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Exam 2 Flashcards

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1
Q

How do you figure out if pelvis is aligned?

A

Look at ASIS, PSIS, and ischial tuberosities (just under each landmark)

See if all landmarks are level

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2
Q

What is muscle energy?

A

Contraction followed by relaxation in order to move bone

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3
Q

What are the ligaments of the SI joint?

A 
Anterior sacroiliac
Interosseus sacroiliac
Posterior sacroiliac
Sacrotuberous
Sacrospinous
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4
Q

Which ligament is usually the culprit of the SI joint?

A

The sacrotuberous

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5
Q

What causes Si joint dysfunction?

A

Malalignment or abnormal movement of joint

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6
Q

What is the main function of the SI joint?

A

Built for stability over mobility

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7
Q

What is treatment for SI dysfunction?

A

Soft tissue
Alignment
Core and hip stabilization
Stretching

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8
Q

What are good exercises for hip and glute stabilization for SI dysfunction?

A

Planks, hip drops, lower level lumbar

Look for tightness, asymmetry and perform shotgun technique

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9
Q

What is pain origin testing?

A

Cluster of tests

Thigh thrust, distraction, sacral thrust, and compress = 2+

Distraction, compression, thigh thrust, FABER, and Gaenslen’s = 3+

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10
Q

What are the special tests for the lumbar spine?

A

Straight leg test - Well leg test

Cross leg test

Slump sit test

Centralization

Prone instability test

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11
Q

What is a good HEP for pt with LBP?

A

Active rest - IE. walking

Do not want to sit around

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12
Q

What are the nonosseous structures of the spine?

A

Intervertebral discs

Surrounding ligaments

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13
Q

What is the direction of facets in the lumbar spine?

A

Vertical

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14
Q

What motion do lumbar facets allow?

A

Flex/ext

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15
Q

What is the direction of facets in the thoracic spine?

A

Frontal plane

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16
Q

What motion do thoracic facets allow?

A

Lateral bend

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17
Q

What is the direction of facets in the cervical spine?

A

Transverse plane

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18
Q

What motion do cerv facets allow?

A

Rotation

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19
Q

What is the role of zygapophyseal joints?

A

Guide ROM of spine

Lumbar spine = flex/ext

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20
Q

How many intervertebral discs are between vertebral bodies?

A

23

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21
Q

What is the annulus of the vertebral disc?

A

Outer wall

Composed of 12-18 consecutive rings

Contains the nucleus pulposus

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22
Q

What composes the nucleus pulposus?

A

Mucopolysaccharide gel that transmits force, equalize stress, and promote movement

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23
Q

Do intervertebral discs have vascularity and nerves?

A

Largely avascular and aneural

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24
Q

Where does the minimal vascular supply of the intervertebral disc come from?

