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89 Cards in this Set
- Front
- Back
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What 3 categories can shoulder problems be divided into?
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1) Overuse or injury
2) Decreased motion 3) Increased motion |
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What category does tendinitis, rotator cuff tear, impingement and bursitis fit into?
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Overuse or injury
*ROM w/ localized inflammation |
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What category does frozen shoulder, muscle flexibility, arthritis and muscle weakness fit into?
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Decreased motion
*ROM w/ CT dysfunction |
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What category does instability, dislocation and trauma fit into?
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Increased motion
*ROM w/ CT dysfunction |
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What is the definition of overuse?
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Repetitive motion of tissue causing it to fatigue
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What is another description of overuse?
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RSI (repetitive strain injury)
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What is the typical sequence of overuse?
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Overuse → impingement → tendinitis → bursitis → partial RC tear → full RC tear
*Does not need to be in this order or go in exact sequence |
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How can carrying an item in hand cause pain in the shoulder?
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The corcacohumeral lig. holds the humerus in GHJ when gravity of extra load pulls, the ligament tightens and RC muscles work.
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What is a sign of acute inflammation?
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Pain before resistance
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What is a sign of repair/fibroblastic stage?
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Pain at the same time as resistance. Can do some activities w/out pain.
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What is a sign of the maturation stage?
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Pain after or w/ overstretch. Can do most activities.
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What are some functional causes of impingement?
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1) Overuse
2) Interruption of arthrokinematics 3) Muscle imbalance 4) Scapulohumeral rhythm 5) Trauma 6) Posture 7) Bone structure |
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When is the sternoclavicular (SC) jt. activated during arm elevation?
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0 to 90 degrees
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What does the SC joint do?
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Elevates the clavicle
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When is the acromioclavicular (AC) jt. activated during arm elevation?
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90 to 180 degrees
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What does the AC joint do?
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Upwardly rotates the scapula
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What happens w/ the kinomatics of the shoulder in elevation w/ impingement?
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1) Decreases upward rotation of scapula
2) Increases clavicular elevation 3) Increases IR of scapula 4) Increases superior and anterior GH glides (translations) |
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What 2 force couples can lead to overuse and impingement due to muscle imbalance?
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1) Deltoid and supraspinatus
2) Mid/lower traps and SA |
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How does supraspinatus-deltoid force couple cause an imbalance and impinge?
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When supraspinatus is weak, the deltoid overpowers bringing the humerus more superiorly causing an impingement
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What can cause weakness in the supraspinatus?
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1) disuse/misuse
2) tear 3) fatigue/overuse 4) suprascapular n. problem causing weakness in supraspinatus and infraspinatus muscles |
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How is the suprascapular nerve affected w/ impingement?
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The suprascapular nerve travels through the notch of the scapula and w/ foward shoulders (bad posture), the nerve is stretched w/ protraction and downward rotation of the scap
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What muscles can cause impingement?
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1) weak lower traps
2) weak mid traps w/ poor posture 3) tight pec minor pulling scap downward, IR w/ anterior tilt 4) SA weak w/ upward rotation 5) overactive upper traps causing increased clavicle elevation in order to compensate weak SA |
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What muscles hold the medial border of the scapula?
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1) lower traps
2) mid traps 3) SA |
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Describe phase I of the scapulohumeral rhythm
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Humerus ABD 30 degrees
Scap minimal mvmt |
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Describe phase II of the scapulohumeral rhythm
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Humerus ABD 40 degrees (total of 70)
Scap 20 degrees rotation Clavicle 15 degrees elevation |
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Describe phase III of the scapulohumeral rhythm
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Humers ABD 60 degrees and ER 90
Scap 30 degrees rotation Clavicle 30-50 degress POS rotation, 15 degrees elevated |
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How does posture influence impingement?
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Forward rolled shoulders from weak mid/lower traps causes scap to ABD, DW rotate causing coracohumeral lig. to slack in keeping humerus in place. The humerus drops causing a stretch on the supraspinatus.
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What are some structural causes of impingement?
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1) anatomy of the cuff w/ critical zone
2) shape of the acromion 3) encroachment of subacromial space 4) capsular stiffness 5) relationship b/w coracohumeral lig. and supraspinatus |
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What makes up the critical zone?
