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Patho II PT > Lecture 6 > Flashcards

Lecture 6 Flashcards

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1
Q

What are the 2 ligaments that make up the coracoclavicular ligament

A

Conoid ligament
Trapezoid ligament

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2
Q

What is a grade 1 “sprain” in assessment in AC joint separation

A

Sprain to AC ligament, coracoclavicular ligaments intact
Observation - no deformity
No instability occurs w/ AC joint stress testing

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3
Q

What is a grade 2 “subluxation” in assessment AC joint separation

A

AC ligament rupture, coracoclavicular ligaments intact

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4
Q

What is a grade 3 “dislocation” in assessment AC joint separation

A

AC and coracoclavicular ligaments ruptured

AC joint severely unstable w/ AC joint stress testing

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5
Q

What is are grades 4-6 in assessment AC joint separation

A

More severe displacement injuries

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6
Q

For clinical management, what are grades 1-2

A
  1. Sling/brace and physical therapy recommended
  2. Protect/optimize tissue healing and then transition to functional
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7
Q

For clinical management, what is a grade 3

A

Surgical management sometimes considered however outcomes not shown to be significant different vs non surgical management

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8
Q

For clinical management, what are grades 4-6

A

Usually require surgical management follow by PT

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9
Q

What is bicipital tendonitis

A

Inflammation of long head tendon beneath transverse humeral ligament

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10
Q

What is a proximal rupture in the biceps tendon

A

Long head tendon ruptures and long head forms a LUMP in the arm

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11
Q

What is a distal rupture in the biceps tendon

A

Rupture in the distal attachment of biceps brachii

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12
Q

What is the mechanism of injury for bicipital tendonitis

A

Non traumatic, gradual onset of pain
Resistive use of injury due to poor ergonomics

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13
Q

What are the mechanisms of injury for proximal biceps tendon rupture

A

Acute, traumatic onset

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14
Q

What are the mechanisms of injury for proximal biceps tendons rupture for younger adults

A

Tendon may fail due to hard FOOSH or very heavy loading forces on biceps (heavy lifting)

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15
Q

What are the mechanisms of injury for proximal biceps tendons rupture for middle age/older adults

A

Tendon weakens w/ age and may fail from less severe loading forces on bicep (moderate lifting may cause tendon to fail)

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16
Q

What is the difference between proximal vs distal rupture

A

Proximal rupture =biceps lumps closer to elbow
Distal rupture = biceps lumps closer to shoulder

