Shoulder Flashcards
(107 cards)
1
Q
T/F: With non-traumatic shoulder instabiltiy an apprehension test will be negative.
A
True
1
Q
Q: What is an assistive device plan for SLAP lesions?
A
Sling when acute
1
Q
Defn: Primary Impingement (2)
A
- Structures that occupy the subacromial space
- Causes the impingement
2
Q
Content: Stage 3 of impingement syndrome (2)
A
- Marked by more chronic changes (partial/complete tear) of rotator cuff
- Pts. > 40 yo
2
Q
Q: What is an education plan for frozen shoulder?
A
Explain the nature of the disease and prepare pt. for extended recovery
3
Q
Q: What is an assistvie device plan for shoulder instability?
A
Sling when acute
4
Q
Content: Deep muscles/rotator cuff (4)
A
- Supraspinatus
- Infraspinatus
- Teres minor
- Subscapularis
4
Q
Q: What movements occur at the ST joint?
A
- IR/ER
- Upward/lateral rotation/Downard/medial rotation
- Posterior tilting/Anterior tilting
4
Q
Q: For what degrees of motion does elevation through abduction occur?
A
170-180
4
Q
Term: A mechanical impingement of the subacromial structure, esp. the rotator cuff tendons, beneath the atnerior-inferior poriotn of the acromion
A
Impingement syndrome
4
Q
Content: Intrinsic classification of impingement syndrome (4)
A
- Primary or secondary
- Rotator cuff weakness
- Overuse of the shoulder
- Degerenative tendinopathy
4
Q
Defn: Intrinsic Impingement
A
Intratendinous
5
Q
Content: Stages of Adhesive Capsulitis - Pain (4)
A
1: w/AROM & PROM
2: Chronic pain w/AROM & PROM
3: Min pain except at end ROM
4: Min pain
5
Q
Content: Stages of Adhesive Capsulitis - Pathologic changes (3)
A
1: Hypertrophic, hypervascular synovitis, rare inflammatory cell infiltrates, normal underlying capsule
2: Hypertrophic, hypervascular synovitis with perivascular and subsynovial scar, fibroplasias and scar formation in the underlying capsule
3: “Burned-out” synovitis without significant hypertrophy or hypervascularity. Underlying capsule shows dense scar formation
5
Q
Defn: Subacromial space
A
Coracoacromial arch: coracoacromial ligament or coracoid process and greater tuberosity of the humerus
6
Q
Term: Biceps anchor peels off from the supraglenoid tubercle with the associated detachment of the labrum extending for a variable distance anteriorly and/or posteriorly
A
SLAP type 2
7
Q
Q: What is an education plan for SLAP lesions?
A
Avoid MOI and overhead activites
7
Q
Q: What is a therapeutic exercise plan for SLAP lesions? (2)
A
- Scapular stabilization exercises
- Posterior capsular stretching
9
Q
Diagram: Identify the 4 joints
A
Left to Right, Top to Bottom
- Sternoclavicular
- Acromioclavicular
- Scapulothoracic
- Glenohumeral
9
Q
Diagram: Ligaments
A
Top to bottom
- Conoid
- Trapezoid (with conoid = coracoclavicular
- Acromioclavicular
- Coraco-acromial
- Coraco-humeral
- Transverse humeral
- Superior GHL
- Middle GHL
- Inferior GHL
10
Q
Q: What is a HEP plan for shoulder instability?
A
Follow the presribed TherEx
11
Q
Q: What is a modalities plan for shoulder instability? (3)
A
- Ice,
- Electrical currents
- Diathermy (SWD)
12
Q
Q: What effects does diathermy have?
A
Effects similar to subacromial corticosteroid injecitons
13
Q
Q: For what degrees of motion does IR occur?
A
60-100
13
Q: If your scapula is anteriorly tilted you stretch ____________ and strengthen \_\_\_\_\_\_\_\_\_\_\_.
Pectoralis minor, lower trap
13
Content: MOI for shoulder impingement (8)
1. Age
2. Position of the arm during activites
3. Repetitive overhead
4. Muscle imbalances
5. Capsular tightness
6. Postural imbalance
7. Structural asymmetry
8. Impaired scapular kinematics
14
Q: What are the symptoms of non-traumatic shoulder instabiltiy?
1. Tendinitis
2. Sensation of instability and laxity
15
Q: Which SLAP classification is most common?
Type 2
16
Q: For what degrees of motion does adduction occur?
50-75
16
Term: Flap tear of anterior labrum with detrachment of biceps anchor
SLAP type 6
17
Q: What are the symtpoms for traumatic shoulder instability?
