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57 Cards in this Set

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Name two assessment techniques that PTs use to confirm muscle strains.
They resist the motion and stretch the suspected injured muscle. If theses reproduce symptoms then it confirms a muscle strain.
A PT is assessing a patient with a strained anterior deltoid. When the PT tests the strength of the muscle he finds the following results: strong but painful. What is the correct intrpretation of these findings?
Minor lesion of the musculotendinous unit
What is the recommended treatment of grade I and II AC separations.
Strengthening to the RC especially IR and ER
What grades of AC separation usually require surgical intervention?
Four, five and six
Name the two causes of impingement syndromes (IS).
Repetitive motion and anatomical
Define impingement of the shoulder
Lack of humeral depression during elevation causes the subacromial structures to be compressed against the acromion process. This compression, over time, will eventually lead to an impingement syndrome as described by Neer.
What are the 2 categories of extrinsic factors with contribute to IS?
Primary and secondary
Differentiate primary from secondary impingement.
Primary refers a those conditions that reduce the subacromial space.Secondary pertains to the mechanical compression of the subacromial tissues.
True or False: An abnormally shaped acromion process (type III) is an example of a primary cause of IS.
TRUE
Name the two clinical signs associated with impingement syndrome.
Painful arc and reproduction of pain with the combined movements of elevation (abduction or flexion) and IR
What structures are commonly involved with an impingement syndrome?
Subacromial bursa and RC (specifically the supraspinatus)
What special tests are used to confirm the diagnosis of impingement syndrome?
Neer's, Hawkins and Empty can tests
What is the treatment philosophy associated with impingement syndromes?
Resort normal arthrokinematics by increasing the strength of the humeral depressors (infraspinatus and Teres minor), scapular stabilization and stretch the inferior capsule.
True or False: an unresolved impingement syndrome can progress to a RC tear.
TRUE
When prescribing strengthening exercises to a patient with IS what special precautions should be taken?
Avoid performing the exercises in positions which exacerbate or reproduce the impingement.
What motion is commonly restricted with IS?
IR of the shoulder
What joint mobilization techniques is emphasized with IS?
Inferior (Shankman page 415) and posterior glides
True or False: Initial treatments of IS should focus on reducing pain.
False, they should be geared at reducing the inflammation.
What surgery is used to treat IS that have not improved with conservative treatments?
SAD
Chronic RC tears are usually attributed to what factor?
Poor vascularity
Name the 3 clinical signs associated with RC tears.
Painful arc, decreased strength and ROM and loss of functional use of the shoulder.
What test is used to confirm a RC tear?
Drop Arm
Name the 4 goals associated with the conservative treatment of RC tears.
Control inflammation, Activity modification, maintain normal shoulder kinematics and Ant/Post capsule stretching.
Name the 3 phases of rehab associated with RC surgery.
Maximum, moderate and minimal protection phase
Name four factors that influence the progression of rehab after RC repair.
Size and location of the tear, associated pathologies, age of the patient, and type of repair. ( For entire list see Colby)
In the maximum protection phase (MaxPP) of rehab for a RC, what kinds of exercises are allowed?
PROM
What are the goals of treatment in the MaxPP of S/P RC repair?
Protect the repair, reduce pain and inflammation and prevent the adverse effects of immobilization
How long does the MaxPP usually last for a S/P RC repair?
6-8 weeks for large tears and 3-4 weeks for small and medium tears
What is the criteria used to determine when a patient with a RC repair can progress to the ModPP?
Healed incision, minimal pain with assisted shoulder movements, and progressive improvement in ROM
What are the goals associated with the ModPP of a RC repair?
Develop strength, endurance, and neuromuscular control while continuing to regain ROM
What is the criteria used to determine when a patient with a RC repair can progress to the MinPP?
Full, pain-free passive ROM , progressive improvement in shoulder strength and endurance and a stable GH joint
What direction of shoulder dislocation is the most commonly seen?
Anterior
Name the special tests that detect injury to the GH ligaments?
Sulcus sign, Load and Shift, Fulcrum, Apprehension and Drawer
What are the two categories used to classify shoulder dislocations?
TUBS and AMBRI
True or False: The treatment of choice for patients who suffer from Multidirectional Instability is surgery.
False, conservative rehab is recommended
What co comment movements of the shoulder are associated with anterior dislocation?
ER and Abd
In the MaxPP of an anterior dislocation rehab program, either post-surgery or when treated conservatively, what movements are contraindicated
Abd, ER and extension
A key goal in the conservative treatment of Ant Dislocations is to increase muscular dynamic stabilization. What muscles should rehab focus on?
IR and adductors to support the anterior capsule, the ER to stabilize the humeral head against anterior translating forces and to restore deltoid-RC force couple
What surgeries are used to correct unresolved Ant Dislocations of the shoulder?
Bankart, Capsular Shift and Thermal Capsulorrhaphy.
What muscles are targeted for strengthening when treating Post Dislocations of the shoulder?
Adductors and ER
What motions should be avoided in the acute phase of Post Dislocations?
Abduction and IR
What is the primary reason for performing a shoulder atrhoplasty?
Pain Relief
Correcting a faulty posture is an important goal of rehab to shoulder problems. Describe the pathomechanics associated with a forward head and thoracic kyphosis?
Forward tilt and downward rotation of the scapula with abd and IR of the humerus.
What are the three phases of adhesive capsulitis (Ad Cap)?
Freezing, frozen and thawing
What grade of sustained translatory joint mobilization techniques are indicated for Ad Cap?
Grade III
True or False: the goal of treating an Ad Cap is plastic deformation of the tissues.
TRUE
Placing a low load (stretch) for a prolonged period of time on shortened tissues incorporates what concept?
Creep
What modality would be appropriate to use in the frozen phase of an Ad Cap to improve soft tissue extensibility.
US
What test is used to detect labrum tears?
Crank or clunk test
What motions should be avoided in the early phases of rehab to a torn labrum?
Abd concurrent with ER
What guidelines should be followed regarding motion in the sagittal plane after the treatment of a surgically repaired torn labrum.
Limit passive or AROM to 60 degrees for the first 2 weeks and to 90 degrees at 3-4 wks postoperatively.
What guidelines should be followed regarding motion in the transverse plane after the treatment of a surgically repaired torn labrum.
Only PROM and IR should be limited to 45 degrees and ER to 15 degrees w/in the first 2 weeks.
Why are Codman's (Pendulum) exercises commonly prescribed in the maximum and moderate protection phase of most shoulder rehab programs?
They simulate grade II oscillation techniques which inhibit pain and maintain joint mobility.
Name three advantages of having a patient perform shoulder exercises in the plane of scapula also refered to as scaption.
More functional activies occur in this plane compared to the other planes, no ER or IR is required to prevent impingement from the greater tubercle and there is less tension in the joint capsule
Colby page 487
What symptoms are associated with the Freezing phase of idiopathic frozen shoulder?
Intense pain, limitations of motion by 2 to 3 weeks after onset.
What symptoms are associated with the Frozen phase of idiopathic frozen shoulder?
Pain only with motion, limited GH motions with substitute motions of the scapula, and atrophy of the deltoid, RC, biceps and triceps.
What symptoms are associated with the Thawing phase of idiopathic frozen shoulder?
No pain and no synovitis but significant capsular restrictions