Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
78 Cards in this Set
- Front
- Back
|
Clinical presentation of Type I adhesive capsulitis and general length of this stage |
Sudden onset of severe pain which can disrupt sleep Lasts 10-36 weeks |
|
|
What is adhesive capsulitis? |
Thickening and contracture of the glenohumeral joint capsule, loss of the axillary fold of the capsule and adhesion of the associated ligaments |
|
|
Clinical presentation of Type II adhesive capsulitis and general length of this stage |
Restricted ROM primarily in the capsular pattern i.e. ER>ABD>IR Lasts 4-12 months |
|
|
Clinical presentation of Type III adhesive capsulitis and general length of this stage |
Gradual recovery of ROM however may never achieve full ROM Lasts 5-26 months |
|
|
General rule of thumb for ROM following rotator cuff surgery? |
PROM only 0-4 weeks, AAROM 4-8 weeks, AROM 8+ weeks |
|
|
Muscles that attach to the greater tubercle of the humerus |
Supraspinatus Infraspinatus Teres minor |
|
|
Muscle(s) that attach to the lesser tubercle of the humerus |
Subscapularis |
|
|
Components of the GH joint |
RTC tendons Long head of biceps Sub acromial sub deltoid bursa Subscapularis bursa Subcoracoid bursa Coracohumeral ligament |
|
|
Static stabilizers of the Gh joint |
Articular surface: poor congruity, likened to a golf ball on a tee, humeral head 3-4x larger than glenoid fossa SGHL MGHL IGHL |
|
|
Role of superior glenohumeral ligament |
Restrains inferior translation and ER in 0 degrees abducted arm Restrains posterior translation in flexion, addiction, and IR |
|
|
Laxity of what structure causes a "sulcus" sign? |
Superior glenohumeral ligament |
|
|
Roles of middle glenohumeral ligament? |
Restrains anterior translation at 45 Abd/ER |
|
|
Roles of inferior glenohumeral ligament? |
anterior band is Primary anterior restraint in 90 Abd, 90 ER Thickened bands form a hammock to support the humerus in the axillary pouch Posterior portion is primary restraint to posterior translation in Abd/IR |
|
|
2 tests of shoulder anterior instability |
Apprehension sign: over pressure to ER, look for apprehension or pain Relocation test: apply posterior force to relocate, look for relief of apprehension |
|
|
Describe shoulder abduction force couple |
Early in abduction, the anterior/middle deltoid pulls superiority (an upward shear force) while the supraspinatus gets abduction started. As the arm is abducted to 90 degrees, the direction of pull of the deltoid becomes similar to the pull of the supraspinatus. |
|
|
Describe the rotator cuff force couple |
The subscap, infraspinatus, and teres minor depress the humeral head, counteracting the upward pull of the supraspinatus and deltoid. The infraspinatus becomes a humeral head depressor with the arm at 90 Abd and neutral rotation. The subscapularis acts as a humeral head depressor in ER. The rotator cuff provides direct joint compression, keeps the humeral head compressed to and centered within the gleoid and allows the deltoid to function. |
|
|
Average ROM shoulder: - flexion - extension - IR/ER total arm at side - IR/ER total arm abducted |
Flexion: 165-172 or ~170, some people can reach 180 Extension: ~62 degrees IR/ER arm at side: 150-180 degrees IR/ER arm abducted: 120 degrees |
|
|
Scapular is positioned where, in relation to the spine? |
Super angle T2 Inferior angle T7 |
|
|
Upward rotators of the scapula? |
Upper trapezius Lower trapezius Serratus Anterior |
|
|
Downward rotators of the scapula? |
Levator scapula Rhomboid major and minor Pectoralis minor |
|
|
Elevators of the scapula? |
Levator scapula Upper trapezius Rhomboid major and minor |
|
|
Depressors of the scapula? |
Pectoralis minor and major Lower trapezius Latissimus dorsi Lower fibers of the serratus anterior |