A

Diffusion from vertebral bodies above and below the disc

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25
Can a disc heal if it is injured?
Limited capacity to heal and repair
26
Which portion of the disc is more vascular and have more nerves?
Outer portion
27
What are the 3 classifications of the McKenzie method?
Posture Syndrome Dysfunction syndrome Derangement
28
What is Posture Syndrome?
Mechanical deformation of soft tissue intermittent in nature appears when soft tissues are placed under prolonged stress Slouch overcorrected procedure
29
What is dysfunction syndrome?
Pain caused by mechanical loading of structurally impaired soft tissue Tx to elongate adaptively shortened tissue Take extend periods of time to allow full elongation
30
What is derangement?
Aimed at disc tissue Mechanics obstruction to movement within the joint
31
What is the purpose of the McKenzie method?
Good for centralization Find direction of preference and do exercises in that direction Many reps
32
What motion do you perform if there is an anterior herniation?
Extension exercise
33
What motion do you perform if there is a posterior herniation?
Flexion exercise
34
What motion causes the most pressure on the lumbar spine?
Bending forward
35
What is radiculopathy?
Tingling Peripheralization of pain Numbness, burning Indirection of loss of function
36
What is the true direction sign of radiculopathy?
Muscle weakness, sensation, and loss of reflex
37
What is the cause of muscle strain?
Sudden, violent contraction, rapid stretching, combined lumbar ext and rot, eccentric loading, and repetitive overuse resulting in microscopic damage
38
What is the treatment for a muscle strain?
``` LB strengthening Restore flexibility Enhance cardioresp fitness Restore function Protect affected area ```
39
How should core stabilization progress?
``` Start hooklying - drawing in Add limb loading Seated Quadruped Half kneel Plank Standing ```
40
What is transitional pain?
Those who struggle to transfer/get out bed, etc
41
What are the spinal ligaments?
Anterior longitudinal ligament Posterior longitudinal ligament Ligamentum flavum Interspinous ligament Supraspinous ligament
42
What is the function of the ALL?
Anterior SC to posterior body
43
What is the function of the PLL?
Back of central cord
44
What is the function of the LF?
Connecting lamina
45
What is the function of the ISL?
Between spine of each vertebrae
46
What is the cause of lumbar radiculopathy?
Mechanical compression or inflammation of nerve root
47
What are the symptoms of the lumbar radiculopathy?
``` Pain Numbness Tingling Weakness Burning Paresthesias Change in reflexes Strength loss Sensory loss ```
48
What is another term for lumbar radiculopathies?
Sciatica or pinched nerve
49
Is lumbar radiculopathy unilateral or bilateral?
Unilateral
50
What are the tests for lumbar radiculopathies?
SLR/Crossed SLR WELLS test
51
What are treatment options for lumbar radiculopathies?
``` Centralization Clinical prediction rule Traction Wait and see Steroid pack Surgery (laminectomy) ```
52
What is the clinical prediction rule?
Radicular pain less than two weeks and is still above the knee PT manipulates = high success rate
53
What is lumbar protrusion?
Annulus protrudes outwards
54
What is lumbar extruded?
Nucleus extends all the way through the annulus, but confined and maintained within PLL
55
What is lumbar sequesterated?
Nucleus moves through annulus and PLL Might need surgery Severe pain
56
What are the types of disc protrusion?
Type I: peripheral annular bulge Type II: localized annular bulge
57
What are the types of disc herniation?
Type I: prolapsed intervertebral disc Type II: extruded disc Type III: sequestrated disc
58
What is spondylolysis?
Bony defect in pars interarticularis of the posterior spine - IE. stress fracture
59
What is spondylolisthesis?
Anterior slippage of superior vertebra over the inferior
60
What is pars interarticularis?
Scotty dog fracture - side of lumbar spine
61
What are the classifications of lumbar slippage?
Type I: congenital or dysplastic Type II: isthmic spondylolisthesis Type III: degenerative spondylolisthesis Type IV: traumatic spondylolisthesis Type V: pathologic spondylolistesis
62
What types of people get spondylolisthesis?
V-ball players Gymnasts Football players
63
Where is pain generally found with spondylolisthesis?
Belt line
64
What type of motions increase pain in those with spondylolisthesis?
Extension
65
