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DPT 516 > Quiz #7 > Flashcards

Quiz #7 Flashcards

1
Q

what is subacromial impingment syndrome?

A

anatomic variations that lead to decreased subacromial space

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2
Q

what is the etiology of subacromial impingement syndrome?

A

space issue

anatomic variations

shoulder girdle kinematics

rotator cuff pathology

degenerative changes

overuse

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3
Q

what are the intrinsic factors of impingement?

A

vascular changes in RC tendons

tissue tension overload

collagen disorientation

collagen degeneration

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4
Q

what are the primary extrinsic factors of impingement?

A

structural posterior capsule tightness, anterior capsule tightness

RC pathology

increased superior migration of the humeral head

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5
Q

what are the secondary extrinsic factors of impingement?

A

instability, impaired coordination, weakness of the scapular stabilizers

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6
Q

what are the tertiary extrinsic factors of impingement?

A

contact of the greater tuberosity with the posterosuperior aspect of the glenoid when the arm is abducted and externally rotated

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7
Q

why would rotator cuff pathology cause impingement?

A

the RC isn’t depressing the humeral head to clear the acromion

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8
Q

what does the coracoacromial lig do?

A

spans the coronoid to acromion creating the coracoacromial arch where impingement can occur

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9
Q

what tendons run through the coracoacromial arch and can cause trouble in impingement?

A

supraspinatus, infraspinatus, and long biceps tendon as well as the subacromial bursa

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10
Q

what acromial variation is the most common?

A

curved

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11
Q

what acromial variation causes the most problems?

A

hooked

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12
Q

order these anatomical variation of the acromion from least to most problematic: hooked, flat, curved

A

flat<curved<hooked

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13
Q

what is the MOI for subacromial impingement syndrome?

A

overhead use

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14
Q

what is the history of subacromial impingement syndrome?

A

insidious onset

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15
Q

what is the CC of subacromial impingement syndrome?

A

OH pain

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16
Q

what are other complaints of subacromial impingement syndrome?

A

painful arc (80-120 deg abd)

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17
Q

what are the ROM limits of subacromial impingement syndrome?

A

passive abduction, IR, and horizontal adduction

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18
Q

what are the special tests for subacromial impingement?

A

(+) Hawkins Kennedy
(+) Neer

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19
Q

what are the contributing factors of subacromial impingement syndrome?

A

RC weakness

hooked acromion

shoulder kinesthesia

capsule tightness

decreased space

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20
Q

how much space does the subacromial space usually have?

A

4-11 mm

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21
Q

is a tight posterior or anterior capsule more common in subacromial impingement?

A

tight posterior capsule

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22
Q

t/f: RC weakness/fatigue, capsular restrictions, anatomical variations, mobility impairments all impact tendinitis

A

true

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23
Q

what tendons are affected by tendinitis most?

A

supraspinatus and long head of the biceps tendon

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24
Q

t/f: tendinitis/opathy can become calicific or rupture

A

true

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25
Q

what % of females over 40 y/o have tendinitis develop into calcific tendinopathy?

A

3-7%

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26
Q

how do we differentiate different tendons in tendinitis?

A

resistance testing

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27
Q

what is the history of tendinitis?

A

possible overuse

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28
Q

what is the CC of tendinitis?

A

OH pain

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29
Q

what is the MOI of tendinitis?

A

OH use and CTD

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30
Q

what are other complaints of tendinitis?

A

painful arc

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31
Q

what are comorbidities of tendinitis?

A

UE weakness

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32
Q

what are the ROM limitations in tendinitis?

A

OH loss of ROM an decreased IR/ER

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33
Q

what are the special tests for tendinitis?

A

HK, Neer, and resistive tests for pain

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34
Q

what are the contributing factors of tendinitis?

A

RC weakness, decreased space, shoulder kinesthesia, and instability

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35
Q

t/f: the treatment of bursitis and tendinitis are usually the same/similar

A

true

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36
Q

do we expect pain with muscles and tendon injuries?

A

yes

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37
Q

a tendon problem with no pain

A

tear

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38
Q

a tendon problem with pain

A

-opathy, -itis, -osis

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39
Q

t/f: it is easy to differentiate tendinopathy from arthritis, bursitis, fractures, and dislocations

A

false, these present very similarly

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40
Q

bursitis causes shoulder pain with what actions?

A

passive abduction, IR, and horizontal adduction

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41
Q

bursitis is TTP where?

