Upper Quarter Ortho

Front 1

What is the typical position of dislocation of the shoulder? What parts of the capsule does it stress?

Back 1

ABD + ER combined
Stresses the ANT + INF portion of the capsule

Front 2

What does a FOOSH injury entail? What direction does it dislocate the shoulder?

Back 2

Fall On Out Stretched Hand
Anterior or posterior dislocation depending on where hand falls

Front 3

What is a Bankart lesion (Torn Loose)? What does it affect? What happens to the joint?

Back 3

Labrum pulled out ANT + INF
Affects negative pressure
Joint becomes unstable

Front 4

What structures can be damaged with a SLAP lesion?

Back 4

1) Superior labrum
2) Anterior labrum
3) Posterior labrum
Doesn't have to be all

Front 5

Where does a SLAP tear occur?

Back 5

Where the biceps tendon anchors to the labrum

Front 6

What is the most severe SLAP tear type?

Back 6

Type 4

Front 7

What is a Hill-Sachs lesion?

Back 7

A compression fx of the head of the humerus on the posterior side, pushing on anterior lip of the labrum.

Front 8

What can be secondary to dislocations?

Back 8

Rotator cuff tears

Front 9

What nerve is affected by head of the humerus dislocating?

Back 9

Axillary nerve is stretched when the head of the humerus is pulled down. Loss of sensation and deltoid muscle.

Front 10

How do nerve/vascular injuries occur in older populations?

Back 10

Decrease in elasticity with the older population.

Front 11

What is atraumatic recurrent instability?

Back 11

No hx of injury or it was minor and may have patterns of instability in other joints. AKA "Born Loose."

Front 12

Name 6 traumatic dislocations of the shoulder

Back 12

1) Bankhart lesion
2) SLAP lesion
3) Hill-Sachs lesion
4) Rotator cuff tears with dislocation
5) Nerve/Vascular injuries
6) Anterior dislocation

Front 13

What does "born loose" mean? What do you look for as a PT?

Back 13

-Atraumatic recurrent instability of no hx of injury or it was minor.
-Look for patterns of instability in other jts.

Front 14

What does AMBRI mean?

Back 14

Atraumatic multidirectional bilateral (shoulders) rehabilitation, inferior capsule shift (surgery)

Front 15

What are key tests for instability?

Back 15

1) Load and shift
2) Apprehension (crank) test
3) Jobe sublaxation/relocation
4) Posterior Apprehension
5) Push-pull
6) Jerk
7) Sulcus sign

Front 16

How do you manage instability?

Back 16

Depends on Bankhart lesion. If none, then conservative approach. If lesion is present, surgery.

Front 17

What conservative tactics can you use for dislocation?

Back 17

-Immobilization at the beginning (young 6-8 weeks, older 2-3 weeks).
-Controlled motion 2-5 weeks from initial injury by doing PROM/AROM and isometrics.

Front 18

What are key precautions for dislocation?

Back 18

Avoid:
-ER past neutral, EXT which can lead to stress on anterior capsule.
-ABD past 90⁰
-anterior glide of humerus

Front 19

Why would you want to immobilize younger people rather than older when dealing with instability?

Back 19

-Young 6 to 8 weeks, more likely to reinjure w/ lots of mvmt.
-Older 2 to 3 weeks, prone to capsilitis w/ high collagen.

Front 20

What is the most invasive surgery for RC tear?

Back 20

Open Bankhart repair on labrum and capsule

Front 21

What key structures are disrupted with open Bankhart repair?

Back 21

1) Subscapularis is cut and reattached
2) Anterior capsule is reinforced both lateral to medial and medial to lateral
3) Possible removal and reattachment of coracoid process

Front 22

What is an alternative way of surgery for capsule?

Back 22

T-cut incision

Front 23

Describe staple capsulorrhaphy w/ arthroscopic repair

Back 23

Repair of the capsule to the edge of the glenoid. Subscapularis is removed and tightened.

Front 24

What motions should PTs avoid w/ staple capsulorraphy (arthroscopic repair)?

Back 24

Want to limit ER w/ the tightening of anterior capsule.

Front 25

What are pros and cons of open Bankhart v. arthroscopic repair?

