shoulder Flashcards
(92 cards)
1
Q
compression and resultant damage to soft tissue structures within the shoulder region
A
impingement syndrome
2
Q
most common sites of impingement of shoulder
A
-b/w inferior acromion and superior humeral head
-space is narrowed during GH abduction
3
Q
tendons most commonly entrapped in impingement syndrome
A
supraspinatus
infraspinatus
Long head Biceps
4
Q
primary external impingement
A
-abnormalities in superior structures
-diminished subacromial space
-causes congenital (os acromiale), osteophytes, thickening of subacromial arch
- older 35
5
Q
secondary external impingement
A
-excessive downward angulation of acromion secondary to inadequate muscle stabilization of scapula
-anterior and inferior movement of acromion encroaches into subacriomial space
- younger 35
-younger athletes
-
6
Q
internal impingement
A
increased joint instability results in posterior impingement
-underside cuff rubs against labrum causing friction
-baseball pitchers, tennis players
7
Q
external impingement pain where
A
anterior and lateral
8
Q
internal impingement pain where
A
posterior
9
Q
impingement syndrome weakness where
A
RC muscles
scapular control muscles (SA and Levator)
10
Q
external impingement pain in ____ and ____
A
flexion and abduction
11
Q
internal impingement pain increased ____ and decreased ____ rotation
A
increased ER and decreased IR when range is tested at 90 degrees of abduction
12
Q
coracoid impingement pain
A
horizontal adduction
13
Q
rehab for shoulder impingement
A
-develop scapular stabilizers
-progress ICE rotator cuff exercise
-sport specific training
14
Q
rehab shoulder impingement:
isotonic (fixed weight) more preferable
free weight resistance better than over band resistance
A
15
Q
loss of muscle integreity to one of the four RC
A
rotator cuff tear
16
Q
most common muscle to be affected in RC tear
A
supraspinatus
b/c most prominent muscle and tendon in subacromial space
17
Q
local pain, mild swelling, ecchymosis, tenderness; mild tightness or spasm locally. minimal loss of ROM
A
grade 1 - subacromial bursitis/ tendonitis
18
Q
symptoms similar to grade 1 but more pronounced
A
grade II: partial RC tear
19
Q
severe loss of ROM and strength, significant swelling and ecchymosis
A
grade III- full thickness tear of RC
20
Q
age of RC tear acute
A
acute and traumatic (any age)
21
Q
age of RC tear chronic and degenerative
A
> 50
22
Q
chronic and repetitive ____ impingement can cause RC tear
A
subacromial
23
Q
_____ injury:
any undue stress or strain on the tendon that occurs with overhead throwing, FOOSH, lifting heavy objects
may be associated with fractures, dislocations, sublux
A
acute
24
Q
____ injury:
chronic and persistent subacromial impingement such as occurs with repetitive overhead motions
A
degenerative
25
RC tear S&S
_____ deltoid/arm pain
point tender pain at _______
diffuse ______ pain
diffuse thoracic/ interscapular pain
lateral deltoid/arm pain
point tender pain at greater tub
diffuse Upper trap pain
diffuse thoracic/ interscapular pain
note: if shoulder is irritable may cause peripheral numbness or tingle from impingement through shoulder complex --> peripheral distribution and shoulder instability
26
will acute recruitment of a torn supraspinatus cause pain
yes
27
prolonged activities that promote ____ shoulder will facilitate early subacromial impingement and cause pain when moving into elevation
forward
note:
overhead activities
lifting objects
hand behind back
computer work
lifting
28
RC tear easing activities:
out of aggravating position
activities and movements that facilitate _______
RICE
NSAIDS
shoulder in ____ and ____ (loose packed position)
scapular retraction
adduction/internal rotation
29
surgeons recommend _____ treatment for pts who are most bothered by pain ,rather than weakness because strength does not improve without surgery
nonsurgical
30
RC tear:
predictors of poor outcome for nonsurgical treatment
long duration of symptoms more than 6-12 months
large tears more than 3 cm
31
disadvantage of nonsurgical treatment for RC tear
-strength may not improve
-tear may increase in size over time
-pt may need decrease activity level
repair may be indicated
32
prehab for RC tear
once the inflammation process has decreased, focus on increasing ROM and strength
_____ROM
scapular _____
joint mobilization and myofasical release
progressive pain free muscle strengthening
prehab for RC tear
once the inflammation process has decreased, focus on increasing ROM and strength
AAROM ROM
scapular retraction
joint mobilization and myofasical release
progressive pain free muscle strengthening
33
Post op -RC tear
RC repair typically are _____ an no AROM for _____ weeks after surgery
immobilized; 4-6 weeks
34
post op RC tear
rehab start _____ weeks post op
PROM ____ and _____
AROM initiated from 1-4 weeks depending on irrtiability
1-4 weeks
flexion and ER
35
RC tear
once the patient has been removed from AROM restrictions, progressive strengthening begins with ______ and progresses as appropriate
isometrics
36
Rc tear
_______ mobilization can being early
-improves scapulohumeral rhythm
