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54 Cards in this Set

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6 Entities that refer pain to the shoulder
heart
gallbladder
diaphragm
dermatomes (C4 trap; C5 deltoid & lateral arm)
trigger pts (supra/infraspinatus/trap)
C-spine
4 Common Impairments affecting the GH Joint
RA/OA
traumatic arthritis
post-immob arthritis
adhesive capsulitis
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
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
Adhesive Capsulitis
Functional Limitations
overhead reach
hand to mouth
grooming activities
bra clasping or tucking in shirt
poor endurance
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
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
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
AC/SC Joint Common Problems
overuse syndromes
sublux/dislocations
hypomobility
AC/SC Joint Impairment
Overuse Etiology
repeated overuse of arm at waist level, or repeated diagonal Ext, ADD, and IR.
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
AC/SC Joint Impairment
Hypomobility
usually results from faulty posture in depression/retraction
may contribute to TOS
AC/SC Joint Impairment
Signs and Symptoms
localized pain
painful arc w/ elevation
pain w/ horiz ADD/ABD
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
Painful Shoulder Syndrome
Impairment List
Supraspinatus Tendonitis
Infraspinatus Tendonitis
Bicipital Tendonitis
Postural Imbalance
Shoulder Instability
Rotator Cuff Tear
Painful Shoulder Syndrome
Symptoms
sharp painful twinges in lateral brachial region with ABD/overhead movement
Painful Shoulder Syndrome
Etiology
gradual onset, usually overuse in younger population or degenerative changes and poor blood supply in older
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
Painful Shoulder Syndrome
Common Problems
kyphosis and fwd head posture
decreased thoracic ROM
Rotator Cuff overuse/fatigue
neuropathic muscle weakness
hypomobile posterior GHJ Capsule
Painful Shoulder Syndrome
Functional Limitations
sleep disturbance
pain with overhead activity
difficulty lifting
poor endurance with activity involving shoulder
grooming/dressing difficulty
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
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)
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
3 Components to Joint Stability
active restraints-muscle
passive restraints-ligaments
neuromuscular control-coordination
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
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
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
Shoulder Dislocations
Common Problems
pain, muscle guarding, inflammation
possible RC tear
asymmetric hypo/hypermobility (posterior hypo w/ ant dislocation)
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
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)
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
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
Thoracic Outlet Syndrome
Functional Etiology
subclavian a&v/brachial plexus compression as result of ant. scalene adaptive shortening or elevation/hypomobile 1st rib
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
Thoracic Outlet Syndrome
Symptoms
deep ache
Raynaud's
Pallor, cold
intermittent edema
cyanosis
dorsal scapular pain
parasthesias into hand
Thoracic Outlet Syndrome
Signs
fwd head & round shldrs
raynaud's
upper respiratory breathing
raised 1st rib
upper tspine hypomobility
tight/hypertrophied pec minor
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
TOS
Management
postural education
manipulate hypomobilities
diaphragmatic breathing
stretch tight anterior muscles
HEP for stretching and self-mobilization
Reflex Sympathetic Dystrophy
"AKA"
shoulder hand syndrome
sudek's atrophy
complex regional pain syndrome
RSD
Etiology
unknown
usually develops in association with trauma, MI, CVA
RSD
Common Impairments
disproportionate pain in s/e/w/h
developing limit of motion
edema
vasomotor instability
trophic changes to skin
RSD
Management
best intervention is prevention/early recognition as it is a progressive disorder
pt education
relieve pain
control edema
pain free ROM
desensitization
Double Crush Injury
symptoms of one nerve injury exacerbated by entrapment at another site on same nerve
1st Degree Nerve Injury
nerve compression without axon disruption
may go undetected
vibration/proprioception lost 1st
may have motor loss
may be caused by ischemia
2nd Degree Nerve Injury
axon damage, endoneural tube intact
sensory, motor, autonomic loss
traction or ischemic injury mechanism
3rd Degree Nerve Injury
axon and endoneural tube damage
poor prognosis for full sensory/motor return
scar tissue may impede regeneration
4th Degree Nerve Injury
perineurium damage, endoneurium intact
neuroma usually develops
5th Degree Nerve Injury
nerve severed completely
poor prognosis
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
Long Thoracic Nerve Injury C5-C6
Management
maintain ROM, espec OH
strengthen scapular muscles and agonists
stretch antagonists
maintain RC strength
Suprascapular Nerve C5-C6
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
Suprascapular Nerve C5-C6
Management
avoid scap protraction
correct posture
maintain ROM
stretch IRs
strengthen ERs
Axillary Nerve C567
associated w/ ant. shldr dislocation
sensory change to lat. shldr
deltoid atrophy
weak ABD and ER
Axillary Nerve C567
Management
Maintain ROM
strengthen deltoid and teres minor