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82 Cards in this Set
- Front
- Back
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Primary vs secondary subacromial impingement. |
Primary: mechanical compression of RC tendons Secondary: GH instability creating reduced subacromial space |
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The three types of acromion morphologies. |
Type I - flat (normal amount of space) Type II - curved and downward dipping (less anterior space) Type III - hooked and downward dipping (even less anterior space) |
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Neer's stages of impingment. Stage I.(4) |
Occurs in younger patients < 25 years old Edema & hemorrhage Pain increased w/ abduction > 90 deg. Responds well to PT
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Neer's stages of impingement. Stage II. (5) |
Affects patients between 25-40 years old Fibrosis of tendon, bursa Pain with ADLs Night pain Irreversible, but responds to PT |
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Neer's stages of impingement. Stage III. (4) |
Affects patients > 40 years old Tendon degeneration Rotator cuff tears and ruptures Pain Weakness Atrophy Hard to gain full functional restoration |
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PT examination of shoulder. (5) |
History Posture ROM MMT Special tests |
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What are the goals of non-operative rehabilitation? (3) |
Control pain and swelling (medication, modalities) Restore posture (stretching/strengthening) Return to functional activities |
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Common shoulder impingement tests. (2) |
Hawkins/Kennedy Neer |
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Phase I non-operative treatment of impingement syndrome. (Voight)(4) |
Symptom relief (modalities for deep tissues) Activity modification Motion stretching exercises in pain free ROM Initial strengthening |
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Phase II non-operative treatment of impingement syndrome. (Voight)(2) |
Emphasize strength of rotator cuff and scapular stabilizers Progressive resistive OKC exercises Gradual return to function |
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How big is a "small" rotator cuff tear? |
<1cm |
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How big is a "medium" rotator cuff tear? |
<3cm |
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How big is a "large" rotator cuff tear? |
>5cm |
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What special test used to test supraspinatus? |
Empty can test |
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What special test to use when testing supraspinatus or infraspinatus? |
Drop arm test |
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What special test to use when testing infraspinatus or teres minor? |
Hornblower's sign |
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What special test to use when testing subscapularis and scapula? |
IR lag sign |
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What size tears require tissue protection such as a sling, abduction pillow and minimal allowable AROM? |
1-5cm tears |
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What are the three phases of post operative rotator cuff rehabilitation? |
Phase 1: Maximum protection Phase 2: Moderate protection Phase 3: Minimum protection |
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How long is phase 1 of post-op RC rehab? |
About 6 weeks |
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How long is phase 2 of post-op RC rehab? |
7-12 weeks |
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How long is phase 3 of post-op RC rehab? |
13-21 weeks |
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What is phase 1 of post-op RC rehab and what is done? (6) |
Max protection: Modalities Codman's pendulum exercises AAROM pulley exercises Scapular stabilization Control inflammation Scar mobility |
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What is phase 2 of post-op RC rehab and what is done? (5) |
Moderate protection: Progressive ROM with caution > 90deg Theraband and tubing exercises Concentric exercises Eccentric with caution Re-educationg musculature |
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What is phase 3 of post-op RC rehab and what is done? |
Minimal protection: Advanced CKC exercises Gradual return to normal activities May take up to 10 months post-op |
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What is contraindicated for first 3 to 4 months post-op RC repair? |
No AROM No concentric exercises No eccentric exercises |
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Anterior GH dislocation position. |
Abduction Extension External rotation |
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Posterior GH dislocation position. |
Abduction Flexion Internal rotation |
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What is a Hill-sachs lesion? |
Dent in head of humerus |
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What is a SLAP lesion? |
Superior labral tear from anterior to posterior |
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What is a Bankart lesion? |
Injury of anterior inferior glenoid labrum due to anterior shoulder dislocation |
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Men or women more likely of suffer shoulder dislocation? |
Men |
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Anterior or posterior dislocation more common? |
Anterior dislocation |
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What is TUBS? |
Traumatic, Unidirectional Bankart Surgery. |
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What is AMBRI? |
Atraumatic, Multidirectional, Bilateral responds to Rehabilitation, but in case of surgery Inferior capsular shift is indicated |
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Special tests to do when dislocation is suspected or when a history of dislocation. |
Anterior apprehension test Relocation test Surprise test Posterior drawer test Labral tests |
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What are the four labral tests? |
Anterior slide test Crank test SLAPrehension test Biceps Load Test 1 & 2 |
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Non-operative management of shoulder dislocations |
Modalities for pain inflammation Elbow, wrist and hand ROM General conditioning Avoid dislocation motion Codman's AAROM pulley exercises Avoid excessive abduction of external rotation Submax isometrics 0deg abduction ER/IR with theraband when Max isometrics without pain Eccentric RC exercises Progress to Phase 3 |
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Progression to Phase 3 or minimum protection phase should depend on... (3) |
Full, nonpainful ROM No palpable tenderness Continued progression of shoulder strength |
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What are the types of surgical procedure for open stabilization? |