A

in the subacromial with shoulder extension

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42
Q

is there pain with resistance testing of bursitis?

A

yes

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43
Q

what is the CC of bursitis?

A

OH pain

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44
Q

what is the MOI of bursitis?

A

OH use, CTD

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45
Q

what are other complaints with bursitis?

A

painful arc and resistance +/- pain

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46
Q

what are comorbidities of bursitis?

A

UE weakness

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47
Q

what are the ROM limitations of bursitis?

A

possible oH motion loss

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48
Q

what are the special tests for bursitis?

A

(+) HK
(+) Neer

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49
Q

what are the contributing factors of bursitis?

A

RC weakness, decreased space, hooked acromion, shoulder kinesthesia, and capsular tightness

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50
Q

what is stage 1 bursitis?

A

<25 y/o

localized edema

acute/repeated trauma

TTP anterior acromion

painful arc

pain related RC weakness

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51
Q

what is the intervention for stage 1 bursitis?

A

RICE, non-rpovocative RC training, OMPT to improve jt mobility

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52
Q

what is arthrogenic inhibition?

A

pain around a jt inhibits the muscles around it

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53
Q

what is the Hawkins Kennedy test?

A

shoulder flexion to 90 deg

elbow flexion to 90 deg

IR

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54
Q

what things can be tested with the HK test?

A

subacromial impingement syndrome

bursitis

tendinitis

possibly AMBRI

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55
Q

what is the Neer test?

A

depress the scap

IR

max flexion of the GH

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56
Q

what things can be tested using the Neer test?

A

subacromial impingement

bursitis

tendinitis

possibly AMBRI

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57
Q

what is the intervention for bursitis/tendinitis?

A

control inflammation

modalities for pain and edema

TFM

RC training (pure motion, multiplanar motions, provocative motions)

OMPT (orthopedic manual PT) for jt stability

NM re-education (ST)

ADL modification

surgery (acromioplasty, RC repair, SA decompression)

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58
Q

RC pathology accounts for what % of all shoulder injuries?

A

50-70%

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59
Q

order these tendons from most to least affected in RC pathology: infraspinatus, subscapularis, supraspinatus

A

supraspinatus>infraspinatus>subscapularis

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60
Q

what is the CC in RC pathology?

A

pain and weakness

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61
Q

what is the MOI of RC pathology?

A

OH and CTD

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62
Q

what are other complaints with RC pathology?

A

painful arc

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63
Q

what are the comorbidities of RC pathology?

A

being older than 50 y/o

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64
Q

what are the ROM limitations in RC pathology?

A

decreased flexion and rotation

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65
Q

what are the special tests for RC pathology?

A

(+) drop arm

ER Lag

Hornblower

full/empty can

lift off

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66
Q

what are the contributing factors of RC pathology?

A

decreased space

RC weakness

hooked acromion

tight capsule

instability

progression of SAI and tendinopathy

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67
Q

in RC pathology there is compression of what?

A

the SA space

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68
Q

in RC pathology there is tension in what motions?

A

horizontal adduction

IR

anterior translation

distraction (throwing)

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69
Q

t/f: RC tears increase with age

A

true

70
Q

in people over 40 y/o, what % RC tears are full thickness and what % are partial thickness?

A

5-20% are full thickness

30-40% are partial thickness

71
Q

t/f: RC tears could be on either the bursa side or jt side of the tendons

A

true

72
Q

what are the s/s of RC pathology?

A

painful arc

pain during/after activity

TTP at the GH, coracoacromial lig, and LHB tendon

73
Q

what is the drop arm test?

A

resist pure abduction

supraspinatus test

74
Q

what is the ER Lag test?

A

put the pt in ER and see if they can hold the position

infraspinatus test

75
Q

what is the Hornblower’s sign?

A

ask pt to hold max ER with 90 flexion

teres minor test

76
Q

what is the lift off test?

A

have pt go into IR w/hand behind back

subscapularis test

77
Q

what is the empty can test?

A

resist the pt in scaption to see if it elicits pain

thumb down

supraspinatus test

78
Q

what is the full can test?

A

resist the pt in scaption to see if it elicits pain

thumb up

supraspinatus test

less provocative than empty can

79
Q

what is the disadvantage of open repair of the RC?

A

you have to cut through the deltoids

80
Q

what is the advantage of using an arthroscope for RC repair?

A

you can just split some of the fibers of the deltoids to get to the RC w/o cutting the deltoids

less trauma, easier repair, easier recovery

81
Q

why are holes drilled in the bone with RC repairs?

