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54 Cards in this Set
- Front
- Back
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6 Entities that refer pain to the shoulder
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heart
gallbladder diaphragm dermatomes (C4 trap; C5 deltoid & lateral arm) trigger pts (supra/infraspinatus/trap) C-spine |
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4 Common Impairments affecting the GH Joint
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RA/OA
traumatic arthritis post-immob arthritis adhesive capsulitis |
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Adhesive Capsulitis
Etiology |
idiopathic
dense adhesions to inf. capsule F>M, 40-60 y.o. and elderly possibly related to kyphotic posture/muscle imbalance, hormonal influence, metabolic influence, or post immobilization may also develop as result of chronic inflammation of jt. capsule, tendonitis, or synovitis |
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Adhesive Capsulitis
Signs and Symptoms |
pain w/ elevation
possible pain and muscle guarding of upper trap insidious onset fxnal limitations with ADL, overhead activities decrease PROM ER>ABD>IR decrease accPROM ant>inf>post |
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Adhesive Capsulitis
Functional Limitations |
overhead reach
hand to mouth grooming activities bra clasping or tucking in shirt poor endurance |
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Adhesive Capsulitis
Acute Management |
"protection phase"
possible sling for rest/pain relief grade I oscillations for pain pain free PROM all directions Codman's muscle setting maintain AROM exercises as tolerated of scapula, elbow, wrist and hand educate pt re: posture, sleep position Stretching is contraindicated until acute inflammation has subsided |
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Adhesive Capsulitis
Subacute Management |
therex to promote proper posture
begin to restore mobility: accPROM->PROM->AAROM->AROM incorporating new range as it is achieved progressive oscillations gentle passive stretching strength:submax isometrics->MRE->AROM->isotonics with theraband |
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Adhesive Capsulitis
Settled Management |
progress postural exercises
gd III&IV oscillations to improve mobility continue stretching to end ROM with overpressure, reinforce with AROM in new range incorporate functional exercises |
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AC/SC Joint Common Problems
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overuse syndromes
sublux/dislocations hypomobility |
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AC/SC Joint Impairment
Overuse Etiology |
repeated overuse of arm at waist level, or repeated diagonal Ext, ADD, and IR.
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AC/SC Joint Impairment
Sublux/Dislocations |
usually falling on shoulder or FOOSH injury
resulting hypermobility usually permanent because of lack of muscular support to both structures |
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AC/SC Joint Impairment
Hypomobility |
usually results from faulty posture in depression/retraction
may contribute to TOS |
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AC/SC Joint Impairment
Signs and Symptoms |
localized pain
painful arc w/ elevation pain w/ horiz ADD/ABD |
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AC/SC Joint Impairment
Functional Limitations |
limited overhead movements
limited ability to sustain loaded fwd/bkwd movement of involved arm with packing, assembly, or construction work |
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Painful Shoulder Syndrome
Impairment List |
Supraspinatus Tendonitis
Infraspinatus Tendonitis Bicipital Tendonitis Postural Imbalance Shoulder Instability Rotator Cuff Tear |
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Painful Shoulder Syndrome
Symptoms |
sharp painful twinges in lateral brachial region with ABD/overhead movement
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Painful Shoulder Syndrome
Etiology |
gradual onset, usually overuse in younger population or degenerative changes and poor blood supply in older
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Painful Shoulder Syndrome
Signs |
MSTT-strong & painful with/ABD & ER
Palp Tend-pain over tendon Palp Cond-warmth and swelling MLT-gives tissue reactivity, defer if too painful |
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Painful Shoulder Syndrome
Common Problems |
kyphosis and fwd head posture
decreased thoracic ROM Rotator Cuff overuse/fatigue neuropathic muscle weakness hypomobile posterior GHJ Capsule |
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Painful Shoulder Syndrome
Functional Limitations |
sleep disturbance
pain with overhead activity difficulty lifting poor endurance with activity involving shoulder grooming/dressing difficulty |
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Painful Shoulder Syndrome
Acute Non-Operative Management |
sling for rest/decreased blood vessel compression assisting bloodflow
control swelling and pain PROM or AAROM and muscle setting to maintain soft tissue integrity as tolerated codman's maintain use of associated areas gd I oscillations for pain pt education |
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Painful Shoulder Syndrome
Subacute Non-Operative Management |
TFM
improve postural awareness codman's AAROM to AROM painfree gd II oscillations inferiorly agonist contract or gentle passive stretching to muscles crossing GHJ begin gentle RC strengthening (MRE) |
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Painful Shoulder Syndrome
Settled Non-Operative Management |
further develop posture with therex
gd III & IV oscillations if hypomobility present passive stretch or active inhibition begin isotonic strengthening below 90 deg. as ROM increases and pain decreases implement functional exercise to aid return to activity |
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3 Components to Joint Stability
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active restraints-muscle
passive restraints-ligaments neuromuscular control-coordination |
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GHJ Instability/Laxity
Signs |
Posture - fwd shoulders
AROM - decreased all directions AccPROM - increased in at least one direction, may be uni- or bilateral laxity MLT - tight pec minor with fwd shldr |
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GHJ Instability/Laxity
Management |
pt education
