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DPT 730/1: MSK > E3- RTC tear-Labrum Tears > Flashcards

E3- RTC tear-Labrum Tears Flashcards

1
Q

what type of impingement is a RTC tear

A

secondary
you are tearing tissues causing instability within the jt

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2
Q

what can cause acute RTC tears

A

high UE velocity
heavy lifting
impact of FOOSH

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3
Q

how can a RTC tear be from degeneration

A

tendinosis tears from repetitive overhead activities

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4
Q

what structures are involved with RTC tear

A

supra/infraspinatus
labrum
biceps tendon

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5
Q

what is a SLAP tear

A

superior labral ant/post tear

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6
Q

how can a SLAP tear occur

A

gradual degeneration
excessive contraction of bicep tendon

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7
Q

what are the S&S with RTC tear

A

increased pain with overhead activities
painful arc around 90 deg ele

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8
Q

what can be found in a scan for RTC tear

A

RST- weak and painful (FLX, ABD, IR)
ST- possible +
Sp. Test- + for cuff and maybe labrum/bicep

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9
Q

how do we treat RTC tear

A

treat as worse case of hypermobility

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10
Q

what is the ultimate MET purpose for RTC tear

A

stabilization
tissue proliferation

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11
Q

what can be beneficial with degenerative tears of RTC

A

early ROM
accelerated recovery in most

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12
Q

what is the biggest predictor of a RTC tear going into surgery

A

pt negative perception

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13
Q

what are other factors taking into consideration for a pt to have RTC reconstruction sx

A

size of tear
retraction
fatty infiltration
age
pain

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14
Q

what is the corticosteriod injection with RTC tear

A

no evidence of effectiveness
does allow for window of opportunity to progress pt

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15
Q

what is an arthroscopic with arthroplasty

A

sewing back together and reattaching to the bone
full ROM under anesthesia

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16
Q

what are the outcomes of PT with degenerative tears

A

successful
especially for this with small, partial tears or unfit for sx

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17
Q

what are the outcomes of Sx with degenerative tears

A

good clinical outcome with pain, ROM, strength, quality of life, and sleep

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18
Q

what does radiology outcomes contradict Sx and PT outcomes for degenerative tears

A

structures doesn’t have to entirely change to have better function or symptoms

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19
Q

what are the outcomes of PT with acute small to medium tears

A

may help

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20
Q

what are the outcomes of Sx with acute small to medium tears

A

no difference from PT or slightly more beneficial
more critical for young people due to higher activity levels

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21
Q

what are the outcomes of PT with full thickness/multi-tendon tear

A

may help in low demand patients or unfit for sx
increase the likelihood of tear progression and other tissue damage

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22
Q

what are the outcomes of Sx with full thickness/multi-tendon tear

A

80% satisfaction

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23
Q

why would we do a RTSA

A

irreparable tears- tendon distance is too far apart due to shortening to pull back together