A

the tendon is pulled into the raw bone to heal the bone with the tendon and form a new entheses

82
Q

what is the point of an acromioplasty?

A

to create more SA space

83
Q

what is patch augmentation for RC repair?

A

using patches of porous type 1 collagen to improve vascularity and collagen formation and encourage natural healing with native tissue

for large tears (3-5cm)

for PT who had prior repairs/chronic tears

84
Q

what is the difference b/w allografts and autografts?

A

autografts come from yourself, while allografts come from someone else/some other source

85
Q

what is phase 1 of RC repair healing?

A

0-6 wks

goals: pt education, control pain, ROM

post op day 1: sling or abduction splint (3-6 wks), pendulums, distal AROM

post op day 7-10: PROM flexion and ER, modalities

no AROM or PREs

86
Q

what is phase 2 of RC repair healing?

A

6-12 wks

goals: ROM, NM control

intervention: ER, IR, horizontal adduction stretch, submax manual resistance ER/IR, subscap PREs (all <90 deg)

87
Q

what is phase 3 of RC repair healing?

A

12-16 weeks

goals: full ROM, NM control, endurance, return to fxn

intervention: PREs for abduction, flexion, and ER at 45 deg in POS, PREs in ER/IR, deltoid

88
Q

what is phase 4 of RC repair healing?

A

16 weeks to 6 months

goals: return to fxn, prevention

intervention: proprioception and plyometrics, sport-specific training

89
Q

is there greater mobility or stability in the GH jt?

A

mobility

90
Q

what does it mean when a jt is reduced?

A

it is put back in place

91
Q

what is the etiology of GH instability?

A

laxity

mobility>stability

dislocation/subluxation

92
Q

how is GH instability classified?

A

by frequency, magnitude, direction, and origin

93
Q

what is the indicidence of GH instability?

A

anterior (80%) >inferior>posterior

94
Q

what is the reoccurrence rate of GH instability in people older than 40?

A

15%

95
Q

what is the reoccurrence rate of GH instability in people older than 30?

A

> 79%

96
Q

why is the incidence of GH instability less as you age?

A

bc you do less provocative motions as you age and the jts stiffen

97
Q

85% of anterior dislocations involve RCT in people older than…

A

40 y/o

98
Q

t/f: a tight posterior capsule may cause the shoulder to go forward?

A

true

99
Q

what are the special tests for GH instability?

A

(+) apprehension

(+) relocation

(+) sulcus

100
Q

what is the apprehension sign?

A

put the pt in supine and take them into abduction and ER

(+)=pt acts scared and freaks out about the shoulder popping out

101
Q

what is the relocation sign?

A

put pressure on the apprehension sign and the pt feels better

used to keep the glenoid in the fossa

102
Q

what is the sulcus sign?

A

purpose: inferior GH instability testing

pt position: sitting w/arm at their side

PT position: next to the pt

procedure: palpate the superior aspect of the GH jt w/ inferior distraction for the humerus

interpretation: (+) if >1 finger gap is noted

103
Q

when would conservative intervention be used?

A

in the protective phase

104
Q

what are conservative interventions used with GH instability?

A

mobilization of the post and info capsules

scratch the post cuff (sleeper stretch)

PREs for RC

normalize ST, AC, SC mechanics

105
Q

what does TUBS stand for?

A

Traumatic Unidirectional instability w/Bankart lesion requiring Surgery

106
Q

what is a Bankart lesion?

A

avulsion of the anterior labrum from the glenoid rim that requires surgery

3-6 o’clock tear

107
Q

what is a Hill-Sachs lesion?

A

compression fx of the posterior humeral head where the head is impacted in the inferior glenoid rim

108
Q

what does a Bankart repair involve?

A

reattachment of labrum and GH to anterior glenoid

detachment and reattachment of the subscap

tightens the anterior capsule

arthroscopic

109
Q

what are the phase 1 Bankart rehab guidelines?

A

0-4 weeks

goals: pt education, control pain, ROM

post op day 1: precautions, pendulums, distal AROM, grip strengthening, and ice

post op day 7-10: stretch for flexion, ER at 45 deg in POS (no >30 deg)

110
Q

what are the phase 2 Bankart rehab guidelines?

