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Musculoskeletal 1 > Shoulder hypo mobility > Flashcards

Shoulder hypo mobility Flashcards

1
Q

What is the abnormal capsular end feel and capsular pattern of a hypo mobile shoulder

A
  • Abnormal capsular end feels: abnormal - sit without creep, leather like
  • Capsular pattern: GH limitation of ER>ABD>IR
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2
Q

Joint assessments of a hypo mobile shoulder

A

Quality, quantity
Joint play, accessory/component motions – limited

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3
Q

Shoulder hypomobility presents as?

A
  1. Joint restriction:
    - Capsular ligamentous tightness
    - AROM = PROM
    - Pain at the end ranges
  2. Muscle tightness
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4
Q

What are the typical causes of hypomobility

A
  • post trauma/injury or surgery
  • protection, immobilization, habitual poor posture
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5
Q

Post trauma/injury or post surgery - tissue repair phase 2:

A
  • : proliferation: peaks 3 weeks tapers 3-6 weeks
  • Controlled mobility: tissue healing, protocol may restrict range
  • Want controlled mobility here while the tissue is being laid down to make it more extensible and align the fibers
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6
Q

Post trauma/injury or post surgery - tissue repair phase 3

A
  • maturation:
  • Window of 14 weeks best influence on scar tissue mobility
  • Progressive - prevent non-yielding scar tissue
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7
Q

Protection, immobilization, habitual poor posture

A
  • Adaptive shortening
  • Hypomobile: involved joint or adjacent joint
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8
Q

Cause of adhesive capsulitis/frozen shoulder

A
  • Cause: idiopathic/insidious onset
  • Generally occurs post injury or post surgery due to immobilization/protection
  • Post surgery - shoulder, cardiac, abdominal
  • Inflammatory process
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9
Q

Incidence of adhesive capsulitis

A
  • Older population: age 40-60
  • Females more likely to get it than males
  • Greater risk patients: diabetes, thyroid disease
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10
Q

Classification types of adhesive capsulitis

A
  • primary
  • secondary
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11
Q

Primary adhesive capsulitis

A
  • idiopathic
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12
Q

secondary adhesive capsulitis

A
  • systemic
  • extrinsic
  • intrinsic
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13
Q

Secondary adhesive capsulitis: systemic

A
  • diabetes
  • thyroid disease
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14
Q

extrinsic secondary adhesive capsulitis

A
  • Humerus shaft fracture
  • CVA
  • Cardiac surgery
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15
Q

Intrinsic secondary adhesive capsulitis casues

A
  • rotator cuff or long head of biceps tendonitis or tear
  • shoulder surgery
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16
Q

Pathogenesis/clinical manifestations of adhesive capsulitis

A
  • Contracture of capsule and ligaments
  • Inflammatory synovitis → capsule fibrosis
  • Capsule fibrosis notes upon arthroscopy (there are certain areas where these are generally located) -Coracohumeral ligament, Capsular ligament, Axillary pouch
  • Shoulder contracture
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17
Q

Limited motion for adhesive capsulitis

A
  • Capsular pattern for shoulder = ER limited > abduction limited > IR
  • Diminished joint play and accessory motions
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18
Q

What are the stages of adhesive capsulitis

A
  • freezing
  • frozen
  • thawing
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19
Q

Freezing stage of adhesive capsulitis - time frame
- signs and symptoms

A
  • 2.5-9 months
  • Inflammatory synovitis
  • Pain at rest
  • ROM progressively decreasing
  • Empty end feel → wont let you move it they are in too much pain
  • High irritability classification
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20
Q

Frozen phase of adhesive capsultits
- time Frame
- signs and symptoms

A
  • 4-12 months:
  • Fibrosis adhesions in joint capsule (capsular fibrosis)
  • Decreased ROM capsule pattern (ER>ABD>IR)
  • Pain at end ranges
  • See RC, deltoid atrophy due to decrease use
  • No inflammation
  • Moderate irritability classification
21
Q

Thawing phase of adhesive capsulitis

A
  • 2-24 months
  • No inflammatory synovitis
  • ROM improving: no/minimal pain except at end ranges
  • Returning to function
  • Low irritability classification
22
Q

What is the irritability classifications (adhesive capsulitis

A
  • high irritability
  • moderate irritability
  • low irritability
23
Q

High irritability classification

A
  • Pain: 7 or higher + night and resting pain
  • Disability score: high DASH
  • End range pain: prior to reaching end range
  • AROM < PROM secondary to pain (they do not want to initiate pain)
24
Q

Moderate irritability classification

A
  • Pain: 4-6 + intermittent night and rest pain
  • Diability score: moderate DASH score
  • Pain at end range ROM
  • AROM ~ PROM
25
Q

Low irritability classification

A
  • Pain 3 or less + no night or resting pain
  • Disability score: low DASH
  • Minimal pain with end ROM or over pressure
  • AROM = PROM
26
Q

