | UE guarding. The pain is described as intense, constant, throbbing or dull and limits all shoulder movements. Pain refers to elbow, forearm and hand; area maybe swollen anteriorly and warm. Empty end-feel |
| chronic symptoms of shoulder bursitis | ROM- usually 90o of flex and abduction, pain free at rest and typically more movement available than during the acute phase. |
| causes of shoulder bursitis | overuse or trauma |
| treatment for acute shoulder bursitis | Ultrasound, NSAIDs, gentle exercise (pendulums, PNF, etc), posture |
| treatment for chronic shoulder bursitis | corticosteroid injections, ultrasound, manual therapies, PROM, AAROM |
| treatment for anterior instability/dislocation | Minimize chance of reoccurrence – tape or brace Strengthening serratus anterior, traps and rotator cuff muscles with slow speed concentrics, light resistance, safe range (as per MD) Move towards fast eccentric-concentric with greater ROM |
| treatment for posterior instability/dislocation | Minimize IR, abduction, and Horizontal adduction and strengthen the rotator cuff and scapular stabilizers |
| treatment for multidirectional instability/dislocation | Difficult due to laxity of joint Isometrics with arm in neutral or protected position Rotator cuff strengthening Closed chain exercises |
| Grimsby 3 stage program for dislocators | low speed, high reps, min resistance in mid range resistance, isometrics in inner ranges resistance (80% max), and full but not max range |
| acute phase fracture tx (pt will likely have sling) | Pendulums PROM Scapular mobility exercises |
| 3 weeks post op fx tx (may begin weaning off sling ) | Table/ball/wall slides Isometrics |
| 8 weeks post op fx tx (healed) | Stretching Shoulder dowel exercises flex/abd etc Rows and straight arm pulldowns |
| impingement syndrome may involve | tendonitis of supraspinatus (poor blood supply) → subdeltoid bursitis → bicep tendonitis or teres minor and subscap tendonitis |
| modalities/procedures for treatment of impingement syndrome | Mobilization - inferior and posterior glides Steroid injection Surgery - Remove part of acromion or slice coracoacromial ligament |
| education for impingement syndrome | Posture Place pillow between trunk and elbow while sleeping - increases blood flow to supraspinatus Decrease overhead use and abduction |
| exercises for impingement syndrome | Bike for Cardiovascular warm up to warm up body followed by codman's AAROM hand crawls Shoulder Int/Ext rotator cuff exercises banded Lateral raises Banded IYT Overhead press, lat pull downs |
| Total shoulder day 1 post op | Reduce pain and inflammation (cryo, positioning etc) AROM of elbow, wrist and hand |
| TSA day 2 post op | Pendulums only at shoulder Postural adjustments |
| week 2 TSA post op | PROM Scapula Isometrics |
| week 4 TSA post op | AROM exercises progressions AAROM dowel or cane exercises for ER |
| goals for TSA with rotator cuff intact | flex/abd - 160deg,v60% of normal strength |
| goals for TSA without rotator cuff intact | 120deg flex/abd, 30deg ER, 45deg ER/IR, 50% of normal strength |
| modalities/ procedures for biceps tendonitis | Massage to muscle belly to increase circulation Modalities to decrease inflammation (cryo, etc) Supportive Taping |
| exercise for biceps tendonitis acute phase | PROM of shoulder and elbow (NO AROM at elbow), scapular clock exercises, wrist and hand exercises (ball squeezes, putty etc) |
| exercise for biceps tendonitis for return to sport | progressive stretching, overhead strengthening exercises (pulleys, dumbbells etc), isotonic strengthening (light resistance, high reps),pre-injury activities with MD clearance (sports, hobbies) |
| what causes adhesive capsulitis | Usually unknown may be due to ↑ kyphosis. May be triggered by trauma, but typically is chronically asymptomatic. |
| capsular pattern for ROM loss with adhesive capsulitis | ER ABD IR Flex |
| treatment for adhesive capsulitis acute phase | Massage E-stim Heat Infrared laser |
| treatment for adhesive capsulitis | High grade mobilizations Low-load prolonged stretches PNF patterns Reciprocal/Autogenic inhibition |
Created by:
bdavis53102
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