-decreaes UT tone and allow for muscle balance
scapular
37
what positions after RC repair cause most strain on graft and be avoided in early stages of PROM
ext, IR, hand behind back
38
early PROM of _____ and _____ rotation
elevation and ER
39
an acute inflammatory disorder
in response to trauma body produces inflammation that irritates biceps tendon
tendonitis
40
a degenerative disorder
-accumulation of microtrauma
tendinosis
41
is tendinitis a precursor of tendinosis
yes
42
the injury of the biceps tendon as it runs in the intertubercular groove
biceps tendinopathy
43
loss of continuity of biceps tendon and usually occurs at long head of biceps
tendon rupture
44
biceps ________ is suscpetive to overuse injuries
musculoskeletal junction
45
biceps tendinopathy is rarely seen in isolation and typ found with co morbid RC pathology, subdeltoid bursitis and GH instability t/f
T
46
MOI of bicep tendon pathology
-repetive overhead activity
-resisted shld and elbow fleixon involves load greater than physiological strength of myotendinosis complex
-pop in arm
-humeral head translate anteriorly and superiorly and impinging biceps tendon
47
anterior GH pain
usually near ____ groove
exaerbated at ___ onset of activities
activity _____
may radiate to _____
noctural pain may occur
anterior GH pain
usually near bicipital groove
exaerbated at iniital onset of activities
activity dependent
may radiate to elbow
noctural pain may occur
48
biceps tendon pathology
aggravating activities
-activities requiring shoulder ____, elbow ____,_____
-lifting overhead
-repetitive lifting and carrying
-reaching behind back
shoulder flexion, elbow flexion, and supination
49
surgery reapproximation in cases of tendon rupture but since it occurs in mostly elderly surgery is not common place t or f
t
50
surgery is _____ indiciated for tendinosis and tendonitis
not
51
bicep tendon pathology
full recovery is anticipated in ______ weeks for tendonitis
6-8 weeks
52
exercises that promote pulleys or peduculum exercises are good for what pathology
bicep tendon pathology
53
cross friction massage to tendon
release of muscles that prevent normal Scapulothoracic and GH motions
joint mobilization may be used to stretch posterior and inferior cuff to allow normal GH joint mechanics
what phase acute or subacute
subacute rehab
54
for biceps tendon pathology should you focus on stabilizing the GH and preventing anterior translation of humeral head before normalzing scapulo rhythm
yes
55
biceps tendon pathology
closed or open chain first
closed
56
tear or distruption to labrum of shoulder
labrum tear
57
labral tears are classified as
SLAP (superior labrum anterior to posterior)
bankart
posterior labral lesion
58
labral tears:
tears of the anterior or inferior portion of labrum usually from 2-6 o clock on shoulder
bankart
59
labral tears:
bankart are associated with ____ shoulder dislocations or sublux
anterior
60
labral tears:
bankart are associated with ______ which are bone divots in the humeral head caused by blunt trauma from the dislocation of humeral head on glenoid fossa
hill sachs lesion
61
labral tears:
____ associated with internal impingement of shoulder
posterior labral tears
note: in hypermobile shoulders at end range ER supraspinatus folds on itself and impinge between greater tub and posterior superior labrum and cause labral tear
62
labral tears MOI
FOOSH
overhead activities such as throwing or swimming --> younger
traction injuries
direct blow to humerus
dislocation of shoulder
____ impingement
degenerative process often associated with poor vascular supply -->older
internal
63
labral tear
Aching of the shoulder region.
▪ Feeling of ______
▪ ______ with motion.
▪ ______of the shoulder with movement.
▪ Diffuse ______ pain.
▪ Diffuse thoracic pain.
▪ If the shoulder is irritable, it may cause peripheral numbness or tingling caused by
impingement of nerves through the shoulder complex.
▪ Symptoms will have a peripheral distribution, which is usually correlated with shoulder irritability.
Aching of the shoulder region.
▪ Feeling of instability.
▪ Clicking or popping with motion.
▪ Catching of the shoulder with movement.
▪ Diffuse upper trapezius pain.
▪ Diffuse thoracic pain.
▪ If the shoulder is irritable, it may cause peripheral numbness or tingling caused by
impingement of nerves through the shoulder complex.
▪ Symptoms will have a peripheral distribution, which is usually correlated with shoulder irritability.
64
labral tear easing postion
Shoulder adducted/internal rotated (loose
packed position)
65
90/90 shoulder position and inferior traction should be minimized with ___ lesions
bankart
66
Most protocols after a SLAP lesion repair will call for no PROM into ______ and no bicep ___ROM resisted for 4 weeks.
Most protocols after a SLAP lesion repair will call for no PROM into external rotation and
no biceps AROM resisted for 4 weeks.
67
A ____ repair will call for no external rotation past 30 degrees and no resisted biceps for 4 weeks.
A ____ repair will call for no external rotation past 30 degrees for 4 weeks.