What are the grades of spondylolisthesis?
Grade I: 0-25% Grade II: 25-50% Grade III: 50-75% Grade IV: 75-100%
66
How is grade I spondylolisthesis treated?
Analgesics, muscle relaxants, NSAIDs, modalities to alleviate acute pain Avoid extension and strengthen core, avoid vertical loading, work on controlled lumbar extension with deep abdominal stabilizers
67
Is surgery required for spondylolisthesis patients?
Rarely More for high-grade slippage
68
What do you expect in post op PT for spondylolisthesis?
Immobilization Pt can amb as tolerated Perform ROM and strengthening exercise of UE and LE
69
What is lumbar spondylosis?
Lumbar OA
70
What are the interventions of lumbar spondylosis?
``` Traction Functional WB activities Stretching Strengthening Breathing Educate on posture ```
71
What are the symptoms of spinal stenosis?
Radicular ache in thigh and less frequently calf Paresthesis of LE Disturbances in motor function
72
What are the spinal stenosis tests?
Ext of the lumbar spine compresses and increases symptoms More forward flexed gait Leg pain while walking Treadmill test
73
What is the treadmill test?
Walking on an inclined t-mill and see if symptoms increase
74
What are important positions for spinal stenosis?
More flexion and activity Work on gait/posture/positions
75
What is the role of PTA in spinal stenosis?
Posture, body mechanics, lifting techniques Address sitting and sleeping changes General conditioning Manual intervention followed by a specific exercise and walking programs
76
What is a teardrop lumbar fracture?
Little fractures or bone chips
77
What is important to remember with lumbar compression fractures?
Get out of flexed position Teach them to lean forward with a long spine and hip hinge WB to stimulate bone growth Balance
78
What are symptoms of vertebral compression fractures?
Acute local pain with essentially no signs
79
What are treatments for vertebral compression fractures?
Relief of pain Activity modification Analgesics, NSAIDs, heat, ice, massage E-stim
80
What are more invasive treatments to vertebral compression fractures?
Epidural steroid injection to relieve pain and inflammation Surgery in presence of disc herniation
81
What is the protocol post-op spine surgery?
For the first 3 days limit sitting for no more than 1 hr at a time and maintain proper position with no flexion Caution forward bend and rotation Encourage proper posture Strengthening begins when initial wound healing is complete and pain is decreased ROM exercise when tolerated Gentle active ext exercise and pelvic tilts
82
What is the goal of rehab after spinal surgery?
Increase motion, control pain, improve endurance, and sufficient strength before beginning general conditioning 3-5 weeks post-op - restore lumbar motion, normalize UE and LE strength, improve aerobic fitness, and decrease pain and swelling
83
What are the 3 categories of rehab classification of spinal surgery?
Symptoms modulation approach (early) Movement control approach (pain comes and goes - not quite chronic - movement patterns) Functional optimization approach
84
What are the 5 L's of lifting
``` Legs Lever Load Lordosis Lung ``` Look - 6th
85
What is the Back School Model?
Designed to provide an understanding of anatomy, causes of LBP, lifting mechanics, posture, self-care for LBP, exercise, nutrition, ergonomics, and stress reduction for high-risk patients Involves 1-2 hr weekly classes for 4-6 weeks
86
What is an FCE?
Screening tool to acquire data related to pre-employment risk assessment and management of back injuries
87
What kind of injuries occur to the thoracic muscles?
Direct contact or indirect overstretching/contraction of muscles
88
What population does thoracic muscle injury typically occur?
Younger, active patients Heal well because of increased blood flow
89
How do you manage thoracic spine muscle injuries?
Control pain and swelling Once pain is controlled, pt should participate in ROM and strengthening
90
What are the muscles of the thoracic region?
``` Intercostals Diaphragm Lats Erector spinae Paraspinals Rhomboids Middle and lower trap Serratus ant/post ```
91
What is upper crossed syndrome related to?
Stretch weakness Post mm are stretched Strengthen these muscles to bring up posture
92
What muscles are part of the anterior thoracic?
Pecs Rectus abdominis Scalenes
93
What exercises strengthen the posterior thoracic?
Important to turn off UT - rows and scap depression Press ups Press up with push up Rows - lats
94