A

4-6 weeks

goals: normalize GH, ST arthrokinematics, increase strength

interventions: stretch ER/IR, horizontal adduction, flexion to 90 deg, manual resistance for stabilization, PREs for IR/ER/extension, shrugs, retractions

111
Q

what are the phase 3 Bankart rehab guidelines?

A

6-12 wks

goals: increase strength RC, delta, ST muscles, PREs in provocative positions, body blade progression, plyoball (chest pass)

112
Q

what are the phase 4 Bankart rehab guidelines?

A

12-16 wks

goals: return to fxn

intervention: OH bodyblades, plyoball throwing, sport-specific training

113
Q

what is the MOI of TUBS?

A

ER w/abd

114
Q

what motions are limited in TUBS?

A

ER w/abd

115
Q

what are the special tests for TUBS?

A

(+) sulcus

(+) apprehension

(+) apprehension w/rot

116
Q

what does AMBRI stand for?

A

Atraumatic, Multidirectional instability, Bilateral, Rehab, Inferior (ant) capsular shift

117
Q

what is the hx of AMBRI?

A

“born loose”

general instability

systemic laxity

118
Q

what is the CC of AMBRI?

A

pain

feels loose

119
Q

what is the CC of TUBS?

A

pain

120
Q

what is the hx of TUBS?

A

trauma

121
Q

what are the comorbidities of AMBRI?

A

posterior systemic laxity

122
Q

what are the ROM limitations in AMBRI?

A

too much motion

pain and instability with ER and abd

123
Q

what are the special tests for AMBRI?

A

(+) sulcus

(+) apprehension

(+) apprehension with relocation

possibly (+) HK and Neer

124
Q

what is the MOI of Bankart tears?

A

dislocation: ant and inf

tackle injury

125
Q

what are the ROM limitations in Bankart lesion?

A

ER

abduction

(especially when combined)

126
Q

t/f: AMBRI has impingement-like symptoms with abd and ER

A

true

127
Q

t/f: AMBRI may results in degenerative arthritis or RCT

A

true

128
Q

what does the “pants over vest” mean with AMBRI?

A

the loose tissue will be folded over itself and tightened

129
Q

what can be done for AMBRI?

A

“pants over vest”

closure of the rotator interval b/w the subscap and supraspinatus

130
Q

is surgery or conservative management more effective in AMBRI?

A

conservative management

131
Q

what is phase 1 of rehab for capsular shift?

A

0-4 wks

goals: independent w/precautions and HEP, control pain, ROM

post op day 1: precautions, pendulums, distal AROM, ice

132
Q

t/f: you may be happy with losing some ROM in AMBRI management to prevent future injury

A

true

133
Q

what is phase 2 of rehab for capsular shift?

A

4-6 wks

goals: normalize GH, ST arthrokinematics, increase strength, decrease pain

intervention: stretch flexion, ER in POS, manual resistance for GH, ST stabilization, shrugs, retractions, bodyblade

134
Q

what is phase 3 of rehab for capsular shift?

A

6-12 wks

goals: increase strength RC, delta, increase strength ST, biceps, triceps, forearm muscles, PREs in provocative positions

intervention: stretch for extension, IR, horizontal adduction, PREs for abduction, flexion at 45 deg in POS, non-provocative bodyblades and progress to functional positions, plyoball progression (chest press)

135
Q

what is phase 4 of rehab for capsular shift?

A

12-16 wks

goals: return to fxn

intervention: OH bodyblades, plyoball throwing, sport-specific training

136
Q

what is a SLAP lesion?

A

SubLabral tears Anterior to Posterior (10-2 o clock) at the origin of the biceps tendon

137
Q

is the superior or posterior labrum most susceptible due to its mobility and close association w/the LHB tendon?

A

superior

138
Q

what lesion is due to FOOSH, sudden traction forces, and instability?

A

SLAP lesion

139
Q

what does FOOSH stand for?

A

fall on an outstretched hand

140
Q

what is the MOI of SLAP lesions?

A

FOOSH (31%)

traction-dislocation (19%)

instability

tackle

throwing

lifting (16%)

141
Q

what are the special tests for SLAP lesions?

A

(+) O’Brien’s
(+) Crank
(+) Biceps load

142
Q

what is an O’Brien test?

A

resist shoulder flexion and IR, then flex and ER

(+)=pain and weakness more with IR than ER

143
Q

what is the pain associated with SLAP lesions?

A

non-specific pain

clicking and grinding sometimes

144
Q

is a SLAP lesion a dx of exclusion?

A

not necessarily

145
Q

what is the crank test?

