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BCPR > Module 3: Lesson 2: Soft Tissue Injuries > Flashcards

Module 3: Lesson 2: Soft Tissue Injuries Flashcards

1
Q

Name the muscles of the rotator cuff

A
  1. Supraspinatus
  2. Infra spinatus
  3. Teres minor
  4. Subscapularis
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2
Q

What do the RTC muscles do?

A

Work together as a force couple to control the head of the humerus and the glenoid fossa during shoulder movements.

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3
Q

What are the RTC ty;es?

A
  1. Shoulder impingement syndrome
  2. Bursitis
  3. Tendonitis
  4. Rotator cuff tear
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4
Q

What type of RTC is described below:

Occurs at the subacromial space, below the acromion and the coracoacromial arch. Structures in that space (bursa, supraspinatus, joint capsule, and long head of the biceps) are vulnerable to impingement as result of repeated above shoulder level movements, sustained above shoulder level postures or a hooked acromion. Most commonly affected is the supraspinatus.

A

Shoulder impingement.

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5
Q

`What RTC condition is described below:

Pain with humeral movement > 90 degrees.

Causes: Overhead use, weakness of shoulder complex muscles or tightness of capsule

A

Tendonitis

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6
Q

What RTC Condition is described below:

Located in the subacromial space. Can be differentiated from tendonitis during palpation as pain continues even with the arm at rest. Pain noted during PROM.

A

Bursitis

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7
Q

Name the RTC tear described below:

Can be a partial or thickness one.

Small tears: 1 cm
Medium tears: 1-3 cm
Large tears: 3-5 cms
Massive tears: greater then 5 cm

A

RTC tear

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8
Q

What are the medical treatments for RTC conditions?

A
  • Rest
  • Non inflammatory medications
  • Cortisone injections
  • Surgery: Arthroscopic repair, mini open, open rotator cuff repair
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9
Q

What tests are used to assess for RTC conditions?

A
  • Hawkins Kennedy Test
  • Neer impingement sign
  • Jobe/empty can test
  • Biceps speed test
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10
Q

What test for RTC conditions is described below:

Bring shoulder to 90 degrees of forward flexion and elbow to 90 degrees, then force clients arm into IR.

Positive sign: pain, which indicates involvement of supraspinatus and or long head of bicep

A

Hawkins Kennedy Test

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11
Q

Describe the hawkins kennedy test

A

Flex shoulder and elbow to 90 degrees, then force clients arm into IR.

Positive sign: pain, which indicates involvement of supraspinatus and or long head of bicep

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12
Q

What RTC test is described below:

Stabilize over scapula and depress. Internally rotate that patients arm and bring into full shoulder flexion at end range.

Positive test: Pain

Indicating: involvement in supraspinatus or long head of bicep

A

Neer impingement sign

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13
Q

What is the neer impingiment sign test?

A

Stabilize over scapula and depress. Internally rotate that patients arm and bring into full shoulder flexion at end range.

Positive test: Pain

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14
Q

What RTC assessment is described below:

Elevate both shoulders in scaption to shoulder height. IR both arms and then attempt to move clients arms down.

Positive test: Pain or weakness

Indicates: Involvement/tear of supraspinatus

A

Jobe/empty can test

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15
Q

Describe the job/empty can test

A

Elevate both shoulders in scaption to shoulder height. IR both arms and then attempt to move clients arms down.

Positive test: Pain or weakness

Indicates: Involvement/tear of supraspinatus

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16
Q

What RTC condition test is described below:

Flex shoulder to 90 degrees with palm up, followed by resistance to flexion.

Positive: Pain and or weakness of long head of biceps

A

Biceps speed test

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17
Q

Describe the biceps speed test

A

Flex shoulder to 90 degrees with palm up, followed by resistance to flexion.

