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Fall Semester PM Exam 1 > Nonsurgical Shoulder Complex Pathologies > Flashcards

Nonsurgical Shoulder Complex Pathologies Flashcards

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1
Q

When does the fibroplastic stage of healing occur and what is it?

A

it follows the acute inflammatory stage, can last up to 6 weeks, and is the laying down of new tissue

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2
Q

Fibroplasia physiology

A

endothelial and fibroblast cells form capiallary buds and collagen
the formation of a functional scar occurs
increase in viscoelastic properties of new tissues

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3
Q

Maturation

A

can occur for a year post-injury
tissue regains mechanical strength
restoration of normal functioning occurs

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4
Q

Referred Pain

A
  • can be myotomal or dermatomal from C5 or sclerotomal (fascial)
  • can be caused from scapula, thoracic, or cervical
  • visceral pain: cardiac, pulmonary, GI (gallbladder!!!!)
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5
Q

4 different pathologies associated with rotator cuff disease

A

Impingement
tendonitis
bursistis
tendinopathy

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6
Q

T/F there are intrinsic and extrinsic factors for impingment

A

true

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7
Q

define impingement

A

compression of the subacromial contents due to the encroachment of the humerus into the coracoacromial arch

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8
Q

the subacromial space is formed by what and contains what?

A

formed by coracoacromial arch and humeral head

contains rotator cuff tendons, long head of biceps tendon, and subacromial bursa

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9
Q

factors for impingemnt can be divided up into what?

A
  1. intrinsic

2. extrinsic: primary and secondary

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10
Q

Intrinsic factors for impingement (3)

A
  1. changes in vascularity of supraspinatus (critical zone)
  2. cuff degeneration (microtears)
  3. muscle dysfunction
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11
Q

What are force couples and what is their purpose

A

groups of muscles that work synergistically but often in opposite ways. purpose is to stabilize the scapula.
excessive upward rotation of the scapula can cause impingement

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12
Q

General extrinsic factors for impingement

A 
muscles imbalances
poor motor control
postural
functional stressors
anatomical abnormalities
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13
Q

extrinsic primary impingement factors are ____ in nature

A

anatomical

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14
Q

extrinsic primary factors for impingement )3)

A

acromion types
osteophytes
tight posterior capsule

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15
Q

extrinsic secondary factors of impingement are caused by what

A

instability

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16
Q

secondary extrinsic factors of impingement

A

poor force couples
postural deviations
poor motor control

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17
Q

a tight posterior capsule will push the humerus in what direction?

A

anteriorly and superiorly

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18
Q

Neer Stages of Impingement

A

Stage 1: edema and hemorrhage
stage 2: fibrosis and tendonitis
stage 3: degeneration of tendon
(stage 1 and 2 are the same for Jobe classification)

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19
Q

stage 1 impingement

A

edema and hemorrhage

usually due to overuse, pain with prolonged activity

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20
Q

stage 2 impingement

A

fibrosis and tendonitis
pain at rest and with activitiy
mild strength loss

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21
Q

stage 3 impingement Neer

A

degeneration of tendon
partial tear
changes in RTC muscles
weakness, decresed ROM and fxn, pain

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22
Q

difference between stage 3 and 4 impingement for Jobe

A

stage 3= small tear

stage 4 = large tear

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23
Q

pain with tendonitis occurs with active or passive motion?

A

active!

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24
Q

Tendinitis occurs due to what?