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24
Q

what are the benefits of RTSA

A

pain relief, function, and active elevation

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25
what is different anatomically about the the RTSA
biomechanics is now concave on convex convex portion is more lateral allowing for more leverage of deltoid of FLX/ABD
26
what is the rehab protocol of RTC tears
criteria + time based bracing - depends on m tens for pain management get moving supervised PT early isometric loading improved outcomes
27
what type of impingement is FSCS
primary limited motion
28
what are RF of FSCS
female hypothyroidism 40-65 yrs previous adhesive capsilitis diabetes family hx
29
what is the primary cause of FSCS
pathology- diabetes, hypothyroidism
30
what is the secondary cause of FSCS
concomitant injury and period of immobilization
31
what is the most often structural changes of FSCS
inflammation of GH capsule and lig reduced jt volume
32
what are symptoms a pt can present with for FSCS
gradual and progressive pain and loss of motion functional limitations
33
what is the capsular pattern of restriction for FSCS
greatest % of loss ROM ER>ABD>FLX>IR
34
what can be found in a scan for FSCS
CM- consistent block RST- possible weak and painful depending on stage ST- + distraction depends on stage AM- hypomobile Sp. test- + for impingement
35
describe stage 1 of FSCS
initial gradual onset, achy pain, sharp with use, night pain, unable to lie on side high irritablility AROM sig
36
describe stage 2 of FSCS
freezing constant pain at night high irritability mod-severe limitations, AROM
37
describe stage 3 of FSCS
frozen stiffness> Pain, intermittent pain mod irritability mod-sev limitations, pain at end range, AROM=PROM firm end feel
38
describe stage 4 of FSCS
thawing minimal to no pain low irritability gradually ROM improvement firm end feels
39
how do we dx FSCS and what is our best dx tool
by exclusion clinical presentation most common tool
40
what is our Rx for FSCS
POLICED Pt edu modalities JM STM MET
41
what do we need to educate the pt on with FSCS
the stages promote pain free activity matching stretching with symptoms
42
why do we need to match stretching/JM with symptoms for FSCS
can create more fibrotic tissue if we stretch or do JM too aggressivly
43
what grade of JM do we do for FSCS
grade 3-4
44
what is our primary focus of MET with FSCS
elasticity and mobility particularly with inhibited m
45
what is the benefit of oral steroids/corticosteriod injection for FSCS
gives window of opportunity for increase in PT
46
what is the evidence for manipulation with FSCS
questionable causes scarring of capsular lig which can lead to more inflammation or fibrotic tissue
47
what happens if FSCS is left untreated
may resolve after 12-42 months 50% with pain out to 4-7 yrs
48
how long does stage 1 of FSCS last
1-2 months roughly due to prolong inflammatory phase
49
how long does FSCS last
12-18 months is the course of pain and mobility deficits
50
what type of impingement is dislocation
secondary
51
what jt is most likely to dislocate
GH jt
52
what type of dislocation is most common at the GH jt
anterior inferior direction ER and ABD with FOOSH
53
what is a post dislocation of GH jt
less common 90 deg flexion with FOOSH
54
what structures are involved with dislocation of GH jt
labrum tendons capsule
55
What is a bankart lesion
anterior inferior labral tear
56
describe fibrocartilage
thick and concave outer portion is thick inner portion is thin deepens and widens jt surface
57
describe the outer portion of fibrocartilage
type 1 collagen resist tension for stability vascular and neural tissue
58
describe the inner portion of fibrocartilage
type 2 collagen resist compression for shock absorption hypo - vascular/neural/lymphatic
59
how can the fibrocartilage be damaged
tears possibly with RTC/dislocation gradual with repetitive stress including impingement
60
why is the outer portion of fibrocartilage hyperneural
proprioception ligament like annulus for stabilization
61
describe fibrocartilage healing
better at periphery due to vascularity tensile strength improves at 3-5 wks dense fibrous tissue fills in at 8-12 wks
62
what is the MET focus for fibrocartilage
tissue integrity/proliferation stabilization
63
what is hill-sachs lesion
compression fx of humeral head
64
what are symptoms of dislocation
trauma in characteristic position- FOOSH acute presentation
65
what can you find in your scan for dislocation
ROM- limited and painful most directions RST- weak and painful most direction ST- + depending on tissue
66
what is the Rx for dislocation
immobilization POLICED MET
67
what is the protocol for immobilization with dislocation
6 weeks improve RTC - contralateral use, ipsilateral squeezing
68
what can shorter periods of immobilization favor
muscle integrity proprioception peripheral and central neural activity dynamic stability
69
what is the primary MET focus for dislocation
stabilization tissue integrity and proliferation
70
for an anterior dislocation what MET can we start them out with to combat the acuity
isometrics and isotonics into opposite directions initially- ADD,EXT, IR - sensitize m spindle for proprioception for after acuity settles FLX,ABD,ER- contraindicated
71
describe the MD rx arthroscopic procedure for dislocation
3-6 months prognosis full ROM under anesthesia follow protocol
72
what is a coracoid transfer
reposition coracoid process and coracobrachialis and short head of bicep to GH neck
73
what is a capsular shift
most common overlap torn portions of capsular folds
74
who is most commonly susceptible to proximal humeral fx and how
elderly FOOSH surgical humeral neck
75
what complications could arise with proximal humeral fx
axillary artery damage- coldness/blanching, avascular necrosis, emergency adhesive capsulitis- prolong immobilization
76
how can a clavicular fx happen
compression mechanism thru long axis of clavicle weak spot at S curve
77
what complications arise from clavicular fx
large displacement may require sx
78
what are S&S of a fx
ROM- painful and limited most directions RST- painful and weak in most directions pain with compression, tuning fork, palpation
79
when can PT start with a fx
after clinical union after 4-8 wks- modeling phase
80
what population can proximal humeral apophysitis affect
male adolescents mostly overhead throwers
81
what is proximal humeral apophysitis
bone growth exceeding RTC lengthening increase tendon tension growth plate is weak spot most often just inflammation
82
what are complications of proximal humeral apophysitis
avulsion and or premature closure
83
what are symptoms of proximal humeral apophysitis
gradual onset of sh pain with overuse
84
what is in our scan for proximal humeral apophysitis
impingement RST- ER weakness, GIRD impingement TTP over antero and posterolateral aspect of proximal humerus (most common)
85
what is the Rx for proximal humeral apophysitis
pt edu POLICED Throwing mechanics
86
how do we edu the pt with proximal humeral apophysitis
soreness rule load management - pitch count, active rest , rest days movement cues
87
what is our MET for proximal humeral apophysitis
cuff but also trunk, scapular, and LE impairments RTP- throwing progression
88
is stretching indicated for GIRD with proximal humeral apophysitis
yes, but be careful due to vulnerable growth plate make sure stretching is stretching the muscle and not reproducing the same symptoms
89
what is the prognosis for proximal humeral apophysitis
most return to preinjury levels and as early as 2 months but could be as long as 8 months can be recurrent
90
what is the prognosis for an avulsion of proximal humeral apophysitis
4.5 months to competition
91
when does the proximal humeral growth plate close
16-20 years
92
scapular m lengthen: levator scapulae/rhomboids
depression and protraction vertical clavicle
93
scapular m lengthen: lat dorsi
elevation and protraction acromion ahead of ear lobe
94
scapular m lengthen: lower serratus
retraction and elevation acromion behind ear lobe
95
scapular m lengthen: pec minor
retraction and depression vertical clavicle
96
what is the postinf labrum test
jerk block scapula, 90 deg ABD/IR with compression moving into H ADD pain with or without clunk
97
what is ant labrum test
1. apprehension - supine, 90 deg ABD/ER and ant glide (pain or apprehension) 2. relocation- supine, 120 deg ABD with post glide (relief of pain and apprehension) speeds- resist shd flx from 0-60 deg with FA supination
98
describe SLAP: biceps load II
120 deg ABD/ER resist elbow FLX pain
99
describe SLAP: pain provocation
90 deg ABD/ER with elbow flx pro and sup the FA pain with pro>sup
100
describe SLAP: passive compression
ER then 30 deg ABD long axis compression and move shd into EXT stabilize scapula pain with or without click
101
describe SLAP: yergasons
90 deg elbow FLX with FA pro resist supination ant shd pain

DPT 730/1: MSK (11 decks)

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