Positive: Pain and or weakness of long head of biceps

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18
Q

Describe conservative interventions for RTC conditions

A

Activity modification
- Avoid activities that cause pain
- Avoid repetitive or sustained above shoulder level activities

Educate in sleeping positions:
- Avoid sleeping with your arm positioned above shoulder level
- If sleeping on univolved side, support the involved side with pillow: hug the pillow

Decrease pain
- PAM

Restore pain free ROM:
- Begin with pain free PROM (pendulum, elevation, IR/ER) and as pain decreases progress to AROM
- Movements above shoulder level should be done in scapular plane

Strengthening (below shoulder level)
- Start with isometrics of the RTC, then progress to therabands and free weights. Strengthen through function

Occupation and role specific training

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19
Q

Name post surgical interventions for RTC conditions

A
  • abduction sling
  • ice to address pain and swelling
  • timing to begin exercises varies depending on the type of surgery, size of tear.
  • Exercise begins with pendulum exercise and PROM: supine, shoulder elevation and IR, ER, adducted position. The same exercises are then progressed to AAROM and AROM staying supine to lessen gravity and progressing to against gravity exercises. May include table glides, wall/ladder exercises and wand exercises.
  • Strengthening: isometerics and progress to isotonic exercises using therabands and light weights.
  • Final phase: Return to leisure and work
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20
Q

What is adhesive capsulitis also known as?

A

Frozen shoulder

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21
Q

How is adhesive capsulitis diagnosed?

A
  • Xrays
  • CAT scan
  • MRI
  • Pattern of ROM limitations - ER, adduction and iR
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22
Q

What are the medical treatments for adhesive capsulitis?

A
  • NSAIDS
  • Cortisone injections into the glenohumeral joint
  • Surgery: manipulation and arthroscopic release
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23
Q

How long can it take adhesive capsulitis to resolve?

A

2-3 years

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24
Q

For what phase of adhesive capusulitis is the OT intervention described below for:

  • Pain free A/PROM
  • Try to preserve functional movements: i.e. reaching to wash opposite underarm, behind back, etc.
  • Do not increase shoulder pain during this phase.
  • HEP: Cane exercises, table glides and wall walking
  • Modalities: Ice packs, TENS
A

Freezing phase

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25
Q

For what phase of adhesive capusulitis is the OT intervention described below for:

  • Continue exercises for freezing phase, but also add joint mobilization, gentle stretching (pain free)
  • Modalities: Begin with hot packs and conclude with ice
A

Frozen phase

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26
Q

For what phase of adhesive capusulitis is the OT intervention described below for:

Therapist can be more aggressive with exercises. The focus is to restore all functional movements w/o compensation

A

Thawing phase

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27
Q

What stage of adhesive capsulitis is described below:

  • Major symptom is pain, usually at end range or with resistance
A

Freezing phase

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28
Q

What stage of adhesive capsulitis is described below:

  • Loss of shoulder movement following capsular pattern with pain at end range
A

Frozen phase

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29
Q

What stage of adhesive capsulitis is described below:

Gradual return to ROM and function

A

Thawing phase

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30
Q

Describe OT and post surgical treatment for adhesive capsulitis

A
  • Ice for pain
  • ROM (begins 1-2 days after sx)
  • Respect pain, but keep patient moving
  • Regain shoulder motion in all planes, focusing on functional movement (.e. washing underarm)
  • Strengthening can be added when approved by MD
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31
Q

What activity would be most restricted because of capsular pattern seen in adhesive capsulitis?

A

Reaching behind head to do hair care

32
Q

What is another term for lateral epicondylitis?

A

Tennis elbow

33
Q

What is lateral epicondylitis?

A
  • Degeneration of the extensor carpi radialis brevis
  • May impact extensor digitorum communis and extensor carpi radialis longus
  • Occurs d/t repetitive wrist extension under load, forceful gripping, and static wrist extension. Common in many sports, vocational, and leisure activities such as tennis, yard work or carpentry.
34
Q

What condition is described below:

  • Degeneration of the extensor carpi radialis brevis
  • May impact extensor digitorum communis and extensor carpi radialis longus
  • Occurs d/t repetitive wrist extension under load, forceful gripping, and static wrist extension. Common in many sports, vocational, and leisure activities such as tennis, yard work or carpentry.
A

Lateral epicondyitis

35
Q

Describe the symptoms of lateral epicondylitis

A
  • Pain (at rest, worsened with wrist extension and radial deviation, supination, digital extension and griping)
  • Nighttime aching of the elbow
  • Morning stiffness of the elbow
  • Reduced grip strength when elbow is extended
  • Tightness of extrinsic extensors
  • Inflammation at the lateral epicondyle
  • Functional weakness of the affected UE
36
Q

Describe the treatment for lateral epicondylitis

A
  • NSAIDs
  • Corticosteroid injections
  • Surgery if no response to conservative treatments, including 9-12 months of therapy
37
Q

What does the cozens test assess?