GH joint play

A
  • GH lateral distraction that can turn into treatment
  • Looks at extensibility of capsule
27
Q

Arthrokinematics glides

A
  • can also turn into treatment - mobs
28
Q

Inferior glide is needed for what movements

A
  • elevation, abduction, posterior elevation, flexion
29
Q

Anterior glide is needed for what movements

A
  • ER, H abd, extension
30
Q

Posterior glide needed for what motions

A
  • IR, flexion, Hadduction
31
Q

SC joint in
- vertical plane
- transverse place

A
  • Vertical plan: convex on concave
  • Transverse plan: concave on convex
32
Q

Joint play assessment of SC joint

A
  • Elevation: inferior glide of clavicular head
  • Retraction: posterior glide of clavicular head
  • Protraction: anterior glide of clavicular head
  • Closed pack: full abduction with full ER
33
Q

SC joint injury

A
  • Rare usually fracture clavicle
  • Exam: ROM, joint play, strength, palation
34
Q

medical Intervention for SC joint injury

A
  • Partial tearing: rest, immobilization for healing, f/b ROM, exercise
  • Complete tearing: instability
  • Surgery, prevent clavicle posterior migration
35
Q

AC joint:
supporting ligaments

A
  • acromioclavicular ligament
  • Coracoclavicular ligament (conoid/trapezoid)
36
Q

Joint play of AC joint

A
  • Assess and can turn into treatment
  • 2 glides of clavicle on acromion (follow joint plane)
  • posterior/superior glide
  • anterior /inferior glide
37
Q

Separated shoulder

What is it and how is it classifyed?

A
  • Step off deformity
  • Grade 1: acromioclavicular ligament sprain (stretched)
  • Grade 2: acromioclavicular ligament torn but coracoclavicular ligament sprained
  • Grade 3: acromioclavicular ligament torn and coracoclavicular ligament torn
38
Q

AC joint injury presentation

A
  • Protect arm held IR and adducted
  • AC, SC shrug shoulders, protract, retract pain
  • ACJ ROM = painful arc 140 and above
  • Increase AC joint play
  • Palpation AC joint - pain, crepitus, swelling
  • Decrease strength of shoulder - muscle inhibition
39
Q

Special test for AC joint injury

A
  • +step off deformity
    +cross over test
    + AC shear test
40
Q

Fractured clavicle

A
  • Can cause brachial plexus injury or injury to subclavian artery and or vein
  • Immobilize to heal, surgery not common
  • Malalignment can compress brachial plexus
  • Can get swelling down into the UE → move wrist, forearm and shoulder to decrease some swelling and decrease ROM losses
41
Q

Examination of shoulder complex for a clavicle fracture

A
  • As healing allows
  • Assess ROM and mobility of AC, SC, GH joint
  • Assess strength of shoulder complex
  • Note an possible brachial plexus Signs and symptoms
42
Q

Clavicle fracture once healed interventions

A
  • Shoulder complex mobility
  • ROM - PROM → AAROM → AROM
  • AC, SC, GH joint mobs as needed
43
Q

What to restore for a clavicle fracture

A
  • Strength of shoulder complex
  • Submax, multiangle isometrics → AROM, Isotonic
44
Q

Treatment for high irritability classification for shoulder hypomobility
- modalities
- activity modification
- ROM
- Manual tech
- strength
- function
- other

A
  • Modalities: yes
  • Activity modification: yes (don’t want to create pain)
  • ROM, stretch: 5 seconds, pain free, PROM/AAROM
  • Manual tech: low grade (1 or 2)
  • Strength: not many
  • Function: min - low function
  • Other: steroid injection 4-6 weeks relief
45
Q

what is open pack position for the shoulder

A
  • 55 abduction
  • 35 ER
46
Q

treatment for Moderate Irritability classification
- Modalities:
- Activity modification:
- ROM, stretch:
- Manual tech:
- Strength:
- Function
- Other:

A
  • Modalities: yes
  • Activity modification: yes
  • ROM, stretch: 15 seconds PROM, AAROM, AROM
  • Manual tech: Low to high grades
  • Strength: not many
  • Function: basic with pain at end ranges
  • Other: n/a
47
Q

treatment for Low irritability classification
modalities:
Activity modification
ROM
Manual tech
Strength
Function
Other

A
  • Modalities: n/a
  • Activity modification: n/a
  • ROM, stretch: end ranges over pressure, TERT
  • Manual tech: high grade
  • Strength: increase resistance
  • Function: high
  • Other: n/a
48
Q

General treatment outline for hypo mobile shoulder

A
  • Warm up: modalities, easy ROM
  • Mobilizations: joint distraction, arthrokinematic glides
  • Stretching TERT
  • PROM, AAROM, AROM
  • Strength progression in available range, Isometric submax, multi-angle, AAROM, AROM, isotonic
  • HEP
49
Q
A

Musculoskeletal 1 (42 decks)

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