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MSK > E3 - Shoulder Complex 3 -5 > Flashcards

E3 - Shoulder Complex 3 -5 Flashcards

1
Q

how do you treat tendinitis and tendinosis

A

pt education - load management
POLICED

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2
Q

how can NSAIDS affect healing of tendinitis and tendinosis

A

shout term pain relief if acute
delays healing if injury at insertion
poor response and no support in persistent presentation

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3
Q

why do NSAIDS not aid in healing during a persistent condition

A

tendon is structurally changing
the issue is not inflammation

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4
Q

how does bracing/taping/straps aid in treatment of tendinitis and tendinosis

A

decreases resistance arm
decreases stress on tendon

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5
Q

what is the soreness rule with ADLs and exercise

A

activities as long as the quality of movement is good and no symptoms during/after 24 hours

keep with the activity to give tendon load to maintain tendon response

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6
Q

what are the primary purposes of MET with tendinosis

A

tendon proliferation

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7
Q

what are the primary parameters of MET with tendinosis

A

implement after any acuity settles
heavy loads
slower eccentrics/3 sec muscle actions

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8
Q

what is the general rx of MET for tendinosis

A

2-3 sets of 10-15 reps to fatigue
2-3 exercises with involved tendon
8-12 weeks

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9
Q

what is the expected activity response of MET with tendinosis

A

mild-moderate increase in pain (5/10)

pain should ease to baseline levels before repeating exercises (24-48 hours)

my soreness rule

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10
Q

what are some complications that could delay healing in tendinosis

A

predisposition/prevalence of “failed healing response”
obesity
diabites
low grade inflammation

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11
Q

how does obesity affect tendinosis healing

A

excessive fat absorbes inflammaoryt cells away from tendon

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12
Q

how does diabetes affect tendinosis healing

A

excessive glucose impairs collagen production/remodeling

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13
Q

how does low grade inflammation affect healing with tendinosis

A

associated with systemic disease/poor diet

persistent inflammation limits proliferation/remodeling

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14
Q

what are MD rx’s for patients with tendinopathy

what is the rare intervention

A

cortisone injections for short-term benefits
glycerin trinitrate patches to increase circulation
surgical debridement

sclerosing injections - stiffens tendon for pain relief

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15
Q

t/f
MET is just/more beneficial than surgical debridement

A

true

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16
Q

what is surgical debridement and how is it intended to aid in tendon healing

A

surgeon scrapes tendon which increases blood flow leading to inflammatory response

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17
Q

how does scapular taping aid in impingement syndrome

A

improved short term pain

may provide an earlier “window” for MET and limit ADL provocation

no difference at 6 weeks

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18
Q

are modalities beneficial for patients with impingment syndrome

A

mostly not beneficial

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19
Q

are JM recommended for impingment syndrome

A

strong recommendation
GH joint
aids in regional interdependence

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20
Q

how does joint mobilities aid in the thoracic spine

A

accelerated recovery and reduced pain and disability immediately when compared to usual care

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21
Q

t/f
JMs added to exercise are more effective than exercise alone

A

true

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22
Q

is high-dose MET more beneficial than conventional low-dose exercise

what is low-dose exercise

A

yes

4-5 exercises for 3x10 reps

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23
Q

what time frame is MET beneficial for tendinosis

A

> 6 months of symptoms

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24
Q

what muscles in the shoulder are targeted with MET with tendinosis

A

cuff (SITS)
scapular exercises (MT/LT/Rhom/SA)

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25
Q

what is the PT rx regarding the HEP

A

HEP with supporting PT visits
not PT with supporting HEP

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26
Q

How many times per day should MET for tendinosis be performed

A

1-2x/day

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27
Q

what is the effect of MET after 3 months with tendinosis patients

A

70% improved pain/function

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28
Q

t/f
MET does not provide long-term benefits for impingement syndrome

A

fals

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29
Q

what are the results of subacromial decompression when compared to exercise alone