Recurrent shoulder dislocation (chronic phase)
18
Content: MOI for SLAP lesions (2)
1. Sudden eccentric biceps contraction as in trying to grap an object while falling from a height or a FOOSH
2. Repetitive overhead activity (overhead athletes) - esp. baseball players
19
Q: What is the diagnosis for a pt who is young with repetitive overhead/athletic activity with painful arc symptoms?
Secondary impingement
21
Content: Stage 2 of impingement syndrome (2)
1. Represents irreversible changes (fibrosis/teninitis) of the rotator cuff
2. pts. 25-40 yo
23
Q: What is an assistive device plan for frozen shoulder?
Low load prolonged stress equipment
24
Q: What is an manual therapy plan for shoulder instability?
Depends on exam findings, may not be applicable
25
Q: For what degrees of motion does elevation through forward flexion occur?
160-180
27
Q: What is the ratio for glenohumeral/scapulothoracic movement?
5:4
28
Content: Stage 1 of impingement syndrome (2)
1. Characterized by edema and hemorrhage of the bursa and cuff
2. Pts. \< 25 yo
29
Q: What is roll and glide for humeral extension?
R = post
G = ant
30
Q: What is roll and glide for humeral horizontal adduction?
R = ant
G = post
31
Q: Why can a pt. not hold up there arm when you perform a drop test?
If the supraspinatus is ruptured, it can not compress the shoulder joint/engage it to allow the deltoid to due it's job.
32
Q: What is laser good for?
Decrease pain and speed the healing process
33
Q: What is an assistvie device plan for a pt. with a shoulder impingement?
sling when acute
34
Q: What is a modality plan for SLAP lesions?
Diathermy (SWD)
35
Term: Inflammed and fibrotic condition of capsuloligamentous tissue
Adhesive capsulitis/frozen shoulder
36
Content: Passive/static glenohumeral stability (5)
1. Bones
2. Cartilage
3. Capsule
4. Labrum
5. Ligaments
37
Content: Stages of Adhesive Capsulitis - Duration of Symptoms (4)
1: 0-3 mo
2: 3-9 mo
3: 9-15 mo
4: 15-24 mo
38
Q: When does scapulohumeral rhythm begin?
After 30 degrees of abduction
38
T/F: With traumatic shoulder instability a apprehension test is negative.
False: positive
40
Term: Bucket handle tear ofthe superior labrum without involvement of the biceps anchor
SLAP type 3
41
Q: What is a therapeutic exercise plan for frozen shoulder?
Stretching: progressive in the amount of stress and time (according with stage) - Hold/relax and LLLD
42
Q: In what ROM does the glenohumeral painful arc occur?
45-60 to 120 and beyond 170 degrees
43
Content: Stages of Adhesive Capsulitis - Examination (4)
1: Pt. under anesthesia - norm/min loss of ROM
2: Pt. under anesthesia - ROM essentially identical to ROM when pt. is awake
3: Pt. under anesthesia - ROM identical to ROM when pt. is awake
4: Data not available
44
Content: Stages of Adhesive Capsulitis - Limitations (4)
1: Forward flexion, abduction, IR, ER
2: Significant limitation of forward flexion, abduction, IR, ER
3: Significant limitation of ROM with rigid end feel
4: Progressive inprovement in ROM
45
Defn: Secondary impingement (2)
1. Structures that DO NOT occupy the subacromial space
2. Instability or neurological disease
46
Q: What is roll and glide for humeral ER?
R = post
G = ant
48
Defn: Adhesive capsulitis or frozen shoulder
Inflammed and fibrotic condition of capsuloligamentous tissue
49
Q: What is a HEP plan for frozen shoulder?
Pendulum and AA exercise 3x/day
50
Q: What is roll and glide for humeral abduction?
R = superior
G = inferior
51
Q: What is a modalities plan for a pt. with a shoulder impingement? (3)
1. Ice
2. Ultrasound
3. Electrical currents
52
Term: The labral tear extends into the biceps anchor na dtendon for a variable distance
SLAP type 4
54
Content: Superficial muscles (6)
1. Deltoid
2. Pectoralis
3. Biceps
4. Trapezius
5. Latissimus dorsi
6. Serratus anterior
56
Q: What is the diagnosis for a pt. \> 40 yo with overuse and painful arc symptoms?
Primary impingement
57
Q: What is roll and glide for humeral flexion?
R = ant
G = post
59
Q: What does SLAP stand for?
Superior Labral tear from Anterior to Posterior
60
Q: What is a modality plan for frozen shoulder? (2)
1. Hotpacks
2. TENS
61
Term: a condition difficult to define, treat, and explain from the point of view of pathology
Adhesive capsulitis/frozen shoulder
62
Q: What is electrical currents good for?
