Exam 4 Flashcards
(89 cards)
1
Q
Flexion - 180
anterior deltoid
pec major
coracobrachialis
biceps brachii
A
2
Q
extension- 50
posterior deltoid
latissimus dorsi
teres major
pec major
A
3
Q
abduction- 180
middle delt
supraspinatus
A
4
Q
Scaption- supraspinatus
plane of motion that scapula move in
not true abduction/ flexion
A
5
Q
Supraspinatus
first 30 is Abduction
first 60 is flexion then Mid and Ant deltoid takes over
A
6
Q
Adduction-0
latissimus dorsi
pec major
teres major
A
7
Q
Internal Rotation/ 70-80
subscapularis , teres major, pec major, anterior deltoid, latissimus dorsi
A
8
Q
External Rotation-90
infraspinatus
teres minor
posterior deltoid
A
9
Q
horizontal abduction
posterior deltoid
infraspinatus
teres minor
A
10
Q
horizontal abduction
posterior deltoid
infraspinatus
teres minor
A
11
Q
horizontal adduction
pec major
anterior deltoid
A
12
Q
Scapula stabilize as glenohumeral is moving = scapulohumeral rhythm
A
13
Q
Scapular protraction - helps to keep scrap down against rib cage if not then it will wing out
serratus anterior and pec minor
A
14
Q
scapular retraction
rhomboid and mid trap
A
15
Q
scapular upward rotation
upper trap
lower trap
serratus anterior
A
16
Q
scapular downward rotation
levator scapulae
rhomboids
pec minor
A
17
Q
scapular elevation
upper trap
levator scapulae
rhomboid
A
18
Q
scapular depression
lower trap
pec minor
A
19
Q
Scapular Dyskinesa
Scapular malpostion
Inferior medial border prominence leads to poor rhythm and movements
Coracoid pain and mal position
dysKinesea of scapular movement
A
20
Q
Scapular Dyskinesa
affects Trap Rhomboid Serratus
tight Pec major
affected shoulder is lower
medial scapular protrusion
asymmetrical ROM
scap and shld pain impinged
A
21
Q
Scapular winging- Serratus Anterior
work on depression of scapulae clock
Scapulae fractures from direct severe tramua fx , GH dislocation, pneumothorax, neuro vascular injuries
A
22
Q
SCAPULAR BODY FX
most common
immobilize for 2-3 was then begin ROM/ strength
need time for bone healing
A
23
Q
GLENOID NECK FX - second most common
immobilize for 6 wks
A
24
Q
GLENOID FOSSA FX ORIF - glenoid instability
need surgery
PROM 2-3 wks post op
active stretch and resistance delay 6/8 wks
A
25
adhesive capsulitis - frozen shld (females 40-65)
decrease ROM, pain , capsular inflammation fibroisis synovial adhesion, reduction of joint cavity
primary idiopathic - random
secondary - trauma in past / immobilize RA or OA
high risk is diabetes or thyroid disease
Joint move for inflammation in joint and close space
26
Stage 1 gradual onset loss of ER, less than 3 months
Stage 2-Freeze stage can’t move in any direction 3-9 months
Stage 3- Frozen stage, pain only with movermnt
weakness of delt, rotator cuff, biceps triceps
Stage 4- Thawing stage , no synovitis - slight pain 15-24 months
27
Capsular pattern lose
ER
Abd
IR
Flex
28
adhesive capsulitis
Stage I- II is max
Stage 3 is mod
Stage 4 is min
joint mobs 3/4 to breakup adhesion and capsular release : surgery to release adhesions
29
Total Shoulder Arthroplasty- OA, avn, fx proximal humerus RA- torn rotator cuff
immobilize 6-8 wks w abduction splint
(pushes head of humerus into glenoid)
TSR- metal ball w stem and plastic socket
Reverse TSR- metal ball and plastic socket
30
Day 1&2 AAROM: isometrics
no deltoid activation if cuff repaired
strengthen hand/ elbow/ wrist
Grade 1&2 JM
Week 1: codman, AAROM
Week 2: scapular motion/ stabilize
isometrics
Limit flexion to 120 and ER to 30 and no extension past neutral (because they dislocate in surgery)
31
MOD/ AROM LIGHT WEIGHT stretching
more sedentary / no motion is reverse shoulder
Cartilage becomes worn and bone spurs appear cause pain
they remove humeral head and clean it out of glenoid fossa then the stem is placed the prosthetic are put in
32
TSR limit flex 120
ER/ IR to 30
and no ext past neutral
don’t put your hand in your back pocket bc surgery they have to reattach subscapularis
precautions for max protect phase
- PROM of scapula/ shld, do Codman/ AAROM/ scap clocks/ isometrics in half flexion & abduction
33
Scapulohumeral Rhythm
GH
First 30 abduction - Supraspinatus
First 60 flexion - Anterior deltoid
34
SCAPULAR WINGING DO PROTRACTION
35
Subacromial Rotator Cuff impingement-
Primary: mechanical compression of rotator cuff tendon passing under coracromial ligament
Secondary: GH instability/ subluxation muscles contract to elevate humerus
36
Subacromial rotator cuff impingement
Painful arc is 60-120 flexion and 90 abduction and forced internal rotation