A

equally or no more effective and more expensive than exercise alone

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30
Q

what is the recommendation of subacromial decompression

A

should not be performed if atraumatic and present for more than 3 months (tendinosis)

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31
Q

what is regional interdependence

A

theory that impairment in one area of the body will contribute to an impairment in another

particularly persistent

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32
Q

what muscles act concentrically with overhead reaching

A

flexors
abductors
external rotators

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33
Q

what muscles act eccentrically with overhead reaching

A

extensors
adductors
internal rotators

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34
Q

what segment is most common cause of shoulder pain in regards to regional interdependence

A

C5-6

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35
Q

dysfunctional overhead reaching is due to what muscle group

A

excessively recruited internal rotators that share innervation from C6

inhibition and protective hypertonicity of external rotators

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36
Q

how does excessively recruited IRs by C5-6 affect GH movement

A

humeral head pulled anterior of coracoid process

creates excess tension and compression underneath LHB tendon that can lead to tendinopathy

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37
Q

how does inhibition and protective hypertonicity of external rotation affect GH motion

A

greater tubercle won’t efficiently move fully out from acromion

impingement of supraspinatus and LHB tendons that can lead to tendinopathy

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38
Q

how does C2-3 dysfunction affect overhead reaching

A

scapula elevated or elevation compensation

creates excess tension and compression on supraspinatus

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39
Q

what will occur if scapular depressors are inhibited

A

scapula won’t depress

impingement especially >150 degrees

supraspinatus and lHB tendons will impinge and can lead to tendinopathy

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40
Q

t/f
GH and AC joint will not compensate with hypermobility/instability to reach higher with overhead reaching

A

False
the GH and AC joints will compensate with hypermobility/instability with overhead reaching

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41
Q

in regard to the muscle, what can limit optimal motion

A

imbalances of position
muscle activity

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42
Q

can treating one area of the body (the spine) influence outcomes at another area that may seem unrelated

A

yes

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43
Q

what are the risk factors of rotator cuff tear

A

gradual/degernative (tendinosis)

repetitive overhead activities

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44
Q

what are the risk factors of acute rotator cuff tears

A

high UE velocity
heavy lifting
impact with fall on outstretched hand (FOOSH)

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45
Q

what structure is most commonly torn in rotator cuff tear

A

supraspinatus or infraspinatus

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46
Q

how are rotator cuff tears graded

A

size (S,M,L)
partial/full thickness tear

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47
Q

what is a SLAP tear

A

superior labral anterior/posterior tear

long head of biceps excessively contracts and tears labrum

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48
Q

what are common traumas that can cause rotator cuff tears

A

SLAP tear
compression onto labrum with FOOSH

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49
Q

what are the S&S of rotator cuff tears

A

worse impingement
increased pain with repetitive overhead activities
painful arc around 90 degrees elevation
resisted test - weak and painful
stress test - possibly positive
positive special test

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50
Q

what motions will most likely be weak and painful with rotator cuff

A

flexion
ABD/ER (supraspinatus)
IR (subscapularis)

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51
Q

if patient experiences pain with compression, what structures in the shoulder are most likely involved after a rotator cuff tear

A

labrum

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52
Q

What S&S indicate a rotator cuff tear

A

> 65 y.o.
weak ER
night pain

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53
Q

what S&S indicates a full-thickness tear

A

> /=60 y.o.
painful arc
drop arm
ER MMT

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54
Q

high/low specificity: drop arm

A

high specificity
indicates supraspinatus tear

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55
Q

what kind of tests are lift off, belly press, and bear hug

A

high specificity
tests subscapularis tears

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56
Q

what is the general PT Rx for rotator cuff tears

A

treat as worse case of hypermobility with tissue damage that has occurred

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57
Q

how does early ROM with degenerative tears affect RC recovery

A

accelerated recovery
limited tendon healing with large tears

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58
Q

what are the MET ultimate purposes for RC tear

A

stabilization
tissue proliferation of muscle, tendon, labrum

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59
Q

what is the biggest predictor of if a tear will go to surgery

A

patient’s negative perception

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60
Q

what is the prognosis of corticosteroid injections for RC tears

A

no evidence of effectiveness
only provides transient relief

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61
Q

what are primary arthroscopic procedures with arthroplasty

A

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

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62
Q

what is the prognosis of PT with degenerative tears

A

successful outcomes especially for those unfit for surgery or with small/partial tears

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63
Q

what is the prognosis of surgery for those with degenerative tears

A

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

64
Q

are radiological outcomes as good as clinical outcomes? why or why not?