|
|
Protractors (abductors) of the scapula? |
Serratus anterior Pectoralis minor and major Latissimus dorsi |
|
|
Retractors (adductors) of the scapula? |
Middle trapezius Rhomboids major and minor |
|
|
Flexors of the humerus? |
Clavicular head of the pectorals major Anterior deltoid Coracobrachialis Short head of the biceps |
|
|
Extensors of the humerus? |
Latissimus dorsi Teres major and minor Posterior deltoid Infraspinatus Long head of the triceps |
|
|
Abductors of the humerus? |
Middle deltoid Supraspinatus |
|
|
Adductors of the humerus? |
Sternal head of pectoralis major Latissimus dorsi Teres major Coracobrachialis |
|
|
External rotators of the humerus? |
Infraspinatus Teres minor Posterior deltoid |
|
|
Internal rotators of the humerus? |
Subscapularis Latissimus dorsi Teres major Anterior deltoid Pectoralis major |
|
|
Horizontal adductors of the humerus? |
Anterior deltoid Clavicular head of pectoralis major |
|
|
Horizontal abductor of the humerus? |
Posterior deltoid |
|
|
When is the superior portion of the GH joint capsule under tension? |
GH adduction |
|
|
When is the anterior and inferior portion of the GH joint capsule under tension? |
GH abduction |
|
|
When is the posterior capsule under tension? |
GH Internal rotation combined with extension. Posterior inferior capsule - IR in scapular plane |
|
|
Describe the capsuloligamentous complex of the GH joint |
- reciprocally tighten and loosen - suctions humerus into the joint - capsule surface is 2x the size of the humeral head - capsule seals the joint and creates a negative intra-articular pressure |
|
|
Shoulder instability: TUBS |
Traumatic, Unilateral, Bankart, Surgery Specific traumatic event leading to dislocation 98% of cases are anterior dislocations (mostly teens), affects anterior, inferior GH joint 4-6 o'clock position 2% posterior dislocations |
|
|
Shoulder instability: AMBRI |
Atraumatic, Multidirectional, Bilateral, Rehabilitation, Inferior Shift No traumatic event Multiple planes of instability 85% successful with rehab If surgery indicated: inferior capsular shift to tighten the capsule Voluntarily dislocates |
|
|
Describe the shoulder instability grades |
0- no humeral head translation 1- humeral head rides up glenoid slope not over rim 2- humeral head rides over glenoid, but reduces as stress is removed 3- humeral head rides over glenoid, remains dislocated as the stress is removed |
|
|
Describe the apprehension test |
Tests for anterior instability shoulder 90 abduction, ER |
|
|
Describe the subluxation/relocation test |
Tests for anterior instability Shoulder 90 abduction, er, grasp wrist and add posterior force to humeral head |
|
|
Describe the load and shift test |
Tests anterior and posterior instability Stabilize the scapula and move humerus anteriorly and posteriorly |
|
|
Describe the sulcus sign |
Tests for inferior instability Traction arm. If 2 cm or more inferior trnaslation, then positive sign. |
|
|
Conservative management for anterior GH dislocation |
Phase 1: sling with 10 degrees ER, reduce pain and inflammation Phase 2: Sling as needed, AROM as tolerated starting at 30/30 ER/ABD then progressing AROM 90/90, isotonic training (avoid 90/90 ER/ABD), rhythmic stabilization, strengthen RTC Phase 3: isotonic training of TRC to ER/ABD 90/90, scapular strengthening, plyometrics |
|
|
Describe a Bankart lesion |
Tear of anterior-inferior labrum and/or attenuation and stretching of the anterior-inferior capsule and inferior GH ligament and periosteal stripping of subscapularis from glenoid fossa (Forms a pocket at front of glenoid that the humeral head can dislocate into) |
|
|
Describe arthroscopic repair of Bankart lesion |