A

Lateral epicondylitis

38
Q

Describe the cozens test

A
  • Position the forearm on a table
  • Stabilize the clients elbow and palpate the lateral epicondyle
  • Aske client to pronate forearm, radially deviate wrist and make a fist
  • Ask client to actively extend the wrist, while therapist resists motion
  • Pain in the area of the lateral epicondyle is a positive test
39
Q

Describe the mills tennis elbow test

A
  • Palpate the most tender area under the lateral epicondyle
  • Place clients shoulder in neutral with the elbow partically flexed, pronate the forearm and flex the wrist
  • Therapist moves the elbow from flexion to extension
  • Pain in the area of the lateral epicondyle is a positive test
40
Q

Describe OT assessment for lateral epicondylitis

A
  1. Pain (palpation and pain scale)
  2. ROM (active and passive in wrist, forearm and elbow)
  3. Special tests: Cozens test and mills tennis elbow test
  4. Grip strength (have pt complete with elbow extended and only squeeze to start of pain).
  5. Sensation (to rule out radial nerve pathology)
  6. Occupational performance
  7. Ergonomic assessment of workplaces
  8. Sleep
  9. Fatigue
  10. Psychsocial feelings (i.e. depression)
41
Q

What is the focus of acute phase of lateral epicondylitis?

A

Focus is to decrease pain and promote rest of involved structures

  • Ice several times a day
  • Activity modification
  • Orthosis: Wrist cock-up, counterforce bracing
  • Gentle AROM of elbow, wrist and hand
  • Gentle transverse friction massage
  • PAMS: ESTIM, iontophoresis, anti inflammatory modalities
  • If pain allows, begin gentle submaximal isometric exercises for UE
42
Q

What are some orthoses used for conservative management of lateral epicondylitis?

A
  • Wrist cock up orthosis (should be worn at night and during day with activities that require gripping and wrist extension)
  • Counterforce bracing
43
Q

Describe conservative treatment for the chronic/restorative phase of lateral epicondylitis.

A
  • Continue activity modification to avoid aggravating movements such as lifting, gripping, etc.
  • Continue to use counterforce bracing and watch for signs of ulnar or radial nerve compression
  • PAMS: hot packs, deep ultrasound heat before and ice after stretching, exercise, or activity
  • Transverse friction massage
  • Stretching (combine wrist flexion, pronation and elbow extension as well as gentle UE and cervical stretches).
  • Strengthening of upper quarter (begin with hand/wrist/elbow with elbow flexed, then progress with elbow extended, progress to shoulder, back and scapula). begin with isometric and progress to resistive concentric isotonic contractions, then eccentric. Start with isometric gripping prior to beginning repetitive gripping activities.
  • Adaptation and modification of equipment and tools to promote better ergonomics
  • Educate on proper positioning for tasks
44
Q

Describe post operative management for lateral epicondylitis

A
  • Use ice to control pain
  • Edema management using elastic sleeves or ace bandages
  • Elbow immobilizer after surgery with elbow in 90 degrees of flexion and forearm in neutral (usually 6-10 days post op)- AROM of wrist and hand w/i 48 hours and increased as tolerated and light ADLs can be started
  • Progressive resistive exercises with use of a counterforce brace (begin with isometric progressing to isotonic). Full ROM of wrist, elbow and hand should be achieved. (Usually 3 weeks post op)
  • Sport training and eccentric exercise (approx 4-6 wks post op)
  • Unrestricted activities by approx 2 months post op
45
Q

What is DeQuervains Tenosynovitis?

A
  • Fiborous thickening of the extensor retinaculum
  • Inflammation and impaired gliding of the abductor pollicis longus and extensor pollicis brevis in the first dorsal compartment.
46
Q

What condition is described below?

  • Fiborous thickening of the extensor retinaculum
  • Inflammation and impaired gliding of the abductor pollicis longus and extensor pollicis brevis in the first dorsal compartment.
A

DeQuervains Tenosynovitis

47
Q

What are some causes of DeQuervains tenosynovitis?