Back 25

Open Bankhart:
pro-better results of stability
con-more damage to other structures
Arthroscopic:
pro-less damage to other structures
con-long term benefit isn't as good as open

Front 26

What is thermal capsulorraphy? When was it most used? Why is it no longer used?

Back 26

-The tightening of the capsule using a probe w/ light to shrink wrap the capsule.
-in the 90s.
-Short rehab, but loosens back up quickly

Front 27

How long is the acute phase of healing for Bankhart repair?

Back 27

1 week (inflammation)

Front 28

What restrictions are given to what structures in a Bankhart repair?

Back 28

-Contractile tissue: subscap w/ active IR and passive/active ER
-Non-contractile: capsule/lig w/ active and passive EXT (not past frontal plane) and active/passive ER

Front 29

Given the 1st week restrictions of Bankhart repair, what motions are appropriate?

Back 29

PROM: IR, <45⁰ ABD, <90⁰ FLEX, passive pendulum exercises, hand slides on table.
AAROM: ER limited w/in IR quadrant to 0⁰. EXT not passed 0⁰.
AROM: Elbow, wrist, hand, scap m. and cervical spine.
Isometrics: resist ER and FLEX w/in limits.

Front 30

Is the Tx the same for arthroscopic compared to open Bankhart?

Back 30

No, subscap will not be injured. Follow same Tx, but can add in subscap motions.

Front 31

How long is the repair/fibroblastic phase of healing for Bankhart repair?

Back 31

1 to 3 weeks (could be up to 4-6wks)

Front 32

What will be the Tx for the repair/fibroblastic phase?

Back 32

-Gradual progression to maintain protection
-Start to place stress and strain to pain, not through pain on tissues.
-Isometrics must be done in short length to avoid stretch.

Front 33

What are the precautions and appropriate motions on tissues for a person in the repair/fibroblasitic phase of repair?

Back 33

Contractile: No increased pain (sharp, stabbing, long-lasting)
Isometrics, AROM (ER to 0⁰) and PROM/AAROM
Non-contracile: Lig/Cap: Don't want to stretch at all, but need to stress tissues (stay in toe region) when reach little resistance.

Front 34

What are some specific exercise considerations of a person in the repair/fibroblastic phase of repair?

Back 34

Early ex: AAROM to AROM (↓ load, ↓ reps). FLEX before ABD b/c of ABD strain on capsule. ER in FLEX prior to ER in ABD (more slack on capsule). Isometrics. Submax to subscap. AROM.
Later ex: ↑ intensity and reps to above.

Front 35

What are some specific muscles and methods to gain IR and ADD strength in GHJ?

Back 35

1) Lats
2) Pecs
3) Teres major
All having long fibers, want larger ROM exercises

Front 36

Why is subscap not included w/ strengthening IR/ADD in GHJ?

Back 36

Subscapularis have short fibers; therefore, a stabilizer.

Front 37

What are specific muscles and methods to gain ER and ABD strength in GHJ?

Back 37

1) Deltoid
2) Supraspinatus
3) Infraspinatus
4) Teres minor
Short fibers & ROM, isolated
Group Delt + Subscap (↑PCSA, ↑ load, ↓reps)-scaption IR, military press, FLEX, ABD

Front 38

From the articles, how did they determine muscle activity?

Back 38

->50% max MMT
-3 consecutive arcs of 30⁰
-low intensity, speed concentric/eccentric, 10 reps for scap

Front 39

What are condensed exercises that uses most muscles?

Back 39

1) Military press
2) Horizontal ABD ER/IR
3) Press up
4) Scaption ER/IR
5) FLEXION

Front 40

What muscles are used doing H. ABD IR lying prone?

Back 40

1) Mid/Pos Delt
2) Infraspinatus
3) Teres m.

Front 41

What muscles are used doing a rowing exercise lying prone?

Back 41

1) Mid/Pos Delt
2) Upper/mid/lower traps
3) levator
4) Rhomboids

Front 42

What muscles are used doing shoulder flexion arm in neutral?

Back 42

1) Ant/Mid Delt
2) Supraspinatus
3) Infraspinatus
4) Subscapularis

Front 43

What muscles are used doing scaption IR?

Back 43

1) Ant/Mid Delt
2) Supraspinatus
3) Subscapularis

Front 44

What muscles are used doing press-ups?

Back 44

1) Lats
2) Pecs