Subscapularis is split longitudinally Capsule is split to expose labral lesion Lesion repairable with anchors Capsule is repaired Subscapularis is then repaired |
|
|
Bankart rehab guidelines for arthroscopic repair |
Phase 1: wear sling, controlled PROM, limit to ER 0-20 in scaption for 5-6 weks, limit flexion and scaption to 0-90 degrees. Reduce pain and inflammation. AROM in scaption at 4-6 weeks avoiding ER and ext beyond neutral. Phase 2: Discharge sling, progress PROM, PROM ABD/ER 30/30 gradually progressing to 90/90 by 12 weeks, improve NM control. No aggressive ABD/ER. Phase 3: No ROM restrictions, scapular stabilization and RTC strengthening |
|
|
Bankart rehab guidlines for open repair |
Phase 1: Wear sling, PrOM ER to 0-20 in scaption first 4 weeks then 0-40 4-6 weeks, PROM flexion and scaption to 90 degrees, reduce pain and inflammation, sub-maximal isometrics at 4-6 weeks Phase 2: Discharges ling, progress PROM, begin A/AAROM, 30/30 to 90/90 ABD/ER gentle and in scapular plane, improve NM control, strength and endurance, isokinetic 8-10 wks post op Phase 3: restore strength, dynamic stabilization |
|
|
Describe rotator cuff injury tear sizes |
small = <1 cm medium = 1-3 cm large = 3-5 cm massive = 5+ cm |
|
|
Describe the clinical presentation of a rotator cuff tear |
- painful - If partial thickness, MMT is weak and painful - If full thickness, MMT is weak and painless - Reduced AROM and PROM - Abnormal scapular position - Abnormal posture - Perhaps pain at subacromial space |
|
|
Describe when open repair of RTC tear is warranted |
- Muscle retraction - Poor tissue quality - Weak bones |
|
|
Describe open repair of RTC tear |
- Requires 2-3 incisions - Deltoid is moved off the acromion (post-op will need to avoid deltoid contraction for 8 weeks) - RTC is repaired - Acromioplasty also usually performed - Therapy is slower, pain levels higher |
|
|
Describe arthroscopic repair of RTC tear |
- Deltoid does Not have to be detached - Less pain - Better visualization - Rehab progression is faster - May have higher rate of re-tear with large to massive tears - Post-op calls for 6 weeks of PROM and 6-12 weeks of AAROM |
|
|
Describe mini-open repair of RTC tear |
- Shoulder is assessed arthroscopically - 3/4" to 1" incision made - Deltoid split longitudinally, so rehab is faster - Shoulder is assessed arthrscopically - Acromioplasty is usually performed - Post-op calls for 6-8 weeks PROM and 6-12 weeks of AAROM |
|
|
Post-op RTC repair sling positions and precautions |
- Sling in scapular plane and abduction 30-45 degrees - Limit passive flexion to 120 degrees |
|
|
Describe RTC repair Phase I |
Maximal protection, passive ROM - Protect with sling - Scapular retraction and depression - ROM for cervical spine, elbow, wrist and hand - PROM ER to 30-45 degrees - PROM flexion and scaption to 120 - PROM abduction to 90 - Ice or cold cuff |
|
|
Describe RTC repair Phase 2 |
Minimal Protection AROM - AAROM pain-free: IR, ER, flexion, scaption - AROM (5-6 wks): sidelying ER, flexion, scaption, prone horizontal abduction with ER - Low load prolonged stretches (sleeper, IR, ER) - ADLs with up to 5 lb limitations |
|
|
Describe RTC repair Phase 3 |
Initial resistance strengthening and proprioception - 8 weeks post-op - Theraband - IR/ER - Pinches - Biceps curls - Prone lower traps - closed chain stability |
|
|
Describe RTC repair Phase 4 |
Advanced resistance strengthening and proprioception - 12 weeks post-op - Begin sports-specific training - PNF with resistance |
|
|
Shoulder instability conservative management |
- Reduce pain and inflammation - Restore ROM - Avoid excessive ER and abduction - Stretch posterior capsule - Strengthen rotator cuff, deltoids, and peri-scapular muscles |
|
|
Describe SLAP Lesions |