What is kyphosis?
Increase thoracic posterior convexity
95
What causes kyphosis?
Congenital Neuromuscular Poor posture Osteoporosis
96
What is the main symptom someone has with kyphosis?
Pain due to extra stress on PLL Continuous eccentric contraction Lots of trigger points
97
What are tx options for kypohsis?
Depends on degree of curvature Supportive bracing (minimize compression) PTA - pt education, postural awareness, and apply exercise and stretch If it gets really bad there are surgical interventions (replace discs, add rods, etc)
98
What PT is involved for someone with kyphosis?
Strengthen scap retractors, rhomboids, middle trap, and erector spinae Stretch anterior shoulder mm
99
What should be avoided with someone who has osteoporosis and kyphosis?
Repetitive flexion
100
What is involved in back breathing for kyphosis?
Childs pose or squat holding on to something and breath
101
What should be avoided in someone with a rigid thoracic spine?
Do not start large movements because you could increase soreness Start small and progress
102
How is scoliosis named?
Named for the side of curvature
103
What is the cause of scoliosis?
Often idiopathic
104
What are some sx/sx of scoliosis?
Pain Trouble breathing Can cause stenosis
105
What is structural scoliosis?
Irreversible
106
What is nonstructural scoliosis?
Can be reversed Rib hump - rotate thoracic spine. If it goes away it is considered nonstructural
107
What interventions are included in non-op scoliosis
Strengthen and stretch to improve motion, increase mm length, and reduce pain Bracing can also be done
108
What is 1 dimensional scoliosis treatment?
Strengthen convex Stretch concave Add breathing
109
How can you tell if someone has scoliosis?
Supine observation Lumbar flexion to see if there is rib hump Pure observation Scoliometer
110
What degree is seen on a positive scoliometer test?
5-10 degree curve
111
How do you use a scoliometer?
Have pt bend forward like diving into pool. Scoliometer should be at a right angle and go down thoracic and/or lumbar spine.. It sits just at the top of the skin
112
What are the muscles of inspirataion?
Primary - diaphragm and intercostals Accessory - scalenes, SCM, levator costarum, and serratus
113
What are the muscles of expiration?
Primary - relaxation of inspiratory mm (passive) Accessory - QL, intercostals, obliques, rectus abdominis
114
How does the diaphragm move in inspiration and expiration?
``` Inhale = move down Exhale = move up ```
115
How to assess bucket handle breathing?
Place hands on ribs Should see inspiration and expiration be even Look in both supine and sitting
116
What is the process of diaphragmatic breathing?
One hand on chest and the other on belly Should only see hand on belly move up and down Hand on chest should not move
117
What is the process of pursed lip breathing?
"In with the roses, blowing out candles" Big inhale Slowly exhale through pursed lips
118
T/F men are affected more by neck pain than women?
False
119
What are cues to cervical spine posture?
Start at thoracic - lift ribs off your stomach or lift your chest up Tell pt to balance head over shoulders
120
What is the cause of neck pain?
Not identifiable for a lot of pt
121
What are common ways someone may sprain or strain their cerv mm?
Young athletes MVA Whiplash injuries
122
What is whiplash?
Reflexive mechanism to protect the carotid arteries Mm spindles and GTO respond to speed and force
123
What is the goal for whiplash treatment?
Reduce pain early on - typically use modalities, relaxation techniques, breathing, etc. DO NOT use traction Find a pain free postural position
124
What are some signs in pt with whiplash?
Unable to lift head off table in supine
125
What is cerv radiculopathy?
Mechanical compression or inflammation of nerve root causing neurologic symptoms in UE
126
What are some common causes of cerv radiculopathy?
Spondylosis Bone fragments Stenosis
127
What are the treatment goals for cerv radiculopathy?
Get out of compressive positioning
128
What is cerv spondylosis?
Chronic degenerative disc disease
129
What population experiences cerv spondylosis the most?
Women more than men between 40-50 y/o
130
What are causative factors of cerv spondylosis?
Repetitive microtrauma Sustained impact loading
131
What are tx options for cerv spondylosis?
PT intervention Surgery - anterior discectomy and fusion or posterior foraminotomy or multilevel laminectomy
132
What is cerv facet syndrome?