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17
Q

How will a pt locate there bicipital tendonitis

A

Pt will locate pain by pointing directly on the bicipital groove

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18
Q

What is the palpation for bicipital tendonitis

A

Strongest exam findings

Palpatory pain over the bicipital groove

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19
Q

What is the strength for pt w/ bicipital tendonitis

A

Elbow flexion - weak and painful

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20
Q

What are the special tests for bicipital tendonitis

A

Speed tests
Yergason test

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21
Q

What is the Speed’s test

A

Flex to 90 degrees w/ arm ER and supinated

Examiner applies downward pressure

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22
Q

What is the yergason’s test

A

Humerus in neutral
Elbow flexed to 90
Forearm supinated

Pt externally rotates and supinates against manual resistance

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23
Q

What is a nonsurgical management for proximal biceps tenons rupture

A

Physical therapy

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24
Q

What are surgical managements for proximal biceps tenons rupture

A

Surgery is recommended for full strength recovery

PT recommended post surgery

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25
What are some surgical procedures for proximal biceps tendon rupture
1. Biceps tenotomy 2. Biceps tenodesis
26
What is biceps tenotomy
Cut tendon but do not attach it
27
What is biceps tenodesis
Cut tendon and reattach to humerus
28
(T/F) 95% of GH dislocations are posterior
FALSE They are anterior !!!!
29
What are the possible complications for anterior GH dislocation
Hills Sachs lesion Bankart lesion
30
What is Hill Sachs lesion
Humeral head gets “dented” as humeral head “pops out” of the glenoid fossa
31
What is Bankart lesion
Lower rim of labrum is torn as humeral head dislocates and “pops out of the glenoid fossa Axillary artery or brachial plexus damage
32
How would you immobilized anterior GH dislocation
Sling for up to 6 weeks to allow for adequate capsular/tissue healing
33
What is the primary goal of PT for anterior GH dislocation
Restore/optimize stability 1. Precautions w external rotation and ABD 2. Proximal stabilization of upper quadrant 3. Dynamic stabilization
34
What is subacromial impingement syndrome
ABD compresses the subacromial bursa and supraspinatus tendon which leads to inflammation and pain of those structures
35
What is are the biomechanics for external impingement
Abnormal Scapulothoracic kinematics and strength
36
What is congenital external impingement
Structure of acromion may cause compression of subacromial space
37
What is Bigliani classification of acromion shapes type 1
Type 1 - flat acromion
38
What is Bigliani classification of acromion shapes type 2
Type 2 - curved acromion
39
What is Bigliani classification of acromion shapes type 3
Type 3 - hooked acromion
40
What is internal impingement
Posterior/superior aspect of LABRUM IS IMPINGED by the greater tuberosity when arm ABD and externally rotated
41
What is the palpation for subacromial impingement syndrome
Tenderness on supraspinatus tendon in subacromial space
42
What is the ROM of subacromial impingement syndrome
Painful arc Pain during 70 degrees W and 120 degree of elevation
43
What are the special tests/clinical predication rules for SAIS
If 3 test are positive then VERY HIGH LIKELIHOOD that pt has SAIS 1. Hawkins Kennedy test 2. Painful arc test 3. Infraspinatus test
44
What is the Neer’s test
If the test is negative, High likelihood that the patient does not have SAIS
45
What is the surgical managements for subacromial impingement syndrome
Subacromial decompression/acromioplasty
46
What is subacromial decompression/acromioplasty
Arthroscopically remove the under surface of acromion to increase subacromial space
47
What are the collective action of RC muscles
RC muscles collectively acts as dynamic stabilizer that “pulls” the humeral head into the glenoid fossa during all movements
48
What’s the action of supraspinatus
ABD
49
What does external rotation in the RC muscles
Infraspinatus Teres minor
50
What does internal rotation in the RC muscles
Subscapularis
51
What is partial thickness tear in the rotator cuff
Section of torn tend tendon is still attached to the bone
52
What is a full thickness tear in the rotator cuff
The tear detaches all or part of tendon from bone which “exposes” the humeral head and creates a “hole” in the tendon
53
What muscle in the RC gets is MOST COMMONLY teared
Supraspinatus
54
What is the epidemiology for RC tears
80% treated non surgically 20% treated surgically
55
What are the risk factors for RC tears
Age Poor posture associated with RC pathologies Overhead activity
56
What is the clinical algorithm for surgery for RC tears
Pts with acute onset of pain from acute event/trauma and who have HEALTHY RC TENDONS/MUSCLES
57
What is the clinical algorithm for PT/non-surgery for RC tears
Pt with gradual onsets of pain without an acute event/trauma regardless IF THEY HAVE HEALTHY RC TENDONS/MUSCLES
58
(T/F) patients with acute or gradual onset RC tears whose tendons are unlikely to heal
True
59
Where is the pain in RC tear
Pain often radiates to lateral shoulder Sleep disruption Unable to lie down to sleep (Sleep in a chair)
60
What are the special tests for RC tears
Empty can test Drop arm test ER test ER lag sign (INFRASPINATUS SPRING BACK TEST) Hornblower’s sign IR lag (IR spring back or modified lift test) Belly press test Bear hug test
61
what is SLAP lesion
Superior labrum tear “SLAP- superior labrum anterior to posterior
62
What is the mechanism of injury for SLAP lesion
“Dead arm” syndrome in which they experience paralyzing pain when in max ABD/ER and can’t throw
63
What is type 1 of SLAP lesions
Fraying of superior labrum anterior
64
What is the biceps load II test
Supine with shoulder in 120 of elevation and full ER Elbow fixed to 90 Forearm supinated
65
What is the biceps loading test
Produce deep GH joint pain consistent with biceps long head attachment If ALL 3 ARE POSITIVE THEN 90% SPECIFITY
66
What are the special tests for the SLAP lesions
Congruency test Crank test, clunk test - PT manually circumducts the GH joint in different positions to produce “clunk, click and/or deep joint pain”
67
What is the anatomy of adhesive capsulitis
Thickened bands of GH joint capsule form the GH ligaments (superior, middle, inferior and posterior) and PROVIDE STABILITY to GH joint
68
With arm in ABD and ER the inferior GH ligament prevents …
Anterior dislocation
69
With arm in 30-45 degree ABD and ER, the middle GH ligament prevents …
Anterior dislocation
70
With arm in ADD and ER, the superior GH ligament prevents …
Inferior dislocation
71
With arm in flexion and IR, the posterior GH ligament prevents…
Posterior dislocation
72
What is adhesive capsulitis
GH joint capsule inflammation and gradually (hypertrophy) and becomes FIBROTIC which causes JOINT CONTRACTURE
73
What is stage 1: freezing for adhesive capsulitis
Gradual progression of pain and loss of ROM Last 3-9 months
74
What is stage 2: frozen in adhesive capsulitis
Pain reaches plateau and then may begin to decrease Last anywhere from 4-6 months
75
What is stage 3: thawing of adhesive capsulitis
Pain subsides and and ROM slowly returns slowly to NORMAL Takes 6 months to 2 years
76
What is the etiology of adhesive capsulitis
Idiopathic - not fully understood Immobilization - due to surgery, fracture, or injury
77
What is the ROM for adhesive capsulitis
Most severe restriction are ER, ABD and IR
78
What are ways PT can manage adhesive capsulitis
Reduce inflammation, alleviate pain and restore ROM Reduce freezing Stage Reduce frozen stage Reduce thawing stage
79
What can steroid injectections do for adhesive capsilitis
Cortisone reduces inflammation and may alleviate pain
80
What are the types of surgery for adhesive capsulitis
Manipulation under anesthesia Shoulder arthroscopy
81
What is manipulation under anesthesia
Releases the tightening and increases of ROM
82
What is shoulder arthroscopy
Small incisions in the thickened fibrotic portions of the joint capsule form

Patho II PT (7 decks)

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