Decrease pain
63
Q: What 3 movements occur at the clavicle?
1. Protraction/Retraction
2. Elevation/Depression
3. Posterior rotation/Anterior rotation
64
Diagram: types of os acromiale
66
Q: What is roll and glide for humeral horizontal abduction?
R = post
G = ant
67
Defn: Extrinsic Impingement
Extratendinous
68
Q: What is roll and glide for humeral IR?
R = ant
G = Post
70
Q: For what degrees of motion does ER occur?
80-90
71
Content: Active/dynamic glenohumeral stability (2)
1. Deep muscles (rotator cuff)
2. Neuromuscular balance between deep and superficial muscles
72
Q: What is name of a traumatic shoulder instabiltiy lesion?
Bankart
73
Q: For what degrees of motion does extension occur?
50-60
76
Q: For what degrees of motion does elevation through the plan of the scapula occur?
170-180
77
Diagram: Classification of frozen shoulder
79
Term: SLAP tear associated with anteriocapsuloligamentous tear involving the middle glenohumeral ligament (MGHL)
SLAP type 7
80
Q: What is a HEP plan for SLAP lesions?
Follow prescribed TherEx
81
Q: What is a manual therapy plan for SLAP lesions?
Depending on exam findings - inferior/anterior glides
82
Q: What is non-outlet impingement syndrome?
Occurs secondary to thickening or hypertrophy of the bursa or the rotator cuff tendons
83
Diagram: SLAP lesions classificaiton
84
Q: What are 4 suggested modalities for shoulder pathologies?
1. Ultrasound
2. Diathermy
3. Laser
4. Eletrical currents
85
Defn: Shoulder impingement syndrome
Term: A mechanical impingement of the subacromial structure, esp. the rotator cuff tendons, beneath the atnerior-inferior portion of the acromion
86
Content: Symptoms of a SLAP lesion (2)
1. Pain
2. Feeling of instability/lack of control (when overhead/abd ER)
87
Q: What is outlet impingement syndrome?
Occurs when the coracoarcomial arch encroaches on the supraspinatus outlet
88
Q: What is SLAP lesion?
Injury to the glenoid labrum
89
Q: What is a therapeutic exercise plan for shoulder instability? (2)
1. Scapular stabilization exercises
2. Rotator cuff strengthening
90
Q: What deficits are seen in baseball players with SLAP lesions?
IR with should in 90 degrees of abduction, which predisposes excessive ER
91
Content: Shoulder impingement differential diagnoses (6)
1. Instability (secondary impingement)
2. Adhesive capsulitis
3. Glenohumeral arthritis
4. Biceps tendonosis
5. Labral pathology
6. Cervical radiculopathy
93
Q: What is the ratio for humeral/scapular movement?
2:1
94
Q: What is an education plan for shoulder instability?
Avoid MOI and overhead activities
95
Q: What ligaments are injuried in a non-traumtic shoulder instability injury?
IGHL and AGHL
96
Term: In degenerate shoulders where there is fraying and roughening of the biceps anchor area
SLAP type 1
98
Q: What is a therapeutic exercise plan for a pt. with a shoulder impingement? (3)
1. Postural corrections
2. ROM/stretching
3. Strengthening
99
Q: What is a manual therapy plan for frozen shoulder? (2)
1. ER with inferior glide (rotator cuff interval - RIC)
2. Posterior glide and maneuvers for general mobility
100
Q: What is a HEP plan for a pt. with a shoulder impingement?
Pendulum exercises and others based on the TherEx program
101
Q: What is ultrasound good for?
Decrease pain and speed healing process
102
Term: SLAP with a bankart lesion
SLAP type 5
103
Q: What 4 tests can be done during a OE to confirm/refute a shoulder impingement diagnosis?
1. Painful arc
2. Neer's test
3. Hawkin's test
4. "Empty can" test
104
Q: What is an education plan for a pt. with a shoulder impingement?
Avoid overhead activities and postitions of shoulder impingement
105
Q: What is a manual therapy plan for a pt. with a shoulder impingement?
Inferior and posterior glides
106
Content: Extrinsic classifcation of impingement syndrome (6)
1. Primary or secondary
2. Shape of the acromion
3. Instability (classic)
4. Degeneration of the AC joint
5. Impingement by the coracoacromial ligament or coracoid process
6. Os acromiale (3 types)
107
Q: What are the symptoms of shoulder impingement syndrome? (2)
1. Pain in the anterosuperior part of the shoulder
2. weakness and stiffness