supraspinatus tendon gets impinged and caught underneath with over head activity
37
Tendonitis/ Buristis
Supraspinatus tendinitis- pain with overhead reach and painful arc
Infraspinatus Tendinitis- painful arc with cross body or reach forward, recoil back in throwing
Subdeltoid bursitis- painful arc
Bicipital Tendinitis- palpate bicipital groove
38
If Inflammation is gone and still affecting it is Buristis
39
Supraspinatus tendinitis can mimic subdeltoid buristis
Max- isometric PROM scap clock(work on bringing humerus down)
GH AAROM, rotator cuff strong enough to keep humeral head in place
STRETCH UPPER TRAP WITH TENDONITIS BURSITIS
40
Strengthen rotator - scaption not past 90, abduction not past 30 = supraspinatus
Strengthen ER - side lying first = infraspinatus , teres minor
Strengthen IR- subscapularis
stretch upper trap
MOD- GH strength and rotator cuff IYWT
min- look at deltoid strength endurance with perturbations
- ball on wall circle
41
Subacromial Decompression- SAD
smoothing out bone and bone spurs to clear space arthroscopic
goes in and cleans out acromion process
max- AAAROM codman isometric
early mobility / take off sling when no exercise
MOD/ AROM all direction, PRE not more than 5 lbs
42
Rotator cuff tear- can have labrum tear/ ambulation fx / sad
traditional open/ most invasive- deltoid detached
mini open- slight slit in deltoid to access rotator cuff (cut in deltoid)
arthroscopic small incision
43
Rotator cuff tear
Max- PROM AAROM of GH scap clock GH isometrics
need full pain free rom to progress
MOD- strengthen GH and scap
min/ stabilization w speed
Strengthen - serratus anterior middle and lower trap
Stretch- pec major minor lats levator scap and upper trap
Anterior lateral : taking tendon and tacking it down
44
Glenohumeral Instability/ dislocation
rotator cuff must pull rotator cuff in
most common- anterior instability
trauma with arm abducted/ extend/ ER
- falls and dislocates
with rotator cuff tears
posterior arm- abduct , flexed, IR
45
Bankart lesion- labrum tear (ant dislocation)
avulsion of capsule and glenoid labrum off of anterior rim of glenoid from anterior dislocation
go in and stitch labrum bc it was pulled away from anterior dislocation
can spilt / detach subscapularis to get lesion
- restrict IR ER
arthroscopic - subscapularis left alone
46
Hills Sach lesion( anterior dislocation)
compress or impact fx of Postejor Lateral of humeral head from Anterior instability
47
ANTERIOR AVOID ABD AND ER- max
max- aarom cod and pulley sub max iso
mod- resistance min- adls
don’t want to retear anything
limit ER bc stable to tighten capsule
tighten what’s loose and staple down capsules
can move subscapularis to greater tuberosty
bone block coracoid transfer - attach biceps and coracobrachialis to get neck
detach subscapularis no IR
48
Instabile- more lax and overhead activities not stable
• work on rotator cuff muscles
arthroscopic doesn’t disturb subscapularis
more dislocations occur
49
SLAP- sup euro labrum
anterior posterior lesion
Type I/ frayed intact glenoid
Type II/ detachment of labrum at biceps anchor - reattach labrum to biceps tendon
Type III/ similar to bucket handle meniscal tear and biceps anchor still attach
Type IV/ bucket handle tear. extends into biceps anchor
50
Type II & IV are biceps tendon anchor
usually traction or compress of superior joint surface
labrum either compress or pull away
Type I & III are debridement
Type II & IV are repair
51
Type I - go in and clean up fray
Type II/ reattach labrum to biceps tendon
Type III- take off torn part or stich back together
Type IV- resection biceps tendon torn, take out portion that is torn
50% will have tendonitis - cut off bad part
52
SLAP
ANTERIOR INSTABLITU- avoid ER horz abduction ext
POSTERIOR INSTABLITY- avoid flex add IR
53
Labrum-
Max- scap clocks stretch pec of shoulder forward, isometrics
Mod- increase ROM, TB weight strnegthing, alternating isometrics ;don’t let me move you
stretching do JM 3&4 w precaution
54
Clavicle fx- affect men under 25
direct / indirect trauma
treat/ reduce fx fragments
maintain reduction
minimize immobilization of GH
- figure 8 bandage and too far apart
ORIF w pin
- tell them don’t push off bed and chair to stand up
55
Proximal humerus fx- humeral head, greater tub, lesser tub, humeral shaft
ORIF or immobilize for bones to grow back together
AROM strengthen as bone heals
Risk- AVN of neck of humerus
osteoporosis- poor internal fixation
PROM above fx, abduction isometric , do scap clocks .