A

pt is seated and shoulder is at 160 deg flexion

add compression with IR and ER

pain with clicking/crunching

146
Q

what is the biceps load test?

A

lay pt in supine w/shoulder in ER and abduction

resist elbow flexion and forearm supination at the same time

(+)=pain with resistance

can also pronate them and extend the elbow to stretch the biceps instead of contracting

147
Q

what does it mean to cluster test?

A

to do several tests together to have a higher deg of confidence that a condition may be present

148
Q

what is the dx and intervention for SLAP lesion?

A

similar to RC and instability

special tests for the labrum

address the underlying instability

labral repair has more favorable outcomes than debridement

address secondary impairments

149
Q

what is the systemic etiology of adhesive capsulitis?

A

diabetes

hypothyroidism

hyperthyroidism

hypoadrenalism

150
Q

what is the extrinsic etiology of adhesive capsulitis?

A

cardiopulmonary disease

cervical disc disease

CVA (from not as much shoulder movement)

humeral fx

Parkinsonism

151
Q

what is the etiology of adhesive capsulitis?

A

RC tendinitis

RC tears

biceps tendinitis

calcific tendinitis

AC arthritis

152
Q

what is the hx adhesive capsulitis?

A

insidious

minor injury

153
Q

what is the CC of adhesive capsulitis?

A

pain

stiffness

loss of ROM

154
Q

what is the MOI of adhesive capsulitis?

A

insidious

minor injury

155
Q

what are the comorbidities of adhesive capsulitis?

A

women over 40

post menopause

DM

hypo/hyperthyroidism

hypoadrenalism

hx of CVA

156
Q

what is the general etiology of adhesive capsulitis?

A

capsule goes through inflammatory process for some reason and can’t lift the arm anymore

cascade of inflammation w/subsequent fibrosis

157
Q

what is primary adhesive capsulitis?

A

idiopathic and progressive

gradual loss of ER

progressive loss of fxn

inflammation and pain w/muscle guarding

compensatory scap movement (kicks in a lot earlier)

resolution of pain w/stiff shoulder

158
Q

what is secondary adhesive capsulitis?

A

substantial restriction of both AROM/PROM that occur in the absence of pathology

pain>ROM loss (self-limiting w/recovery in 6-12 months)

pain=ROM loss (capsular pattern and may require injection)

159
Q

what are the 3 phases adhesive capsulitis?

A

freezing, frozen, thawing

160
Q

in the capsular pattern with adhesive capsulitis, what is the order or loss of ER, abd, IR

A

ER>abd>IR

161
Q

what are the risk factors for adhesive capsulitis?

A

female

> 40 y/o

trauma

DM

prolonged immobilization

thyroid disease

stroke

MI

psychosocial overlay

autoimmune disease

post-menopausal

162
Q

what is stage 1 adhesive capsulitis?

A

mild impingement-like symptoms

<3 months

empty>capsular end feel

development of capsular pattern (ER>abd>IR)

163
Q

what is stage 2 adhesive capsulitis?

A

TTP over anterior shoulder w/radiation into deltoid insertion

improved pain but no change in ROM post injection

decreased ROM in all planes

loss of capsular volume

164
Q

what is stage 3 adhesive capsulitis?

A

9-14 mo

severe pain stage w/resolution into extreme stiffness

poor SH rhythm w/UT dominance

decreased inferior GH glide

165
Q

what is stage 4 adhesive capsulitis?

A

“thawing stage”

some return of motion

capsular end feel and pattern

radiographs reveale disuse osteopenia, MRI shows increased perfusion to synovium

166
Q

what is the goal of intervention with adhesive capsulitis?

A

controlled stress to restricted tissues through mobilization and stretching

167
Q

when will self-limiting adhesive capsulitis return to full mobility with intervention?

A

18 months-3 years (at 7 years, 30% decreased mobility, 50% pain and stiffness)

168
Q

t/f: success of corticosteroid injections for adhesive capsulitis depends on duration of symptoms

A

true

169
Q

what is the point of corticosteroid injections for adhesive capsulitis?

A

to limit synovitis and subsequent fibrosis

170
Q

when is MUA used in adhesive capsulitis?

A

when conservative measures fail except for osteopenia, recent RCT repair, fx, neurologic injury, and instability

171
Q

what is MUA and MUGA?

A

manipulation under anesthesia

manipulation under general anesthesia

used to break up adhesions

DPT 516 (14 decks)

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