- Super labrum anterior posterior - Tear at the superior labrum that begins posteriorly and extends anteriorly - Involves anchor of the biceps tendon to the labrum |
|
|
Clinical presentation of SLAP Lesions |
- Traumatic event - Compressive force to shoulder: fall on arm that is abducted and slightly flexed - Traction injury - Shoulder instability (overhead throwing athletes) - Labrum weaker in skeletally immature pts (<25 years of age) - Deep pain, popping and clicking |
|
|
Tests for SLAP Lesions |
- O'Brien's test (sh flexion to 90, IR, downward pressure causes pain and popping. Try again with forearm ER and pt should not have sx) - Load and shift test - Kibler Test (hand on hip, hold elbow and apply upward pressure) - Pain at biceps groove |
|
|
Conservative therapy for SLAP lesion |
- Most treated surgically - Rest - NSAIDs |
|
|
SLAP lesions, 4 types |
I: degenerative fraying of labrum, edge firmly attached II: Most common type. Superior labrum is detached and biceps anchor destabilized. III: Bucket-handle tear of superior labrum IV: Bucket-handle tear of super labrum with extension into the biceps tendon |
|
|
Surgical treatment of SLAP lesions type I and III |
Arthroscopic debridement of frayed portion |
|
|
Surgical treatment of SLAP lesion type II |
- Arthroscropic debridement of frayed portion - Biceps-labral complex is reattached to superior glenoid with suture anchors or biodegradable tacks |
|
|
Surgical treatment of SLAP lesion type IV |
Detached portion is reattached. May perform debridement only depending on extent of biceps involvement. |
|
|
Rehab of SLAP lesion type II |
- Immobilize 3-4 weeks - A/AA/PROM in 90/90 for 8 weeks - Strengthening at 6-8 weeks "respect the biceps tendon" |
|
|
Describe Hill-Sachs Lesion |
Dent in posterior humeral head, occurs during dislocation as the humeral head impacts against the front of the glenoid. |
|
|
Greater tuberosity humeral fracture - Rehab |
- Usually due to fall onto shoulder, common in elderly population - If non-displaced: begin active exercise ASAP to avoid stiffness - If displaced: surgical fixation with post-op immobilization 1-2 weeks |
|
|
Fracture of humeral neck - Treatment |
- Fall on outstretched arm or elbow - If angulation is greater than 45 degrees, will often need a hemiarthroplasty - May require ORIF - Post-op immobilization depends on severity. If nondisplaced, can come out of sling for exercises. If significant displacement, will need to be immobilized for 2-3 weeks. However early movement is desired. |
|
|
Humeral shaft fracture - Describe cause and general treatment |
- Caused by direct blow, twisting force. Leads to spiral fracture. - Early motion is ideal - Immobilization based on stability - May need surgical fixation - Check integrity of radial nerve |
|
|
General rehab for humerus fracture |
- Early motion: A/AROM - PROM if fracture is stable - Grade I and II oscillations - Grade III and IV if low pain levels - Strengthening when fracture is stable and pt has 50% ROM |
|
|
Operative management options for GH arthritis |
- debridement - capsular release - resurfacing - hemiarthroplasty - total shoulder arthroplasty - reverse total shoulder arthroplasty (if failed RTC) |
|
|
When to perform total shoulder arthroplasty? |
- OA, RA, avascular necrosis, cuff tear arthropathy (bone degeneration over time following RTC tear), acute fxs, posttraumatic arthritis |
|
|
Treatment of rotator cuff arthropathy? |
Reverse total shoulder arthroplasty (convex glenoid).
|
|
|
Total shoulder arthroplasty - Rehab guidelines |
- Day 1: AA/PROM - Do not exceed ER achieved in OR for first 6 weeks. If you don't know, do not exceed 30 degrees (protect subscap_ - 2-3 weeks: Scapula exercises - 6-8 weeks: Progressive RTC strengthening |