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1) anterior lip of acromion
2) head of the humerus 3) biceps tendon 4) supraspinatus 5) subacromial space 6) capsule 7) superior glenohumeral lig and coracohumeral lig |
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How does the shape of the acromion cause impingement?
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Type I : flat angle (allows normal space)
Type II: smooth curved angle space Type III: anterior hook (least space) w/ increased tears |
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What area of the GHJ does impingement affect?
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The critical zone
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How do palpate the supraspinatus?
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Move arm behind back to make supraspinatus come out from under the acromion
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How does capsular stiffness affect normal arthrokinematics to lead to impingement?
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Tight POS/INF capsule aggravates impingement by forcing the humeral head up against the tip of the acromion when should is flexed
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What is the anatomical relationship b/w coracohumeral lig. and the RC muscles?
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The coracohumeral lig. surrounds the supraspinatus and biceps tendon which in turn covers the labrum. The RC muscles (subscap, infra) overlay as well. If one part gets inflammed or damaged then others are often affected.
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What are the Neer stages of overuse syndrome?
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1) Edema/hemorrhage
2) Fibrosis/Tendinitis 3) RC tear |
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What stage of overuse is least severe and results in impingement?
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Edema/hemorrhage
-subluxation -AC arthitis -biceps tendinitis |
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What age is the edema/hemorrhage of Neer commonly found in?
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25 yo
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What are the sx of the edema/hemorrhage of impingement?
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1) Little pain while doing activity, more pain after
2) Tenderness to palpation 3) P/AROM WNL 4) May have painful arc 5) Pain at end range 5) Muscle weakness |
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What special tests can be done to dx impingement?
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1) Neers
2) Reverse-impingement 3) Hawkins-Kennedy 4) Yocum |
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What stage of overuse presents impingement and tendinitis?
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Fibrosis/tendinitis
-scar tissue w/ supra, infra, biceps tendon |
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What age is the fibrosis/tendinitis of Neer commonly found in?
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25 to 40 yo
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What are the sx of fibrosis/tendinitis?
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1) No pain w/ light activity, PROM
2) Pain w/ vigorous overhead (during and after) 3) Pain w/ passive stretch and active muscle 3) (+) impingement tests 4) weakness of muscles 5) (+) painful arc 6) Might have (+) arm drop, (+) empty can, (+) speeds, (+) yeargasons 7) Decreased H ABD |
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How do you stretch the supraspinatus?
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ADD, IR behind back and ABD
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How do you stretch the biceps tendon?
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Lay supine, PRO arm and EXT shoulder
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What are some different dx for fibrosis/tendinitis?
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1) Calcification
2) Adhesive capsulitis |
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What age often presents RC tear?
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over 40 yo
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What are the sx of RC tear?
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1) Pain w/ most activity
2) Decreased AROM, variable PROM 3) Decreased strength in cuff, esp. supraspinatus 4) (+) drop arm test, (+) painful arc |
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What are some different dx for RC tear?
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1) Cervical problem (C5-C6)
2) Tendinitis 3) Suprascapular n. problem |
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What are some tx for edema/hemorrhage of Neers?
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1) Rest
2) NSAIDs 3) Modalities 4) Strengthen scapula muscles ER/IR 5) Stretching POS capsule 6) Transverse function massage |
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What are the sx of adhesive capsulitis?
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1) Limited ROM (capsule lig not untwisting)
2) Decreased jt. mobility 3) Pain 4) Arthrogaphy |
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What are some different dx for adhesive capsulitis?
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1) Bicipital tendinitis
2) Bursitis 3) Impingement/Supraspinatus tendinitis |
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What are some tx for adhesive capsulitis?
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1) P/AROM exercise to end feel and add a glide
2) Jt. mobes (Grade 1 to 5) |
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What motions do yo want to avoid in phase I after RC repair?
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Active ER, ABD
Passive H ADD, IR, EXT |
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What motions can you do in phase I of RC repair?
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PROM w/in limited range: FLEX, ABD (ex. pendulums)
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How long is phase I of RC repair?
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1 to 4 weeks
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What exercises can you do after 3 weeks of RC repair (in phase I)?
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1) Start to strengthen w/ isometric ADD, IR, FLEX
2) Manual resistance of scap m. 3) AROM of elbow/wrist/hand w/out shoulder m. |
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What are some tx for fibrosis/tendinitis of Neers?