Degenerative changes to cerv facets and surrounding soft tissue
133
What are symptoms of cerv facet syndrome?
Post neck stiffness Pain in cerv ext/rot Cervicogenic HA Possible pain referral into shoulder and scap
134
What are PT interventions for cerv facet syndrome?
ROM Strengthening General conditioning
135
What is another name for thoracic inlet syndrome?
Thoracic outlet syndrome
136
What is the cause of thoracic inlet syndrome?
Probably neurovascular - proximal compression of subclavian Aa/Vn and brachial plexus Could be compressed by clavicle, first rib, or short/hypertrophied ant scalene
137
What are symptoms of thoracic inlet syndrome?
Radicular signs (because of compressed brachial plexus) - pain, numbness, tingling, weakness, skin and temp change
138
What are tx options for someone with thoracic inlet syndrome?
Postural adjustments Movement/thoracic mobility STM Jt mobs UE Nn flossing Stretching Strengthening Ergonomics
139
What are special tests of thoracic spine?
Adson's test Costoclavicular maneuver Roos test
140
How is tx classified for cerv spine?
Subgroups - Mobility - Centralization - Exercise and conditioning - Pain control - HA
141
What are the special tests for the cerv spine?
Spurlings compression Cerv compression Cerv distraction Upper limb tension test Shoulder ABD test Neck flexor Mm endurance
142
What is the function of the RTC?
Pull humerus back into glenoid fossa
143
Which RTC is most commonly torn?
Supraspinatus
144
What are the mm of the shoulder?
``` Rhomboids major and minor Lats Biceps Teres major and minor Pec major and minor Serratus ant and post Levator scap Deltoids x 3 Traps x 3 Subclavicular Supraspinatus Infraspinatus Subscapularis Coracobrachialis ```
145
What mm are involved in scap stabilization?
Middle and lower traps Serratus Rhomboids
146
What are the passive scap stabilizers?
GH ligaments | Labrum
147
What are the 3 main components of the shoulder?
Osteology Arthrology Passive stabilizers
148
Does the sternoclavicular jt move?
YES
149
What is scapular rhythm?
After first 30-degrees of shoulder flexion, there is 2 degrees of humeral motion for every 1 degree of scapular motion
150
What is a subacromial RTC impingement?
Tendons of RTC are compressed under the coracoacromial arch due to mechanical wear, stress, and friction
151
What might be the cause of a subacromial RTC impingement?
Hooked acromion High riding humerus Degeneration Mechanical wear, stress, and friction
152
What is a primary shoulder impingement?
Mechanical depression | Involves acromion and coracoid process
153
What is a secondary shoulder impingement?
GH instability - reduces space and mm imbalance
154
What is an age-related degenerative impingement?
Bony osteophyte - anatomic crowding
155
What nerve innervates the supraspinatus?
Suprascapular nerve (C5-6)
156
What is the action of the supraspinatus?
ABD and stabilization
157
What is stage I of a RTC impingement?
Younger pt Edema/hemorrhage - reversible lesion Conservative PT less than 90-degrees
158
What is stage II of a RTC impingement?
Fibrosis and tendinitis stage (25-40 y/o) Irreversible Daily pain and difficulty sleeping
159
What do you work on in stage I RTC impingement?
Scap stabilizers and scapulohumeral rhythm
160
What is stage III of RTC impingement?
Affect pt over 40 y/o Tendon degeneration, RTC tears, and RTC ruptures
161
What do you see in stage III RTC impingement?
Significant mm weakness and atrophy (above scap spine and top of clavicular area)
162
What is the tx for primary and secondary RTC impingements?
Scap stabilization exercise Modification of activities Local and systemic methods to control pain and swelling Corticosteroid injections Ice, US, ionto, phonophoresis Stretching and strengthening exercise
163
What is considered a modifying activity for someone with primary or secondary RTC impingment?
Limit OH activities (80-90 degrees) Limit long lever of OH activities
164
Why should someone limit corticosteroid injections?
Cause degeneration No more than 3x/year
165
Where is a corticosteroid injected?
Subacromial space and into tendon
166
What type of stretches are done for someone with a primary or secondary RTC impingement?
Posterior capsule stretch Pec stretch below 90
167
What type of strengthening exercises are done for someone with a primary or secondary RTC injection?
Scap stabilization first Then RTC Then primary movers
168
What are clinical tests for RTC impingements?
Neer painful arc test Hawkins-Kennedy test Yergeson's test