A
  • Cumulative trauma: Forceful, sustained or repetitive thumb abduction, wrist ulnar deviation, grasp and thumb MP flexion
  • Acute trauma
  • Occurs frequently in new parents (lifting babies, certain sports such as golfing and racket sports, knitting, needling, prolonged use of tools such as scissors and surgical retractors, playing instruments)
48
Q

Describe the symptoms of DeQuervains

A
  • Radial side wrist pain, over the radials tyloid radiating to the thumb and distal forearm
  • Resisted thumb extension and abduction is painful
  • Weak pinch strength
  • Increased pain with stretching or contracting the APL or EBP
  • Swelling on radial side of the wrist
49
Q

What is an assessment used to diagnose DeQuervains?

A

Finkelstein test

50
Q

What is the Finkelsteins test?

A
  • Test for DeQuervains
  • Ask client to hold thumb in their palm and ulnarly deviate their wrist
  • Sharp pain over the radial styloid is a positive test
51
Q

What are the medical treatments for DeQuervains?

A
  • NSAIDS
  • Corticosteroid injections
  • Lidocaine injections into the first dorsal compartment for pain relief
52
Q

Describe OT and DeQuervains tests/assessment

A
  • Asses pain
  • Special test: Finkelsteins test
  • Strength: of wrist, elbow and grip
  • Sensation
  • Tendon gliding: Passively test movements of the EPL and APB within the first dorsal compartment
  • ADLs/IADLs
  • Work
  • Leisure: specifically sports and musical instrument use
53
Q

Describe the conservative treatment for DeQuervains

A
  1. Rest and orthotics
  2. Exercise wrist and thumb in between orthosis use
  3. PAM: Ice and heat can be used to relieve pain and inflammation during the acute phases
  4. Activity and ergonomic modifications (avoid movements and activities that cause pain (such as combined MCP flexion with ulnar deviation; gripping, repetitive lifting with thumb abduction).
  5. Stretching and strengthening - Active/passive ROM and stretching of APL and EPB once inflammation has been resolved. Perform components of finkelsteins maneuver to help gliding and stretching of the tendons in the first dorsal compartment. Progress to isometeric strengthieng, light weight and full WB
  6. Patient education
54
Q

What type of orthoses is used for DeQuervains?

A

Forearm based thumb spica orthosis with wrist in neutral and thumb in opposition, leave the thumb IP joint free

  • Instruct client to wear the orthosis during the day as much as possible and throughout the night
55
Q

Describe the surgical interventions for DeQuervains

A
  • Sx: Release the first dorsal compartment to relieve pressure of the APL and EPB with.
  • Post op therapy:
    • If there was reconstruction of the extenor sheath, use a static thumb orthosis with wrist in 20 degrees of extension for 3 weeks.
    • If extensor sheath was not reconstructed, use a forearm based thumb spica orthoses for the first 2-3 weeks
    • Initiate edema and scar management interventions
    • Initiating of ROM exercises with be determined by the physician.
    • Strengthening will begin 2-4 weeks post op
    • 6 to 8 weeks return to regular activity
56
Q

Describe a trigger finger injury

A
  • Occurs d/t constriction of the digital flexor tendons either d/t stenosis of the flexor tendon sheath or the formation of a nodule on the flexor tendon.
  • Most often occurs at the A1 pulley
  • Can also occur d/t overuse
  • Strongly associated with diabetes and RA
  • Occurs in more women in the 50s and 60s
57
Q

What condition is described below:

  • Occurs d/t constriction of the digital flexor tendons either d/t stenosis of the flexor tendon sheath or the formation of a nodule on the flexor tendon.
  • Most often occurs at the A1 pulley
  • Can also occur d/t overuse
  • Strongly associated with diabetes and RA
  • Occurs in more women in the 50s and 60s
A

Trigger finger

58
Q

What are symptoms of trigger finger?

