Quiz 1 Flashcards
(175 cards)
1
Q
Obriens test is for what? Explain the test
A
labral tear
fully supinate then res, fully pronate then res.
if px is worse or only with pronation it’s pos
2
Q
Drop arm test is for
A
supraspinatus tear
3
Q
full or empty can test is for
A
supra. tendonitis
4
Q
cross over test is for
A
AC joint
5
Q
Speeds test is for
A
Biceps lesion
6
Q
Yergason’s test is for
A
tear of Transverse humeral lig
7
Q
2 main impingement tests
A
Hawkins Kennedy
Neers
8
Q
the TOS test for pec minor being the issue
A
Allens
9
Q
The TOS tests for scalenes being the issue
A
Halsteads
Addsons
10
Q
Lift off test is for
A
subscap tear
11
Q
what does Fromonts sign test for
A
Adductor pollicis weakness
Ulnar nerve
12
Q
Murphys sign
A
(looking for depressed 3rd MC)
lunate fx test
13
Q
tendons that are tested by Finklestein’s test
A
abd. poll. longus
Ext. poll brevis
14
Q
how much mobility is needed for Reaching overhead
Flexion/abduction functionally
A
148 degrees
15
Q
what are the functional degrees needed to comb your hair
A
Abduction: 112°
Horizontal add: 104°
ER: 54°
16
Q
2 gross assessments that are good to check for overall functional movement of UE
A
big circle with arm
arrest position
17
Q
functional degrees needed for arrest position
A
Horiz abd: 69°;
IR: 60°
Extension: 56°
18
Q
2 main components of GIRD
A
loss of IR 15-25 degrees compared to non dom side
AND total loss of ROM
19
Q
pec minor actions
A
protracts, depresses, & downwardly rotates scapula (PDDR) (minor is all scap)
20
Q
levator scap actions
A
elevates scap
DR scap
21
Q
serratus ant does what to scap
A
UR
22
Q
If shoulder IR are limited, what part of the capsule is tight
A
post
23
Q
if these are tight, ER can be limited
A
IR: subscap, teres major, lats, pec major
24
Q
If shoulder ER is limited, what part of the capsule is tight
A
ant
25
good post capsule stretch for GIRD
cross over rated better than sleeper stretch
26
adhesive capsulitis, what motions are really limited
Limited in ER, Abd, Flexion, IR
27
how to differentiate between a true capsular issue vs muscular or soft tissue issue with the shoulder
if motion is limited in more than 2 planes its the capsule
28
greatest ROM loss with adhesive capsulitis occurs in what stage
Stiffness/Frozen
29
stages of adhesive capsulitis
Painful/Freezing - usually reversible here
Stiffness/Frozen (loss of ROM here),
Recovery/Thawing
30
instead of the freezing stages of adhesive capsulitis, what is a better way to classify pts
Irritability
High =Pain > 7, consistent, ↑disability, pn limits ROM
Moderate Irritability= 4-6/10, intermittent, mod disability, pn at end of range
Low Irritability=
31
explain how to tx high irritability pts with adhesive capsulitis, what are your limits to tx
ROM: short duration (1-5 sec holds), pn-free range or px less than 3
32
best way to do shoulder flexion with a pulley
bend elbow slightly -it shortens the lever arm
33
tx for mod irritability ad. capsulitis
ROM: (5 – 15 sec holds at end range)
AAROM – AROM
Manual Techniques: Low-high grades (grade 3 – high amplitude motion)
Functional Activities
34
what glide is best to regain ER for adhesive capsulitis (not the norm glide for ER)
ER is usually most limited
| This study found that a post glide was more effective in improving ER
35
treatment for low irritability of adhesive capsulitis
ROM: We are going to end-range, OP, longer duration
Manual technique: higher grades (grade 4)
Strengthen: Low- high resistance at end ranges
Functional activities: increase demand
MOBS: take to end range and then mob
36
If Pec Minor is tight you see what with the scapula
Anterior tilt of scap
37
if levator scap is tight, you might see with what with scapula
elevation and DR
38
if rhomboids are tight, the scap appears how
adducted or retracted
39
muscles prone to weakness that can alter glenoid position and scapular position
Lower trap
Serratus Anterior
Rotator Cuff
40
Which are typically weaker, IR or ER of shoulder
ER
41
what must occur in order to clear acromion in humeral elevation
upwardly rotate scap
posteriorly tilt scap
externally rotate scap
42
what role does serr ant play in humeral elevation (being able to clear and actually elevate shoulder)
UR, post tilt and ER scap
| stabalizes medial brdr and inf angle of scap to prevent winging
43
explain the force couple of serratus and low trap