A

no
clinical outcomes are better than imaging
structure does have to change to get better function
imaging can find things that have no symptoms

65
Q

what is the impact of PT for acute small-medium tears

A

possibly can help
if not progressing well, delays associated with poor surgical outcomes

66
Q

is surgery or PT more beneficial with small-medium tears?

A

surgery has no difference from PT
more critical in younger patients bc of high activity levels

67
Q

what patients with multi-tendon/massive full-thickness tears would benefit from PT

A

low demand patients or those unfit for surgery
increased likelihood of tear progresssion and arthropathy

68
Q

why is there an increased likelihood of tear progression and arthropathy with supra/infraspinatus tear

A

multitendon involvement
increased stress on surrounding tissues

69
Q

__% satisfaction rate is consistent with surgery for multi-tendon/massive full-thickness tears

A

80%

70
Q

joint replacement is mostly used for ____ tears

A

irreparable

71
Q

what would classify an irreparable tear

A

2 ends of the tendon with full thickness tear
has no blood supply = dries and pulls apart

72
Q

what is the new joint arthroplasty for a reverse total shoulder arthroplasty

A

concave on convex

73
Q

describe the results of a reverse total shoulder arthroplasty

A

90% able to participate in sports without significant restriction

good-excellent results

74
Q

what individuals have the best prognosis after surgery

A

younger male
high bone density
no diabetes/obesity
small/single tear

75
Q

what type of impingement is frozen shoulder contraction syndrome

A

primary (hypomobile)

76
Q

what are 3 examples of functional questionnaires for frozen shoulder contraction syndrome

A

DASH
ASES
SPADI

77
Q

what are 2 other names for frozen shoulder contraction syndrome

A

adhesive capsulitis
frozen shoulder

78
Q

t/f
frozen shoulder contraction syndrome is frequently misdiagnosed with any multi-directional limitation in ROM

A

true

79
Q

what are the risk factors for frozen shoulder contraction syndrome

A

female
hypothyroidism
40-65
previous adhesive capsulitis
diabetes
family history

80
Q

what are the primary causes of frozen shoulder contraction syndrome

A

pathology, autoimmune disease

81
Q

what are the secondary causes of frozen shoulder contraction syndrome

A

concomitant injury
period of immobilization

82
Q

what are the common structural changes of frozen shoulder contraction syndrome

A

inflammation of GH capsule and ligaments
reduced joint volume

83
Q

what causes reduced joint volume

A

fluid loss cause structures to bunch up and capsule shrinks around it

84
Q

what structures are involved with frozen shoulder contraction syndrome

A

GH capsule and ligaments
joint space

85
Q

what symptoms are to be expected with frozen shoulder contraction syndrome

A

gradual and progressive pain
loss of motion
functional limitations with reaching, sleeping, basic ADLs

86
Q

what is the capsular pattern of restriction with frozen shoulder contraction syndrome

A

ER > ABD > FLX > IR

87
Q

what are the signs of frozen shoulder contraction syndrome

A

CM - consistent block
RST/MMT - possibly weak or painful depending on stage
Stress test - dstx possibly + depending on stage
Accessory motion - hypomobil e
Special tests - + for impingement

88
Q

can you skip/avoid a stage with frozen shoulder contraction syndrome

A

no, each stage lasts an undetermined amount of time

89
Q

describe stage 1/inital of frozen shoulder contraction syndrome

A

gradual onset
achy/sharp with use
unable to lie on side
high irritability
PROM > AROM
empty/painful end feel