Magnusen-Stack Bristow procedure Capsular shift Capsulorrhaphy |
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What is the Magnusen-Stack procedure? |
Repositioning of subscapularis |
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What is the Bristow procedure? |
Coracoid process repositioned to neck of humerus |
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Rehabilitation after stabilization procedures: (8) |
Rehab must match the procedure Immobilize in sling Cryotherapy Submax isometrics without pain Eccentric exercises UE muscle endurance Progressive resistive exercises Flexibility exercises |
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What is adhesive capsulitis? |
Frozen shoulder |
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What are the characteristics of adhesive capsulitis? (3) |
Decreased shoulder ROM Pain Inflammation with adhesions |
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Is adhesive capsulitis more common in males or females? |
Females between 40-60 years of age |
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What is primary adhesive capsulitis? |
Occurs spontaneously |
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What is secondary adhesive capsulitis? |
Caused by trauma or immobilization |
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Are there typically neurologically associated symptoms associated with adhesive capsulitis? |
No |
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Physical therapy interventions for adhesive capsulitis: |
Control inflammation Symptom management PROM, AROM, AAROM in pain free range Grade I and II mobilization techniques Submax isometrics early |
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AC sprains and dislocations: How are sprains graded? |
Degree of ligamentous damage |
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AC sprains and dislocations: What are the three grades of ligamentous damage? |
Grade 1: Partial tear, no instability Grade 2: Complete rupture Grade 3: Dislocation between clavicle and acromian |
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Grade 1 AC rehab. |
Symptom relief Protect joint from stress |
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When can a patient resume activities after rehab of a grade 1 AC tear? |
2 weeks |
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Grade 2 AC rehab. (4) |
Shoulder immobilizer Submax isometrics AROM motions after immobilizer removed Progressive resistive exercises (scapular stabilization, deltoid and rotator cuff) |
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Grade 3 AC sprain: How long to keep immobilized? |
6 weeks |
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Grade 3 AC sprain: When can light resistive exercise begin? |
3 weeks post op |
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Grade 3 AC sprain: When can more progressive resistive exercises start? |
8-10 weeks post op |
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Grade 3 AC sprain: What are the four categories of repairs? |
Insert stabilizing pins Sutures Screw Distal clavicle re-section |
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Grade 3 AC sprain: How long is heavy exercise delayed post-op? |
8 weeks |
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What causes most scapular fractures?
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Direct trauma |
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Are clavicular fractures more common in men or women?
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Men younger than 25 years old |
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Clavicular fracture: How long to bandage or brace? |
4-6 weeks |
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Clavicular fracture: Active shoulder flexion must not be more than how many degrees and for how long? |
40-50 degrees until 4-6 weeks |
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Proximal humeral fracture: What is the four part classification? |
Humeral head Lesser tuberosity Greater tuberosity Humeral shaft |
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Proximal humeral fracture: What type of this fracture is most common? |
Non-displaced, one part fracture |
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Proximal humeral fracture: What should be emphasized when treating this fracture? |
Functional motion of GH joint Strength |
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Proximal humeral fracture: What is a nerve related risk of this fracture. |
Radial nerve palsy |
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When would shoulder arthroplasty be indicated? |
Secondary to: Four-part fractures Osteoporosis Rheumatoid arthritis Advanced OA Rotator cuff condition |
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If a rotator cuff is repaired with arthroplasty, how long is the immobilization period in an abduction splint? |
6-8 weeks |
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Without rotator cuff repair, what is the post-op abduction average? |
143 degrees |
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If there has been a rotator cuff repair, what is the post-op abduction average? |
63 degrees |
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Shoulder arthroplasty post-op rehab: When can functional use of affected UE be expected? How long may the HEP last post-op? |
6 months 2 years |
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Shoulder arthroplasty post-op rehab: When is the immobilizer removed to perform Codman's exercises? |
1 week |
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Shoulder arthroplasty post-op rehab: When is scapular motion and stabilization exercises added? |
2 weeks |
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Shoulder arthroplasty post-op rehab: When is light resistive exercises added? |
6 weeks |
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Shoulder arthroplasty post-op rehab: When is gentle AAROM and isometrics started? |
Day 1 or 2 |
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Glenohumeral joint instability and dislocation: What is the hallmark of the return to function phase of recovery after anterior shoulder dislocation or subluxation? |
Progressive strengthening of: Rotator cuff Anterior shoulder muscles Scapular stabilizers with: Eccentric strengthening of Teres minor Infraspinatus |
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Glenohumeral joint instability and dislocation: What is done to ensure healing of all soft tissue post-op? |
12 weeks of slow and protective external rotation |
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What is considered a missing link in shoulder rehabilitation? |
Eccentric exercises |
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What type of exercise is known to create a functional carryover of strengthening that leads to improved mobility? |
Isotonic eccentric exercises
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What special test to use when testing subscapularis? |
Gerber lift off test |