Serratus and low trap work together to force couple UR and returning the scap from elevation
If the pt has scap DR syndrome this cannot occur - typically bc the low trap is weak
44
how does the lower trap help with PICR
Maintains PICR of scapula during arm elevation by eccentric control of protraction and elevation
45
the low trap prevents ____ from occuring during lowering of the arm
winging
| so if winging is occuring during lowering-think low trap
46
the RC stabalizes the humerus where
ant and superiorly
47
scapular wall clocks are good for what muscles
low/mid trap
48
wall washes are for what muscles
low trap and serratus
49
if winging is occuring with raising of arm, think what muscle
serratus ant
50
3 main components of pathoanatomic classification of dx
pts with that patho dx look similar and should be treated similar
Must fix pathologic anatomy for pain and function to improve
strong relationship btwn tissue pathology and pt complaint
51
Scap DR syndrome: if pt sx decrease if you assist their scapula in UR, what might you infer
that they are pos for DR syndrome
52
explain scapula DR syndrome
they are stuck in DR, When you abd shoulder the scap should UR. However, with scap DR syndrome it doesn’t UR
Rhomboids and levator are dominating
53
px probs assct w scap DR syndrome (pathos)
GH impingement
rotator cuff tear
humeral subluxation
thoracic outlet
54
explain scap depression syndrome
low trap is dominating
scap elevators are stretched
passive elevation decreases their sx
55
what px or pathos are assct with scap depression syndrome
neck px
| impingement
56
scap depressors
lats, pecs
57
explain scap abd syndrome
stuck in abd and won't return to add (excessive abd)
abd are tight, add are stretched
Dominance of serr ant., dominance of both pecs
Short: pecs
long/weak: scap adductors
58
pathos/px assosiciated with scap abd syndrome
TOS
subluxation
impingement
59
scap tilt syndrome
Dominance of pec minor, dec activity of serratus and low trap
Short: p. minor
long/weak: serratus
60
pathos/px associated with scap tilt
tos
| impingement
61
scap winging syndrome (explain)
Dominance of pec minor
dec activity serratus
timing problem of low trap
62
pathos assct with winging
GH impingement
thoracic outlet
GH subluxation
63
scap elevation syndrome (explain)
stuck in elevation
dominant scap elevators
causes cervical/neck px
64
if pec minor is shortened, it can cause ____ of scap
ant tilt
65
stages of intervention
Stage I: Relieve Primary Impairment
Stage II: Relieve Movement Issues at Adjacent Body Segments
Stage III: Address Global Issues
66
why is Tspine important with humeral/shoulder motion
Upper segments must extend with humeral elevation
this is why we need to stretch tspine for shoulder limitation pathos
Also, you should palpate upper Tspine during shoulder elevation - if Tspine has no mvmt do PAs
67
explain prone low trap therex we did in class
prone
scaption
thumb up, raise arm
68
explain prone mid trap there
prone
arms in t out to side and raise arms
thumbs up
69
explain a simple therex used early on in order to strengthen serratus anterior
```
wall slides
Above 90 degrees
SCAPULAR PLANE
Early in rehab
Watch excessive upper trap activation
prevent winging
```
70
explain 3 serratus ant therexs that would be good to progress to after wall slides
Scaption above 120 deg. with hand weight
Important to work above 90 deg to fire serr. Ant
or upper cuts that go above 90
or dynamic hugs
71
wall washes are a good closed chain therex for what 2 muscles
serr ant
| low trap- coming down
72
scapular clocks are good closed chain therex for what 2 muscles
low and mid trap
73
with the prone therex for mid traps vs rhomboids (arm out to side not in scaption), how would you isolate one vs the other
mid traps is thumb up, rhomboids is thumb down
74
why might serr. punches not be the best therex choice
bc pec major dominates
75
what might we need to consider with isometric therex
their force used
| we need to monitor it (bladder) bc if they over do they can cause ischemia
76
best supraspinatus therex for impingement pts
Open can is best (thumb up) bc it doesn’t cause sx with impingement pts
77
how to isolate/exercise teres minor
prone 90/90 ER with light wt
| elbow on pillow
78
best way to progress (in general) therex
Do Scapular stability before rotator cuff!