90
Q

describe stage 2/freezing frozen shoulder contraction syndrome

A

constant pain - worse at night
high irritability
moderate-severe limitations
PROM > AROM
empty and painful endfeel

91
Q

describe stage 3/frozen of frozen shoulder contraction syndrome

A

stiffness is worse than pain
intermittent pain
moderate irritability
moderate-severe limitations with pain at end rage
PROM = AROM
firm end feel

92
Q

describe stage 4/thawing of frozen shoulder contraction syndrome

A

minimal-no pain
low irritability
ROM gradually improves
firm end feel

93
Q

t/f
early dx of frozen shoulder contraction syndrome is very difficult due to irritability

A

true

94
Q

what are the PT rx for frozen shoulder contraction syndrome

A

POLICED
pt education of 4 courses
promote pain-free functional activity
match intensity of stretching/JM with S&S

95
Q

what modalities are beneficial for frozen shoulder contraction syndrome

A

cryotherapy - additional benefit to JM, improved pain, ROM, function

LASER

96
Q

what grade JM shows mixed benefits for pain/ROM in frozen shoulder contraction syndrome

A

grade 3-5

97
Q

what is the focus of MET for frozen shoulder contraction syndrome

A

elasticity and mobility increases
offset disuse of inhibited muscles

98
Q

____ approach is effective for most patients

A

multimodal

99
Q

t/f
cortisone injections show short term benefits when added to therex and JMs with FSCS

A

true

100
Q

t/f
capsular release is supported by RCTs

A

false
capsular release is not supported by RCTs

101
Q

how long does stage 1 of FSCS last

A

~1-2 months
course of pain and mobility deficits may last 12-18 months

102
Q

if left untreated, how long does FSCS take to resolve

A

12-42 months

103
Q

what joint is the most commonly dislocated joint

A

GH

104
Q

what direction is the GH joint most commonly dislocated

A

anterior

105
Q

what is the mechanism of anterior GH dislocation

A

ER (anterior glide), ABD (inferior glide) with FOOSH

106
Q

what type of shoulder impingement is dislocation considered

A

primary

107
Q

what is the mechanism of posterior GH dislocation

A

90 degree flexion with FOOSH

108
Q

why is shoulder dislocation recurrent

A

once tissue is stretched/torn it is most likely left laxed (mechanical instability)

typically younger people that use arm frequently

most likely results in surgery

109
Q

what structures are involved with dislocation

A

stretch/tear capsule/ligament
anterior labrum tear
SLAP

110
Q

describe fibrocartilage

A

thicker and concave than articular cartilage
outer portion is thick/inner portion is thin
widens and deepens joint surface

111
Q

where is fibrocartilage located

A

shoulder and hip labrum
SC/AC
tibiofemoral, ulnotriquetral, intervertebral, pubic symphysis

112
Q

describe the outer portion of collagen

A

primarily type 1 collagen
resists tension for stabilization
majority type in all fibrocartilage

113
Q

describe the inner portion of collagen

A

secondarily and less type 2, 3, and 4 collagen
resistes compression for shock absorption

114
Q

t/f
stabilized structures are highly neural

A

true
allows for proprioception/kinesthesia like ligament/annulus for stabilization

115
Q

describe the outer portion of fibrocartilage

A

vascular and neural tissue

116
Q

describe the inner portion of fibrocartilage

A

hypo or avascular
aneural
alymphatic

117
Q

describe fibrocartilage healing

A

better at periphery d/t greater vascularity

118
Q

when does tensile strength initially impove

A

3-5 weeks

greater strength when dense fibrous tissue fills in @ 8-12 weeks

119
Q

what are the MET focus for fibrocartilage

A

tissue integrity/proliferation with vascularity issues

stabilization

120
Q

what other structures could possibly be injured during GH dislocation

A

RC tear
neurovasular structures

121
Q

what symptoms are common with GH dislocation

A

trauma in characteristic position
acute presentation

122
Q

what signs are common with GH dislocation

A

ROM - limited/painful most directions
RST/MMT - weak/painful in most directions
ST - likely + depending on structures involved