169
What is the Neer painful arc test?
Pain when shoulder goes into elevation with IR
170
What is Hawkin's-Kennedy test?
Elevate shoulder to 90-degrees in scap plane with IR and over pressure
171
How do you fully palpate the greater tubercle?
Fully ADD, IR, and ext
172
What is part of phase I (prefunctional) of non-op tx of impingement and symptomatic RTC tears?
Relief of symptoms Protective positions Stretches and pain free motion Posterior capsule Scap stabilization, CKC
173
What is part of phase II (return to function) of non-op tx of impingement and symptomatic RTC tears?
Comprehensive GH and scapulothoracic strengthening OKC
174
What is part of phase III (return to activity) of non-op tx of impingement and symptomatic RTC tears?
More dynamic I, Y, and T's - prone Rowing Scaption Push up with scap retraction
175
What are examples of exercises to do in phase I (prefunctional)?
4-way isometrics Pendulum Ice S/L scap clock AAROM Pec stretch below 90-degrees
176
What are examples of exercises to do in phase II (return to function)?
Short arc, eccentrics Shelf reach 90/below in flex/scap Prone rows Rolling ball on wall at or below 90-degrees (add rhythmic stabilization) Body blade S/L ER to midrange (put towel roll underneath)
177
What are examples of exercises to do in phase III (return to activity)?
Upright row Pushup with retraction Wall slides with no pain in flex/scap Lat pulldown 3-way shoulder motion Wall swim Rebounder Bosu rhythmic stabilization - walk over D1/D2 flex/ext
178
What is the middle trap special test?
Prone, ABD to 90, and ER
179
What is the low trap special test?
120-degrees ABD
180
How to avoid painful area of the arc of motion?
ABD Walk to scap and flex Go back to ABD to get to full range
181
What is biceps tendinitis?
When RTC is injured and the long-head of the biceps has to work harder
182
What are the common symptoms of shoulder impingement?
Worse with OH activities Have to modify ADLs to at or below 90-degrees
183
What are the surgical managements for shoulder impingements and RTC tears?
Subacromial decompression (SAD) Acromioplasty - DCE (distal clavicular excision) Open arthrotomy or arthroscopic procedure
184
What is considered a small RTC tear?
Less than 1 cm
185
What is considered a medium RTC tear?
Less than 2-3 cm
186
What is considered a large RTC tear?
Greater than 4-5 cm
187
What type of surgery is done with a small tear?
Decompression
188
What type of shoulder injury do you not do a lot of contraction exercise and why?
Musculotendinous injuries Need to scar over
189
What are the phases of post-op rehab?
Phase I: 3-4 weeks Phase II: 5-12 weeks Phase III: > 12 weeks
190
What is a GH jt instability and dislocation injury?
Indirect trauma with arm ABD, elevated, and IR Anterior most common
191
What is a Bankart lesion?
Avulsion of capsule and glenoid labrum off the anterior rim of glenoid resulting in anterior dislocation
192
What is a Hill-Sachs lesion?
Compression or impaction fracture of posterolateral aspect of humeral head resulting from anterior instability
193
What is the articular capsule of the shoulder?
Encloses jt cavity from margin of glenoid cavity to neck of humerus
194
What ligament has the strongest reinforcement of the shoulder capsule?
Anterior coracohumeral ligament
195
How many ligaments strengthen the front of the capsule?
3
196
What are the muscular tendons that help stabilize the capsule?
Long head of biceps RTC mm
197
What are the GH ligaments?
Superior, middle, inferior, and coracohumeral
198
What is part of the non-op management for shoulder instability and dislocation?
Protection period = 4-6 weeks Immobilization may be needed for healing Manage pain and swelling Prefunctional phase: PROM, AAROM elevation AVOID ABD and ER (return to function_ Can do isometrics in neutral because there is no tendon interruption Be careful not to stretch or tear other tissue CKC
199
What is the process of recovery of someone with shoulder dislocation and instability?
Full function is not always possible Sometimes even minor stress can cause dislocation after an acute traumatic dislocation
200
What are the surgical treatments for dislocations and shoulder instability?
Open or arthroscopic techniques Anterior capsulolabral reconstruction procuedure SLAP
201
What interventions are used in those who have surgery for dislocations and shoulder instability?