| Closed chain before open chain
79
why do closed chain ex first
```
Promotes co-activation (R Cuff)
Increases scapular activity
Decreases tensile stress
Improves proprioception
Start with scapular stabilization
```
80
list the progression of therex if you are working on scap stabiilty
static postures - set scap and hold
isolated GH motion- stabalize scap and do shoulder IR/ER
Large shoulder ROM under controlled situations (proper timing of mm) - bands or pulley through entire range
Loaded mobility upon stability - side plank with pnf
81
explain how to dose RC therex
Rotator cuff mm are endurance-type mm
Increasing load too quickly causes compensatory movement
Do high reps low load
82
explain (in general) the progression of how to increase dosing of therex
```
Increase load
Increase speed
increase Power
Multiplane
Sport-specific
```
83
explain the considerations for hypo/hypermobile joints with dosing therex
Hypomobile joints – exercise through entire range
Hypermobile joints – stay mid to shortened range
** may need to gradually introduce normal end-range motion
84
with shoulder rehab, educate pts to avoid/modify what lifts during workouts
```
bench press (limit range, grip)
military press
pull downs
```
85
is pull or push better for the shoulder/scap
pull
86
easy way to special test either epicondylitis
palpate the origin of the muscle and do resisted testing
lat epi = resist ext
medial epi=resist flexion
87
what is the lat epicondylitis test where you resist 3rd digit ext
Maudsleys
88
tendons effected by DeQuarvains
abd Polli longus
| Extensor polli brevis
89
explain bunnel littner test
you passively measure PIP without MCP flexion then flex the MCP and measure the flexion of the PIP) if they are different there is imbalance
the PIP has more flexion with the MCP flexed then with it is tight intrinsic muscles
If PIP does not move further and does not reach full ROM, consider capsular tightness.
90
froment tests what nerve and what muscle is isolated
ulnar
| adductor pollicus
91
normal sternal rib angle
90 deg
92
narrow sternal rib angle would indicate
tight ext obliques
93
wide sternal rib angle indicates
tight internal obliques
94
tight ext obliques can do what to pelvis/lumbar
: shortness or stiffness contributes to excessive posterior pelvic tilt and lumbar flexion.
95
ext oblique prevents/controls ____ pelvic tilt
ant
96
low lying AC joint might indicate lengthened __
upper traps (ant tight lower traps)
97
Palpate under sternal notch as pt drops chin to chest then chin to ceiling (flex neck)
This describes what test, and what is it for
spinal activated manubrium test
if you get rotation on one side where you are palpating then there is tightness in the spine somewhere (you should feel same thing on both sides of your thumbs/fingers
98
sup angle of scap is approx at T __
T2
99
spine of scap is approx at T __
T3
100
when you are doing the palpation technique where you push the sternum post and palpate the transverse processes, what stays stable and what moves
C7 stays stable with ext
| T1 will move post as you push on sternum
101
Jim says to teach what breathing techniques for any acute Cspine pts
diaphragmatic
102
during diaphragmatic breathing, if there is increased px with exhalation vs inhalation what might this indicate
exhale -disc
| inhale -rib
103
in scap elevation syndrome, if the superior angle of the scapula is high, but the acromion is normal, it suggests tighness of what muscle
short levator scapula.