A

repetitive stress, especially overuse and eccentric contractions

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25
tendinitis primarily effects what 2 muscles?
supraspinatus and long head of biceps, but can effect any of RTC muscles
26
tendinitis presentation
pain with palpation and motion loss of ROM and strength end feel is boggy, firm, mushy
27
5/5 strength presentation with tendonitis tells us what?
acute exacerbation of a chronic condition (painter example)
28
with regards to the critical zone, what muscle are we worried about the vascularization of?
supraspinatus
29
most commonly involved bursa with bursitis of shoulder?
subacromial bursa (located within the subacromial space)
30
Chronic ____ presents with the same symptoms as ____ and what are they?
chronic bursitis presents with the same sx as tendonitis. sx = pain with movement, pain with palpation, loss of ROM and strength
31
bursitis pain is with active or passive motion?
both! pain with active and passive motion
32
causes of bursitis
due to compression and/or irritation of the bursa | can also occur due to trauma: falling onto hands jams the humeral head into the acromion
33
Bursitis
acute is very painful chronic is associated with tendonitis present w/ pain w/ AROM and PROM, decreased ROM and strength, tenderness with palpation
34
etiology of RTC tear
due to cumulative stress or trauma (FOOSH, espc. older adults)
35
most commonly invovled muscle for RTC tear
supraspinatus
36
giveaway symptom for acute RTC tear
night pain!
37
RTC tear pain
pain with acute tear, may be diffuse but specific upon palpation chronic or complete tear may not have pain night pain very common overall
38
RTC tear
complete tear is palpable: firm and bony | ROM: look at quality of mvmt. often will substitute with abduction because supraspinatus does first 30 degrees
39
causes of adhesive capsulitis
idiopathic (insidious onset), can be due to trauma, post surgery, or neuropathic
40
who does adhesive capsulitis affect
females more than males, age 40-60
41
physical presentation of adhesive capsulitis
decreased scapulohumeral rhythm, less than 90-135 degrees elevation, 50-60% of normal ER
42
name the stages of adhesive capsulitis (4)
1. pre-adhesive 2. freezing 3. frozen 4. thawing
43
Pre-adhesive stage of adhesive capsulitis
gradually lose motion, may not be aware it is happening, pain with use, capsular end feel, minorly decreased ROM, commonly misdiagnosed stage 1
44
freezing stage of adhesive capsulitis
stage 2 very painful!!!! synovial thickening, trigger points, can last for several weeks (10-36), open end feel
45
frozen stage of adhesive capsulitis
stage 3 | pain decreases, stiffness, weakness, lasts 4-12 months
46
thawing stage of adhesive capsulitis
lasts 5-42 months | decreased pain, increased ROM, end feel softens, increased functional use of UE
47
purpose of PT for adhesive capsulitis if it will resolve without PT?
reduce the overall amount of ROM patient will lose keep patient functional education on reoccurance - must do exercises for life
48
AC joint separation
occurs from falling on shoulder or FOOSH we can treat type 1 and 2 conservatively via taping or bracing can physically see separation in types 4,5,6
49
most common fracture type for UE
humeral
50
presentation of fractures
pain, limited ROM, altered scapulohumeral rhythm non-displaced fracture will be immoblized in sling. no cast. can move it. work on ROM within first 2 weeks of injury to prevent adhesive capsulitis
51
presentation of labral tears
catching, popping, sx like impingement, instability, pain, scapular dyskinesia
52
SLAP stands for
superior labral anterior to posterior
53
most common type of SLAP leasion
type 2 can progress over time from 1-4 long head of biceps attaches to labrum
54
clicking, popping usually indicates what?
labral tear (Stage 3 or 4)
55
etiology of anterior shoulder instability
force into abduction and ER, FOOSH, posterior blow to shoulder present with subluxation or dislocation
56
pathologies associated with anterior shoulder instability
anterior capsule lesions, bankart lesion, hill sach lesion, brachial plexus injury
57
Hill-SACH lesion
small compression fracture on posterior aspect of humeral head. occurs during an anterior dislocation. Technically the fracture is on the anterior aspect but it is considered posterior when in an abducted, ER position
58
posterior shoulder instability
force into IR and adduction | labral tear or reverse hill sach can occur or compression fracture of humral head
59
multidirectional instability is due to
occupational, recreational or congenital throwers, swimmers, gymnasts present similar to impingement with pain, potential subluxing
60
pathologies associated with multidriectional instability
loose labrum and multi-laxity of capsule
61
Snapping scapula
causes: bursistis, muscle imbalances, bony alignment, luschka's tubercles (bump on superior medial border of scapula) pain, crepitus, potential scapular winging
62
presentation of arthritis (OA or RA)
pain, joint deformity, decreased ROM and strength, functional impairments chief complaint will be pain
63
what is thoracic outlet syndrome?
compression of the neurovascular bundle producing neurovascualr compromise. 90% is neurogenic ( rather than vascular)
64
etiology of thoracic outlet syndrome?
postural deviations, compression injuries, muscle hypertonicity of scalenes, cervical rib, soft tissue abnormalities
65
epidemiology of thoracic outlet syndrome?
female more than males ,age 20-50, history of trauma, type a personality
66
presentation of thoracic outlet syndrome?
diffuse pain radiating to arm that is non-dermatomal fatigue and ache, weakness, paresthesias hand feels cold = vascualr costal breather, postural deficits dull achy sensation that progresses down arm, arm feels heavy
67
common compression sites of thoracic outlet syndrome?
scalene triangle costoclavicular space (1st rib and clavicle) pec minor and chest wall
68
Scapular dyskinesis
abnormal motion of the scapula | due to weak traps, SA, muscle imalances, nerve palsy, muscle tightness
69
difference btwn bursitis and adhesive capsulitis with ROM
AROM and PROM equally as painful = adhesive capsulitis | bursitis will get more PROM than active before being limited by pain

Fall Semester PM Exam 1 (5 decks)

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