A
  • Pain over the A1 pulley area
  • Gripping is painful
  • Decreased ROM of finger flexion or extension
  • Catching or locking of the finger in flexion, especially in the morning
  • Snapping of the locked fingers into extension called “triggering”
  • Inflammation
59
Q

What condition is described below:

  • Pain over the A1 pulley area
  • Gripping is painful
  • Decreased ROM of finger flexion or extension
  • Catching or locking of the finger in flexion, especially in the morning
  • Snapping of the locked fingers into extension called “triggering”
  • Inflammation
A

Trigger finger

60
Q

Describe the treatment for trigger finger

A
  • Medical interventions: Corticosteroid injections into the flexor sheath
  • Surgical interventions: If conservative methods do not work, surgical release of the A1 pully can be done. In some cases if a nodule is present it can be removed.
61
Q

OT evaluation for trigger finger

A
  • Assess pain over A1 pulley area
  • Ask client if finger locks in flexion
  • Evaluate PIP joint flexion contracture and ability to make a fist
  • Check for inflammation
  • Common for multiple fingers to be impacted
62
Q

What type of orthosis are used for trigger finger?

A
  • MP joint orthosis to prevent MP joint flexion
  • PIP or DIP joint extension orthosis to prevent PIP or DIP joint flexion
63
Q

Describe treatment for trigger finger and OT

A
  • Use of orthosis
  • Activity modification
  • Ice for pain
  • HEP
    • Remove orthosis to complete 5-10 reps several times a day. Complete PROM of PIP and DIP joints in flexion and extension. Active full finger flexion/extension within the limits of pain, active hook grips. Progress as symptoms resolve
  • Patient education
  • If surgery, then scar management
64
Q

What are the 2 most common nerve compressions of the UE?

A
  • Carpal tunnel syndrome
  • Cubital tunnel syndrome
65
Q

Describe the causes of nerve compressions.

A
  • Narrowing of tunnel space d/t swelling (inflammation, hypertrophy and or anatomical abnormalities)
  • Cumulative trauma d/t repetitive movements, sustained postures, direct pressure and or vibration
66
Q

Describe medical interventions for CTS

A
  • Cortisone injections
  • OTC wrist orthoses
  • Surgery: CT release the transverse carpal ligament
67
Q

Name the muscles involved in the carpal tunnel

A
  • Tendons of the FDS and FDP
  • Flexor carpi radialis
  • Flexor pollicis longus
  • Median nerve
68
Q

Describe OT and CTS

A
  • Observe for thenar wasting and ability to perform true opposition
  • Sensation testing: monofilament, static and moving 2 point discrim
  • MMT
  • Special tests: Tinels sign, phalens tst, berger test
69
Q

Describe OT treatment for CTS

A
  • Wrist orthosis in neutral: wear at night and during day if activities increase symptoms
    *** If they have a positive berger test the wrist orthosis should extend past the MCP joints to block them in 20-40 degrees of flexion
  • Median nerve glides
  • Tendon glides
  • Ergonomics
  • Patient education
    ** avoid repetitive wrist flexion/extension
    **     avoid sustained, extreme wrist flexion and extension
  • Strengthening: focus on thenar muscles
70
Q

Describe OT post surgical intervention for CTS

A
  • Edema management (elevation and isotoner glove)
  • scar management
  • Nerve and tendon glides
  • Desensitization
  • Pain management
  • Strengthening, once approved by MD
71
Q

Describe compression sites of cupital tunnel issues

A
  • Arcade of struthers
  • Cubital tunnel
  • Arcade of osborne
72
Q

What are the medical interventions for cubital tunnel?

A
  • NSAIDS
  • Cortisone injections
  • Surgery: Nerve decompression
73
Q

OT and cubital tunnel treatment

A
  • Observe for clawing of ring and pinky fingers and wartenbergs sign
  • assess sensation (monofilament, and static and 2 point moving discrimination)
  • MMT
  • Grip and pinch strength
  • Special tests: Tinels sign at cubital tunnel, elbow flexion test, froments sign
74
Q

Describe conservative intervention for cubital tunnel syndrome

A
  • Elbow orthosis in 30-45 degrees of flexion
  • elbow pad to be worn during the day
  • ulnar nerve glides
  • education on sleeping postures
  • patient education
    ** avoid repetition of elbow flexion
    **     avoiding resting/leaning on elbows
    *** ergonomic training
  • strengthening: focus on proximal muscles
75
Q

Where is the cubital tunnel located?

A
  • Walls are the medial epicondyle and olecranon

***at 135 degrees of elbow flexion , the height of the tunnel is decreased and the ulnar nerve is maximally compressed under the cubital retinaculum

76
Q

Describe the arcade of osborne

A

Involved in cubital tunnel

  • between the two heads of the flexor carpi ulnaris (most common site of compression)

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