SLAP
Bankart
68
when does outpatient rehab start for labral tears
1-4 weeks postop
69
labral tears
Strengthening exercises begins with _____ and progresses as appropriate, usually
after 2 to 4 weeks.
Strengthening exercises begins with isometrics and progresses as appropriate, usually
after 2 to 4 weeks.
70
Laxity of the shoulder joint capsule results in the humeral head having difficulty
maintaining its articulation within the glenoid
shoulder instability
71
Overhead sport athletes (i.e., swimmers and volleyball or baseball players) and
patients with a history of dislocations/subluxations are the patient populations most
likely to present with _____
shoulder instability.
72
most dislocations for shoulder instability occur ages _____ and over ____
11-13 over 50
73
younger or older people have more shoulder instabiity
younger adolescent group is more likely to have shoulder instability because
they are more active and tend to have poor technique and adequate strength with
sports.
▪ The older group is more likely to have shoulder instability because they are at higher
risk for falls.
59
74
Shoulder instability can develop as the result of trauma. Usually, trauma will result in _________. Laxity in most cases is felt in the anterior aspect of the joint. The typical unidirectionally unstable shoulder usually occurs after a shoulder dislocation or shoulder subluxation
unidirectional instability
75
Shoulder instability that is multidirectional may be the result of a _______ toward joint laxity. Generally, laxity is experienced in both shoulders,
as well as other joints in the body
genetic
predisposition
76
Generalized shoulder pain that can radiate down ______
▪ Patient will commonly complain of weakness in the shoulder and may complain of _____ with shoulder motion.
▪ Neural irritation is not uncommon in conjunction with shoulder instability.
▪ There can be sensory loss, numbness or tingling, weakness, or complete palsy, within a peripheral
nerve distribution.
61
into the deltoid region of the
shoulder.
clicking or grinding
77
The GH joint capsule becomes inflamed and stiff, developing adhesions
adhesive capsulitis
78
The process greatly restricts GH movement, significant restriction of _____ ROM and is hallmarked by severe chronic pain and functional impairment.
active and passive
79
primary adhesive capsulitis
adhesive capsulitis begins insidiously and without a clear mechanism of
injury.
▪ While chronic inflammation, autoimmunity, and other systemic causes have been hypothesized as
causes for primary adhesive capsulitis, objective data supporting these theories are lacking.
▪ Parallels have been drawn to Dupuytren's contracture, with regard to histological changes in the
connective tissue
80
secondary adhesive capsulitis
adhesive capsulitis occurs in response to trauma or other precipitating
event.
▪ These events often include rotator cuff impingement, bursitis, AC separation, or neuritis.
81
adhesive capsulitis occurs between ___ decades
4-6
82
contralateral adhesive capsulitis typically occur within ___ years of initial onset of symptoms in the first shoudler
5
83
t/f Patients with type 2 diabetes have a 40% chance of developing adhesive capsulitis
in their lifetimes
t
84
____thyroidism
____triglyceridemia area associtaed with increase risk of adhesive capsulitis
Hyperthyroidism and hypertriglyceridemia are also associated with elevated risk.
85
hallmark sign of adhesive capsulitis
noctural pain
Painful, restricted GH AROM
▪ Pain in the deltoid region
▪ Pain both at rest and with activity
▪ Nocturnal pain is a hallmark sign
▪ Progressive stiffness
▪ Some patients will experience pain and stiffness on awakening and after prolonged
periods of inactivity.
86
Insidious, predominantly nocturnal pain
▪ Typically, no clear precipitating factor
▪ Pain in deltoid region
▪ Aggravated with movement to end-ranges
▪ May have pain with rest
▪ ROM is minimally restricted
▪ Elastic GH joint end-feel
▪ Stage/phase I lasts 2 to 9 months
73
the painful phase
87
Pain associated with stage/phase I may persist but is normally diminished
▪ Progressive ROM limitations in capsular pattern
▪ Activities of daily living (ADLs) are severely affected
▪ Pain in deltoid region and possibly into wrist
▪ Pain with or without movement
▪ Elastic or abrupt GH end-feel
stage II the frozen or adhesive phase
88
Pain progressively decreases
▪ ROM progressively increases over 12 to 24 months
▪ Pain into ____
▪ Pain ____ movement
▪ Abrupt GH end feel
▪ Unable to lay sidelying
stage III thrawing or regressive phase
Pain progressively decreases
▪ ROM progressively increases over 12 to 24 months
▪ Pain into wrist
▪ Pain without movement
▪ Abrupt GH end feel
▪ Unable to lay sidelying
89
codman pendulum exercise
adhesive capsulitis
90
adhesive capsulitis
▪ _______ stretching recommended, particularly performed in closed chain
▪ ______ GH joint AROM
▪ Scapular exercises
Active assist ROM (AAROM) stretching recommended, particularly performed in closed chain
▪ Isometric GH joint AROM
▪ Scapular exercises
78
91
primary scapular stabilizers
-SA
-rhomboids
-Traps
-Levator Scapulae
92
secondary scapular stabilizers
-lats
-pec minor