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1) Rest
2) NSAIDs 3) Modalities 4) Strengthen scap m. (ER/IR) 5) Stretch POS capsule 6) Transverse friction massage 7) Acromioplasty to relieve pressure 8) Coracohumeral lig. removed |
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What are some tx for RC tear?
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Same as fibrosis list w/ decision of surgery
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What does strong and painless signify?
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Normalcy. Might be tender to palpation.
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What does strong and painful signify?
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Localized disruption of muscle/tendon complex. Tendinitis muscle strain.
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What does weak and painful signify?
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-More severe disruption of muscle/tendon complex
-Possible fx near jt. -Weakness could be from muscle of from pain |
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What does weak and painless signify?
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Complete rupture of muscle/tendon complex or nerve root involvement
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How long is phase II of RC repair?
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5 to 8 weeks (maturation)
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What is the goal for phase II of RC repair?
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Protect repair (from H ADD, IR, ABD)
Add stress for collagen repair Gradually increase AROM |
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What exercises can be done for phase II of RC repair?
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PROM to AAROM to AROM
Scapular strengthening |
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How long is phase III of RC repair?
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9 to 12 weeks
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What is the goal for phase III of RC tear?
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To get back to functional activities
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What exercises can be done for phase III of RC tear?
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AROM to PRE
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How can you retrain scapulohumeral rhythm patterns back to normal?
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Reach, roll and lift technique
Exercises against the wall to keep scap in place |
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What are the primary IR muscles of the shoulder in sideline adducting position?
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1) Subscapularis
2) Pec major |
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What are the primary shoulder muscles that ER in sideline ABD?
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Infraspinatus > Supraspinatus > Teres minor
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Why would supraspinatus be highly active when ER?
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The person ABD allows their elbows to move out. Need to stabillize elbows.
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What is the primary blood supply to the supraspinatus?
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Suprascapular artery, which passes over the superior transverse lig. that spans across the scap notch.
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Why is the blood supply often decreased to the supraspinatus tendon?
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Due to pressure from the supraspinatus muscle that runs over the artery
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With RC surgery, how is supraspinatus tendon relieved from compression?
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Arm is ABD to suture tendon on humerus
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What are some MOI for bicipital tendinitis?
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1) Secondary to impingement/RC tear
2) Transverse lig. becomes lax and tendon pops in/out of groove 3) Overuse of overhead motions |
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What is the difference b/w tendinosis and tendinitis?
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Tendinosis is degeneration of tendon w/out inflammation w/ nodules and is asymtpomatic. Calcifies over time.
Tendinitis is degeneration of tendon w/ inflammation and is symptomatic w/ vascular disruption, atrophy (acute, subacute and chronic) |
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What are sx of bicep tendinitis?
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1) Pain w/ contraction/stretch
2) Pain at night when rolling on it 3) Pain w/ end range 4) Tenderness to palpation over groove 5) Painful arc (sawing test) 6) Pain w/ overhead use 7) Full P/AROM 8) Normal GHJ glides 9) (+) Yeargasons and/or Speeds |
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What are similar problems to bicep tendinitis?
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1) impingement
2) GH arthritic changes 3) RC tear 4) Instability 5) Labral tears 6) Thoracic outlet syndrome 7) Frozen shoulder 8) Cervial radiopathy |
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Describe bursitis
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Irritated bursa w/ impingement, calcium deposits, trauma, RA
*Could be isolated or w/ other dx |
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What is the cause of bursitis?
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Most of the time we don't know the cause (idiopathic)
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What are the sx of bursitis?
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1) Gradual onset (disconnect from event 1-2 days)
2) Intense pain (pain pattern) 3) Painful arc 4) (+) impinge test, (+) empty can 5) Pain w/ palpation |
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What are some different dx for bursitis?
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RC tear
Tendinitis |
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What muscles cause upward rotation of scapula?
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1) SA
2) Upper traps 3) Lower traps |
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What muscles cause downward rotation of scapula?
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1) Rhomboids
2) Pec minor 3) Levator scapulae |
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What muscle(s) ABD the scapula?
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SA
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What muscles ADD the scapula?
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1) Middle traps
2) Rhomboids |
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What muscles elevate the scapula?
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1) Upper traps
2) Levator scapulae 3) Rhomboids |
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What muscles depress the scapula?
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1) Lower traps
2) Lats 3) Pec minor |