104
in scap elevation syndrome, if the entire scapula AND the acromion are high it suggests tighness of
upper trap
105
differentiate stretching upper trap vs levator scap
upper trap is sb away rot toward
| levator scap is sb away rotate away
106
differentiating btwn look of ant tilt or winged scap
ant tilt= about the inf angle, it comes off ribs
| winged = is about the vert border, it all comes post
107
in general, if the issue is impingement, what should you work on
work on ER of RC to bring the humeral head down
108
a dominant delt would do what to the humerus
sup glide
109
if ER is restricted, how to tell if it is tight IR or capsule issue
If there is decreased glenohumeral ER with the arm abducted to 45º, consider a short subscapularis; if there is decreased ER with the arm abducted to 90º, suspect a tight capsule.
110
humeral head depressors, why are they significant
Infraspinatus
Teres minor
Subscap
During impingement (or shortened delts), working on the depressors can help to add more space and pull the humerus down
111
normal resting position clavicle
normal is slight upward to acromion
112
normal rib cage resting angle
Normal is 90
113
normal resting position humerus
Normal = less than ⅓ of the humeral head should protrude in front of the acromion, antecubital crease should face forward and olecranon should face posterior
114
axns of SCM
CRIS
| contra rotation ipsi SB and neck flexion
115
treatment for moderate stage of ad. capsulitis
● Treat with: 5-15 s AAROM, AROM, grade II-III posterior mobs AP technique, begin functional activity. Work on ER
116
explain sx of moderate stage adhesive capsulitis
their Pain 4-6/10, it's intermittent, moderate disability, pain at end range
117
explain fibromyalgia
a disorder characterized by widespread musculoskeletal pain accompanied by fatigue, sleep, memory and mood issues.
AMPLIFIES painful sensations by affecting the way your brain processes pain signals.
● Causes: physical trauma, surgery, infection or significant psychological stress. In other cases, symptoms gradually accumulate over time with no single triggering event.
● Many people who have fibromyalgia also have tension headaches, temporomandibular joint (TMJ) disorders, irritable bowel syndrome, anxiety and depression.
● Things that can ease symptoms include:
○ exercise
○ relaxation
○ stress-reduction
118
what is myofascial syndrome
Myofascial pain syndrome is a chronic pain disorder. Pressure on sensitive points in your muscles (trigger points) causes pain in unrelated parts of your body.
119
Inf shoulder mobs help improve
abduction
| flexion
120
post shoulder mobs help improve
IR
flexion
hor add
121
Ant shoulder mobs help improve
ext
ER
hor abd
122
○ Form of massage using circular strokes with palm of hand
effluerage (stroke)
123
kneading massage is aka
pettriassage
124
contraindications to massage
1. Obstructive Edema: (note that massage is indicated for non-obstructive edema.)
2. Active malignancy: might spread the malignant cells 3: although massage during end-stage disease is most probably okay.
3. Thrombophlebitis: might throw an embolus.
4. Hematoma
5. fractures
6. In post-operative areas (e.g. around sutures, grafts, etc.)
7. Around lacerations
8. Active communicable diseases (via routine contact, open lesions, etc.)
9. Mental disturbances: if you think there might be a chance that your touch could be misunderstood, don’t do it.
125
Indications for massage
1. Amputations: increases circulation
2. Arthritis: decreases edema
3. Burns: stretches skin to lessen scar formation, increases circulation
4. Bursitis: decreases edema
5. Myositis: increases comfort
6. Facial paralysis (e.g. Bell’s palsy): stimulates circulation around the nerve site.
7. Inflammation (can decrease residual edema)
8. Insomnia: increases relaxation
9. Pain
10. Postural dysfunction: stretches muscle
11. Prolonged bedrest: stimulates circulation to pressure areas.
12. Scar tissue/contracture: softens collagen
13. Edema (non-obstructive)
126
type of effluerage For this stroking technique, both hands are used and typically sweep toward and away from each other
fulling
127
type of effleurage that is used for deep pressure, heavy form of stroke - use fist
knuckling
128
effleurage improves
circ flow (main feature)
129
things we focus on in stage 1 of intervention
● Relieve Primary Impairment - mobs and positioning
```
■ Educate the patient, discuss goals,
○ Immobility/Modified Activity
○ Mobility - how can we improve it?
○ Fear avoidance behavior
○ Educate on positioning
○ Exercise and conditioning - how can we progress it?