posture, pec minor stretch dynamic stabilization of scapula and rotator cuff to improve active restraints and coordination avoid positions of apprehension/pain until dynamic stabilization improves |
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Shoulder Dislocations
Etiology |
trauma: Ant DL-fall on ABD/ER arm or directly on shldr;
Post DL-FOOSH atraumatic:previous dislocation may predispose as would excessive instability bilaterally |
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Shoulder Dislocations
Common Problems |
pain, muscle guarding, inflammation
possible RC tear asymmetric hypo/hypermobility (posterior hypo w/ ant dislocation) |
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Shoulder Dislocations
Functional Limitations |
sleep disturbance with sleeping on involved side
possible recurrence Ant DL-inability to participate in sport activities, especially overhead intensive Post DL-restricted sport activities with follow through motion (golf, throwing) also pushing activities |
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GHJ Instability/Laxity
Acute Non-Operative Management |
Immobilization/protection
protected PROM exercise as per MD muscle setting gd I & II oscillations for pain (K&C p. 352) |
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GHJ Instability/Laxity
Subacute Non-Operative Management |
continue protection, wean from sling
increase mobility of TIGHT structures only multiangle isometrics in pain free ROM CKC PWB stabilization exercises progress to dynamic resistance with limited ER |
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GHJ Instability/Laxity
Settled Non-Operative Management |
develop strength and coordination of scapular stabilizers and shoulder muscles
increase endurance implement eccentric training apply functional motion patterns to therex program |
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Thoracic Outlet Syndrome
Functional Etiology |
subclavian a&v/brachial plexus compression as result of ant. scalene adaptive shortening or elevation/hypomobile 1st rib
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Thoracic Outlet Syndrome
Congenital Etiology |
broad insertion of ant. scalene
fibrous slip from ant to mid scalene bony abnormality of 1st rib cervical rib or c7 fibrous band |
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Thoracic Outlet Syndrome
Symptoms |
deep ache
Raynaud's Pallor, cold intermittent edema cyanosis dorsal scapular pain parasthesias into hand |
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Thoracic Outlet Syndrome
Signs |
fwd head & round shldrs
raynaud's upper respiratory breathing raised 1st rib upper tspine hypomobility tight/hypertrophied pec minor |
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TOS
Functional Limitations |
sleep disturbance
inability to perform prolonged overhead reaching inability to carry briefcase, purse, or other weighted objects on involved side problems doing desk work, cradling phone may have difficulty driving |
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TOS
Management |
postural education
manipulate hypomobilities diaphragmatic breathing stretch tight anterior muscles HEP for stretching and self-mobilization |
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Reflex Sympathetic Dystrophy
"AKA" |
shoulder hand syndrome
sudek's atrophy complex regional pain syndrome |
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RSD
Etiology |
unknown
usually develops in association with trauma, MI, CVA |
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RSD
Common Impairments |
disproportionate pain in s/e/w/h
developing limit of motion edema vasomotor instability trophic changes to skin |
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RSD
Management |
best intervention is prevention/early recognition as it is a progressive disorder
pt education relieve pain control edema pain free ROM desensitization |
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Double Crush Injury
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symptoms of one nerve injury exacerbated by entrapment at another site on same nerve
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1st Degree Nerve Injury
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nerve compression without axon disruption
may go undetected vibration/proprioception lost 1st may have motor loss may be caused by ischemia |
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2nd Degree Nerve Injury
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axon damage, endoneural tube intact
sensory, motor, autonomic loss traction or ischemic injury mechanism |
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3rd Degree Nerve Injury
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axon and endoneural tube damage
poor prognosis for full sensory/motor return scar tissue may impede regeneration |
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4th Degree Nerve Injury
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perineurium damage, endoneurium intact
neuroma usually develops |
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5th Degree Nerve Injury
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nerve severed completely
poor prognosis |
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Long Thoracic Nerve Injury
C5-C6 |
scapular winging
20-30 deg. limitation w/elevation decreased AROM 2* scap winging may cause impingement SA 0/5 Flex 4/5 in available ROM entrapment may occur w/ OH mvmt and fascial restriction b/n 1st & 2nd rib |
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Long Thoracic Nerve Injury C5-C6
Management |
maintain ROM, espec OH
strengthen scapular muscles and agonists stretch antagonists maintain RC strength |
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Suprascapular Nerve C5-C6
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pain at post/lat shldr
atrophy of supra/infraspinatus sensory/proprioceptive loss to post GHJ often nerve traction injury or result of excessive scapular movement |
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Suprascapular Nerve C5-C6
Management |
avoid scap protraction
correct posture maintain ROM stretch IRs strengthen ERs |
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Axillary Nerve C567
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associated w/ ant. shldr dislocation
sensory change to lat. shldr deltoid atrophy weak ABD and ER |
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Axillary Nerve C567
Management |
Maintain ROM
strengthen deltoid and teres minor |
