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MSK 2 > EXAM 3 - OA and clavicle > Flashcards

EXAM 3 - OA and clavicle Flashcards

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1
Q

what allows for stability in the GH joint

A

shape of the joint, the articular cartilage, the labrum, capsule and the intra-articular pressure

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2
Q

degenerative change sis seen in what percentage of adult over 65%

A

17% to 20%

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3
Q

what is the presentation of shoulder OA

A
  • 17% of patients with shoulder pain.9
  • Women
  • Previous history of shoulder injury
  • Overhead sports and occupational endeavors
  • ROM: External rotation appears to be significantly affected
  • Sleep issues
  • Night pain
  • Anxiety / Depression
  • Pain perception
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4
Q

is MRI helpful for the differential diagnosis for OA

A

yes

helpful to confirm the diagnosis and less helpful to rule out the diagnosis

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5
Q

what is indicated in post op management - total shoulder arthorscopy

A

sling and progressive exercise for ROM and strengthing

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6
Q

what position should the shoulder be when placed in a sling

A

neutral position

for those who have undergone a TSA

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7
Q

when should shoulder ROM exercises be implemented in therapy

A

delayed up to 4 weeks

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8
Q

what is the evidence behind pre-op PT before TSA

A

based on clinical expertise

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9
Q

what is the evidence for no surgery but PT

A

absence of evidence

clinical expertise say that PT may help pt who have not undergone TSA

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10
Q

fro conservative management is there any particular intervention that is recommend

A

no

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11
Q

evidence of post op PT outcomes and edema

A

absence of evidence

clinical expertise say that PT may help

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12
Q

what are examples of non-surgical repair of shoulder OA

A

PT

activity modification

Intra-articular Injections

meds

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13
Q

what are Lifestyle modifications for OA

A

ROM restriction – going to need to find different ways to perfrom ADLs

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14
Q

Physical Therapy intervention

A

Modalities
Joint Mobilization
Range of Motion
Strengthening

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15
Q

Intra-articular Injections typically are what

A

Corticosteroids

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16
Q

Medication used for shoulder OA

A

NSAIDS, aspirin, acetaminophen

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17
Q

3 types of shoulder replacement

A

hemi-arthroplasty
total arthroplasty
reverse arthroplasty

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18
Q

Indications for shoulder arthroscopy

A

Rotator cuff tear arthropathy
Degenerative Joint Disease
AVN failed pasts replacement

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19
Q

Degenerative Joint Disease

A

OA

RA

Post Traumatic RA

Proximal Humeral fractures

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20
Q

Rotator cuff tear arthropathy

A

There is RC issue because of the change in the osteokinematics

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21
Q

total shoulder arthroplasty provided better functional outcome than hemiarthroplasty for pt with OA

A

yes is a two year follow up

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22
Q

what happens if the center mech of the shoulder is distrupted

A

subacromial structures can be impinged

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23
Q

During upper extremity elevation, the rotator cuff is responsible for what

A

keeping the humeral head centered in the glenoid

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24
Q

In the presence of a rotator cuff failure what happens to the biomechnics of the shoulder and what does this cause

A

biomechanical alterations and abnormal motions predispose the joint to abnormal wear.

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25
where do we see abnormal wear in the shoulder with RC failure
superior portion of the glenoid and the underside of the acromion followed by degeneration of the articular cartilage in the area.
26
why have total shoulder replacments become the norm
the continued degeneration of the glenoid or humeral head.
27
when is the total shoudler artho indicated
degenerative conditions where the RC is still intact. Revision after hemiarthroplasty
28
goals of a Shoulder Arthroplasty
Restore Function, decrease pain, sleep
29
what is occuring when we do a Hemi Arthroplasty
Only half the articular surfaces are replaced
30
Rehabilitation for a hemi-arthroplasty may be slightly accelerated with what intervention
immediate motion allowed if the rotator cuff is still relatively intact and there was no need for repair
31
which surface is replaced in a Hemi Arthroplasty
glenoid or the humeral head
32
Phase I - goals
Reduce pain and inflammation and Reduce muscular inhibition
33
Phase II
Full PROM Increase AROM Do not overstress healing tissue Initiate dynamic shoulder stability Scapular rhythm Active elevation against gravity Normal swing in gait
34
Phase III
AROM/Strengthening phase
35
Phase IV
functional return
36
general rehab guidelines - sling day and night
day 1-2 weeks nigh 4-6 weeks
37
general rehab guidelines - gerneal ROM
for first 4 -6 weeks
38
general rehab guidelines - when do we add strength in
4 weeks isometrics
39
phase 1- what do we do
Increase PROM, initiate AAROM late in phase
40
pahse 2 - goals
Control pain and inflammation and continued healing of soft tissue
41
phase 2 sling
sling is gradually removed
42
Phase III - part2
Gradual restoration of shoulder strength, power, and endurance Optimize neuromuscular control Gradual return to functional activities with involved upper extremity
43
Phase IV - rom
Nonpainful AROM
44
phase 4 - goals
Functional use of upper extremity Maximize strength, and endurance Gradual return to more advanced functional activities
45
what are the indication for Reverse Total Shoulder Arthroplasty
GH Joint Arthritis Irreparable RC tear Complex fractures Failed TSA with the rotator cuff tendons deficient/absent
46
what is an arthropathy
a joint disease, of which arthritis is a type
47
what is a Cuff tear arthropathy
characterized by a severe humeral head collapse following massive tearing of the RC.
48
what are proposed about inactivity following a massive tear of the RC
results in instability of the humeral head and leakage of the GH joint synovial fluid.
49
what does the loss of synovial fluid do to art cart
predisposes the articular cartilage to degeneration due to poor nutritional status. articular cartilage is worn away and the surfaces are exposed, this lead to painful shoulder motion and learned non-use.
50
what does rTSA do to the biomechanics of the shoulder
Reversal of biomechanics Increased moment arm of the deltoid Increased overhead elevation Decreased pain
51
intervention for AC joint dysfunction
activity modification pain modulation restroation of function - ROM and strength return to sport or occupation
51
phase 1- what do we do
Increase PROM, initiate AAROM late in phase Full distal extremity (elbow, wrist, hand) AROM Independence with modified ADL’s
51
pahse 2 - goals
Control pain and inflammation and continued healing of soft tissue
52
Reverse Total Shoulder Arthroplasty indications
GH Joint Arthritis Irreparable RC tear Complex fractures Failed TSA with the rotator cuff tendons deficient/absent
53
what is a arthropathy
joint disease, of which arthritis is a type
54
Cuff tear arthropathy
characterized by a severe humeral head collapse following massive tearing of the RC.
55
it was proposed that inactivity following a massive tear of the RC results in what
instability of the humeral head and leakage of the GH joint synovial fluid.
56
what does leakage of the synovial fluid lead to
The loss of synovial fluid predisposes the articular cartilage to degeneration due to poor nutritional status. articular cartilage is worn away and the surfaces are exposed, this lead to painful shoulder motion and learned non-use.
57
outcome of Cuff tear arthropathy
destruction of the GH joint articular cartilage, osteoporosis, and ultimately collapse of the humeral head
58
loss of the RC lead to what change in biomechanics
the centering forces on the glenoid are lost, altering GH joint biomechanics. leading to superior migration of the humeral head,
59
what happens if we have superior migration of the humeral head
which, over time, erodes the coracoacromial ligament and the acromioclavicular joint and the glenohumeral joint
60
what happens to the shoulder biomechanics with rTSA
Reversal of biomechanics Increased moment arm of the deltoid - more relient on the deltoid Increased overhead elevation Decreased pain

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