● Start with the concordant signs/sx
```
and mobility needed for function
130
things we focus on in stage 2 of intervention
Relieve movement issues at adjacent body segments
● Treat regional movement impairments;
● PROXIMAL STABILITY BEFORE DISTAL MOBILITY
● ex:
○ First Rib: if elevated could interfere w/ clavicle inf glide needed with humeral elevation
○ T-Spine: upper segments must extend with humeral elevation
131
HU medial glide is for
flexion and add
132
HU lateral glide is for
ext and abd
133
medial and lateral gap glides are for
flex, ext, pronation
134
HR dorsal/post glide is for
ext
135
HR volar/ant glide is for
flexion
136
prox RU post
pro
137
prox UR ant glide is for
sup
138
dist RU post glide is for
sup
139
dist RU ant glide is for
pro
140
post/dorsal wrist glide improves
flexion
141
ant/ventral wrist glide improves
wrist ext
142
radial wrist glide improves
ulnar deviation
143
ulnar wrist glide improves
radial deviation
144
joint mob grade progression for stages of adh. capsulitis
irritable -grade 1
moderate-grade 3
low irritable-grade4
145
what muscles are dominating in scapular DR syndrome
rhomboids
| levator
146
RC tear is assct with what syndrome
DR syndrome
147
proximal ____ before distal _____
stability before mobility
148
diff btwn a neural slider and tensionor
tensioner you are lengthening at both ends
| slider you lengthen 1 end only
149
```
maitland = ____
standard ULNT (1) test = ____
ULNT 2 and 3 = ____
```
maitland = slump
standard = elvey
2 and 3 = butler
150
2 main tension points in body
ant elbow
| post knee
151
pulling like a tight string, catches of pain and tightness is ____ neural
extraneural px
152
symptoms such as bizarre clumps of pain, crawling, antlike, dry, woody, and dragging and report sensations of swelling, burning or electricity are ___ neural
intraneural
153
ULNT 1 stresses what
brachial plexus and the median nerve.
154
ULNT 2a (Mb) stresses what
brachial plexus and the median nerve.
155
steps to ULNT 2a
```
Shoulder girdle depression
Elbow extension
GH lateral rotation
Wrist and finger extension
GH abduction
```
156
steps to ULNT 2b
```
Shoulder girdle depression
Elbow extension
Forearm pronation and shoulder medial rotation
Wrist flexion
Thumb flexion and ulnar deviation
```
157
ULNT 2 b stresses
brachial plexus and radial N
158
ULNT 3 stresses
ulnar nerve
159
steps to ULNT3
```
Shoulder girdle stabilization
Full elbow flexion
Wrist extension
Forearm pronation
Shoulder lateral rotation
```
160
great way to stretch Tspine
lay on vertical bolster or towel
| ball overhead and hold stretch at end range
161
what is a key component to strengthening serr ant (position wise)
do above 90 deg
162
which elbow glides are "backwards" from your thought process
HR
proximal RU
distal RU make sense
163
tx for high irritability adhesive capsulitis
ROM: short duration (1-5 sec holds), pn-free range or px less than 3, PROM, AAROM
164
explain how traps can be weak in scap DR sydrome
it's lower traps
| Serratus and trap force couple for UR, so if these are weak then UR is an issue and the scap is stuck in DR
165
what muscle is weak in scap DR syndrome
lower traps
166
steps to ULNT1
```
○ GH abduction
○ GH external rotation
○ Forearm supination
○ Wrist and finger extension
○ Elbow Extension
```
167
adhesive capsulitis is restricted in both ___ and ___ movements
active and passive
168
the 2 shoulder pathologies with clicking/popping
labral tears/instability
| impingement
169
with a RC tear, is PROM usually an issue
no
170
which flexor is most common for medial epicondylitis
FCR
171
what N is cubital tunnel involved
ulnar
172
diff btwn radial tunnel syndrome and post int syndrome
radial tunnel is sensory loss and px at lat elbow
| post int is motor loss of finger/thumb ext
173
loose bodies
ant LAT elbow px
necrosis
osteochonritis dissecans
174
panners disease
lateral elbow px
young pts
necrosis of bone
175
Little leagers elbow
young
| medial elbow sx/px