56
Acromioclavicular sprain/ dislocation
direct - force on acromion
indirect- outstretched arm
grades determine by space
grade 1- resume activity, control pain
grade 2- sling step off remains , AROM
grade 3- surgical
max- isometrics scap clocks AAROM codman
mod- IYTW rotator cuff strength reistance to flexion abduction extension
check to see if there’s pain
min- functional activities
wall push up
shoulder tap
Ball throw
57
Thoracic Outlet syndrome - injury bad posture clavicle fx
short scalenes
levator , subscapularis, pec minor
impingement in costoclavicular / axillary space
- weight lifters or poor posture
STRETCH SCALENE & stretch manual pec minor
58
150 elbow flexion
biceps - palm up
brachioradialis- thumb up - stabilizer
brachialis- palm down
Biceps brachii- shld flex elbow flex supination
at its strongest is 100 flex
active/ passive insuf
59
Truces brachii- shld ext, elbow ext
active / passive insuf
anconeus - elbow ext
forearm supination- 80
supinator
biceps brachii
forearm probation- 80
pronator teres and quadratus
60
musculocutaneous - biceps brachialis
radial- triceps, brachioradialis, anconeus, supinator
median- pronator teres, quadratus fx
ulnar- lies in trochlear groove (funny bone) injruy to hyperextension - fx
- will have postive Tinels (nerve entrapment)
61
Elbow flexion is Soft
Elbow extension is Hard
Forearm supination & pronation is Firm
open pack 70 flex 10 supination for elbow
open pack 70 flex 35 supination for forearm
62
Lateral Epicondylitis - tennis elbow
overuse tendinitis from excessive extension and radial devation
- wrist extensor training
- train wrist flex: radial devation
iso eccentric strength and stretch extensors
63
medial epicondylitis - golfers elbow
wrist tendons are pulling into the elbow from overuse
/ wrist flexion pain
- pronator pain
- stretch wrist flexors
iso and eccentric
64
median ulnar ligament sprain/ surgery
repetitive throwing - affects MCL ulnar
Max- biceps triceps pro sup iso ; ROM for shld wrist
Mod- strengthen stabilize biceps: triceps/ pronation/ supination
- rom ext and flex
- stretch biceps
surgery/ tommy john UCL tear
direct repair or use of palmaris longus
gets more flexion as you progress
avoid stress going to lateral side
NO ER
65
Fractures of distal (supracondylar fx)
transverse fx of distal humerus, children common
Type I - humerus displaced Posterior
most common/ extend outstretch arm
Type II/ humerus displaced Anterior
flexion injury due to direct trauma on posterior elbow
- mal union; non union, contracture
issue is Volkmans contracture from ischemia , it interrupts brachial artery/ cause contracture
- no passive stretch
Max- elbow iso, JM 1/2,
mod - elbow biceps triceps pro supination strength
JM 3/4
66
Intercondylar Y or T fx - no passive stretch
placed in sling poor bone healing
max- prom at wrist ; elbow stabilized
light isometrics
come to you in mid phase do ROM/ strengthen
67
Radial head fx- fall on outstretched arm
1/3 elbow fx
most common fx w elbow dislocation
carrying angle - males is 10
females is 13
no fracture- can have pushed radial head (anterior) can push radial head back in place
Pulled radial head/ pulled head (Posterior) won’t be able to supinate
can thrust back while supinating
68
Fx of radial head- increase carrying angle
= Gunstock Deformity
type I- immobilize
type II/ radial head excised / ORIF
type III radial head excised
max- ROM shld wrist iso
mod- ROM elbow ext, stretch biceps
69