123
Q

what is hill sachs lesion

A

compression fracture of humeral head

124
Q

what is the PT rx for immobilization after dislocation

A

up to 6 weeks
improve rotator cuff activation with contralateral UE use (uninjured side) and ipsilateral hand squeezing activities (injured side)

125
Q

immobilization for shorter periods after dislocation favors

A

muscle integrity
proprioception
peripheral and central neural activity
dynamic stability

126
Q

what are the MET focuses for dislocation

A

stabilization
tissue integrity and proliferation

127
Q

with anterior dislocation, what motions are initially contraindicated for MET

what motions are beneficial to exercise

A

ER, FLX, ABD ROM are initially contra-indicated

IR, EXT, ADD initially beneficial

128
Q

what MET exercises are initially beneficial with dislocation

A

isometrics and isotonics

129
Q

recurrent dislocations highly likely if < ___ years of age

A

30

130
Q

what is a coracoid transfer

A

reposition coracoid process and coracobrachialis and short biceps head to GH neck

131
Q

what is capsular shift/capsuloraphy

A

most common
overlap of torn portions of capsular folds

132
Q

what age group most commonly experience proximal humeral fractures

A

elderly

133
Q

what is the cause of most proximal humeral fractures

A

FOOSH

134
Q

what structures are involved with proximal humeral fractures

A

surgical humeral neck

135
Q

what are complications of proximal humeral fracture

A

axillary artery damage
adhesive capsulitis from prolonged immobilization

136
Q

what are the symptoms of axillary artery damage

A

coldness and blanching
emergency referral
possible avascular necrosis

137
Q

what is the cause of clavicular fracture

A

compression mechanism through long axis of clavicle

fall on lateral side of shoulder

138
Q

where is the clavicular fracture located

A

weak spot at S curve
most likely snaps in middle

139
Q

what complications can occur with clavicular fracture

A

large displacement may require surgery

epiphyseal plate injury - last bone to ossify @ 18-25 years

140
Q

what test can be used to determine if there is a fracture in the shoulder

A

olecranon-manubrium percussion test

141
Q

when does PT begin after a fracture

A

clinical union occurs between 4-8 weeks
pain is not typically from bone

142
Q

What is the focus of PT following a fracture

A

consequences of prolonged immobilization where every tissue is negatively influenced

143
Q

what is proximal humeral apophysitis

A

little league shoulder
most common in male adolescents
mostly overhead throwers/racquet sports

144
Q

what is the cause of proximal humeral apophysitis or little league shoulder

A

growth with high activity
high activity on changing structure (growth plate)

145
Q

what are the structural changes that are common with PHA

A

bone growth exceeds rotator cuff lengthening
increased tendon tension
growth plate is weak spot
most often inflammation

146
Q

what are complications associated with PHA

A

avulsion (pulling/tearing away)
premature closure - very rare

147
Q

what are the symptoms associated with proximal humeral apophysitis

A

gradual onset of shoulder pain with oversue
“pop” can indicate trauma/avulsion

148
Q

what signs indicate PHA

A

impingment like
asymmetry ER weakness compared to IR
special tests - + impingement test

149
Q

what is the most common sign of PHA

A

Palpation - TTP over antero-/posterolateral aspect of proximal humerus

150
Q

what is included with pt education with PHA

A

soreness rule
load management
movement cues

151
Q

what is the treatment of PHA

A

pt education
POLICED
throwing mechanics

152
Q

what should be avoided with treatment of PHA

A

prolonged stretching d/t vulnerability of growth plate

153
Q

what is the treatment of PHA

A

normalize motion
MET
return to play

154
Q

what is the focus of MET for PHA

A

cuff, trunk, LE impairments
caution with muscle/tendons attached to growth plate

155
Q

what is the prognosis of PHA

A

most return to preinjury levels at 2 months, possibly 2-8 months

~4-5 months to return to competition with an avulsion

can become recurrent/persistent problem

156
Q

at what age does the growth plate typically close

A

16-20 years

MSK (7 decks)

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