Prefunctional phase is required Slow and protected ER up until 12 weeks post-op Meds for pain and swelling Ice 20 min, 3-5 x/day Pt can perform finger, hand, wrist, and elbow ROM Progressive motion and strengthening (~6-8 weeks post-op) Return to function phase
202
What is adhesive capsulitis?
Decreased ROM, pain, inflammation, fibrotic synovial adhesions, and reduction of jt cavity
203
What population is more likely to get adhesive capsulitis?
Women more than men between 40-60 y/o
204
What are the causes of adhesive capsulitis?
Primary - idiopathic | Secondary - post trauma/immobilization
205
What is the best outcome for adhesive capsulitis?
Caught early and get corticosteroid injections
206
What are the sx/sx of adhesive capsulitis?
Early stage - pain at rest and during activity As it progresses pain gradually subsides and spontaneously disappears Severely restricted ROM and loss of function
207
What is treatment for acute phase of adhesive capsulitis?
Treat pain and inflammation
208
What are other tx options for adhesive capsulitis?
Ice, heat, US, phonophresis, and infrared Pain free motion and relaxation of mm guarding Exercise with wand and pulleys for controlled pain-free ROM PT may ask for specific jt mobs to reduce pain
209
What is the goal of treatment for late stage adhesive capsulitis?
Complete restoration of GH jt mobility
210
What are AC sprains and dislocations?
Usually result from direct force on acromion or FOOSH
211
How are AC sprains and dislocations graded?
Degree of injury to specific ligamentous structures
212
What is a first-degree AC sprain?
Grade I: AC jt sprain Minimal loss of function
213
What is second-degree AC sprain?
Grade II: Moderate pain Some dysfunction
214
What is a third-degree AC sprain?
Grade III Ligament injury May need surgical intervention (open surgical repair, closed reduction, immobilization, and progressive rehab) Initial PT is to reduce pain and swelling. Educate for compliance of immobilizer
215
When does prefunction phase for AC sprain occur?
4-6 weeks
216
When does return to function occur with AC sprain?
Follows pt level of motion and strength
217
What causes a scapular fracture?
Direct, severe trauma
218
What part of scapula is most commonly fractured?
Body
219
What is the tx for scapular fractures?
Conservative if associated injuries have not occurred Ice and immobilization for 2-3 weeks Can be as painful as pelvic fractures Don't start AROM and strengthening until there is evidence of healing
220
What causes a clavicular fracture?
Direct or indirect trauma
221
Who is most likely to obtain a clavicular fracture?
Men under 25 y/o
222
What is involved in tx for clavicular fracture?
Focus on reducing fracture fragments Maintain reduction Minimize immobilization of GH jt Figure 8 brace (~4-6 weeks)
223
What is a proximal humerus fracture?
Four-part classification - humeral head, lesser tuberosity, greater tuberosity, and humeral shaft
224
What is a nondisplaced humeral fracture?
Most common - one part fractures Affect arm is placed in immobilizer
225
What tx occurs if the humeral fracture is more complex?
ORIF with screws and plates Longer periods of immobilization
226
What are complications of humeral fractures?
Avascular necrosis
227
What is avascular necrosis?
Found in older population with advancing osteoporosis Four part humeral fracture
228
What is the role of the PTA in a humeral fracture?
Protected limited ROM early on Submax isometrics for scap stabilizers, RTC, and upper arm mm Provide continued protection to injured site
229
What is a TSA?
Proximal humerus may be replaced with prosthesis
230
What are indications for a TSA?
Severe four-part fractures Osteoporosis RA and advanced OA RTC repair plus shoulder arthroplasty guides dictates need for protective limited ROM and longer rehab program
231
What type of procedure may someone have with a total RCT rupture?
Reverse TSA
232
What is the special test for shoulder instability?
Apprehension test
233
What are the special tests for biceps tendon pathology?
Speed's test | Yergason's test
234
What are the special tests for RTC tear?
Drop Arm test | Supraspinatus test: empty can
235
What are the special tests for shoulder impingement?
Neer impingement test | Hawkin's-Kennedy impingement test
236
What is closed packed position for shoulder?
90-degrees ABD | Full ER
237
What is loose packed position for shoulder?
50-degrees ABD | 30ish-degrees Horiz ADD
238
What is the shoulder capsular pattern?
ER > ABD > IR

Ortho PTA (4 decks)

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