Total elbow arthroplasty- RA/ OA non union distal humerus
replace to part of humerus and titanium stem that connects Ulna/ humerus can be cemented or uncemented
Max/ rom , iso
mod- strengthen elbow NO JM
multi angle iso,
No high intensity
70
Olecranon fx- avulsion/ oblique/ transverse
fx that pulls piece of bone away
communitied/ dislocation
fall out outstretch hand- elbow hyperextension
posterior dislocation- most common
it moves on non dominant arm
work on ext
JM to increase ext (brace down and pull forward on humerus)
71
Less grip strength in wrist flex
Dynamometer want wrist ext
fist grasp - thumb over finger
cylindrical- FDP/ thumb on flex, bottle
Spherical- FDS, thumb in opposition, hall
hook- no thumb , carry suitcase
Tip/ tip of thumb to tip finger
Palmar/ pad thumb to pad of finger
lateral/ Thumb and lateral side of finger
72
FOREARM
MEDIAN N- enter through pronator teres
deep injury to wrist/ can impinge
innervates - wrist thumb flexors except FCU, FDP
only covers digits 1-3
Injury/ will lose wrist thumb flexion and forearm pronation = Ape hand
73
FOREARM
ULNAR N- enters flexor carpi ulnaris
FCU to 4:5 digits
minimal wrist flexion / ulnar deviation (fingers curve and bent) = Claw hand
74
FOREARM
RADIAL N- enters through ext carpi/ radialis/ brevis/ supinator
wrist extensors
injury/ lose supination, wrist ext, thumb ext and abd
lose sensory to lateral forearm
= Drop wrist
75
FOREARM
MEDIAN N- through carpal tunnel
all flexor tendons
thenar 1/2 lumbricals
lose / thumb Abd and Opp
sensory/ palmar surface of thumb to 4th digit
76
HAND
Ulnar nerve- pisiform, hamate
Thumb add , instrinsic
injury- 4/5 digits
thumb add
finger abd / add
sensory - planar surface to 5th, middle of 4th
77
HAND
radial nerve- enter dorsal with superior radial nerve and no motor
sensory/ all dorsal of hand
78
Distal Radius & ulna fx - lose all forearm and wrist motions
ROM/ JM
colles fx- foosh -ext
smiths fx- reverse colles- fall on flex hand
Max- iso , rom
mod- flex ext rad ulnar strengthing
risk for AVN bc ischemia at wrist
- Chronic Regional Pain syndrome : pain inflammation swelling
79
Scaphoid fx- most common fx of hand
risk for AVN - work on Opposution
80
Boxers fx - metacarpal
do JM / rom
81
Carpal tunnel syndrome
entrapment of median nerve
Tensils test
arthritis preg repetitive use
overuse stretch injruy of median nerve
9 tendons run through carpal tunnel
multi angle iso, JM, strength / endurance ex
stretch open up space into wrist ext
stretch wrist flex.
82
DeQuervains Tenosynovitis/ inflammation of thumb ext / abd
Finkel sign- test tuck thumb in wrap around and pull down
multi angle iso
strengthen endurance
; finger graps / webs
83
Thumb MCP STRAIN- gamekeepers skiers thumb
- forceful abduction of thumb rupture of ulnar collateral ligament of thumb
rupture of radial deviation
max/ iso, rom
84
Swan neck deformity/ hyperextension of PIP/ flex DIP
stretch involved
strengthen antagonist
use webbing
85
Duputryens contracture - palmar fascia contracture
stretch flexors
strengthen extensors
86
Boutonnière Deformity- PIP flex DIP ext
isolate PIP ext
87
Mallet finger- rupture of ext hood at DIP joint
get back into ext
88
Trigger finger - thickening of flexor tendon sheath
tendon can catch gets stuck
tendon glide
stretch
work on IP ROM
flexor tendon injruy- must be repaired
work on tendon glide
89
Isometric fingers
- straight hand
- hook fist
- full fist
- table top
- straight fist
blocking to focus on particular joint
