Flashcards in Shoulder Diagnosis and Treat Deck (29):
What's the main difference between medical and physical therapy based diagnosis?
Medical is health condition based, PT is body function and structure based.
What general concepts are important to consider (according to Reinold) with procedural intervention?
1. Need to address multi-systems (vitals, vascularity, senses, motor control)
2. Interventions are frequently multi-phasic (progression)
3. Patients’ anatomy, pathoanatomy, biomechanics, and impairments are key factors
Many factors impact intervention, name 5 (in no order of importance).
1. Pre-morbid status
2. Acuity level; nature/stage of healing
Callus -2-3 weeks
Clinical Union - 4-6 weeks
-no structures moving; different than radiological union
Consolidation - 6-8 weeks
-more maturation and resistance to force
3. Barriers or hindrances to healing
4. Patient reactivity level; pain, muscle guarding, effusion, edema
-pain before / after intervention
5. Patient goals
When thinking about intervention, you obviously want to address the MOST important impairment first. What 3 other elements are key considerations (eluding to intervention structure)?
1. Which of the patient’s impairments should be first addressed?
2. Which of the four muscle performance and movement control factors above should be addressed with this patient?
-tissue specificity is important to consider
During intervention, it's necessary to have the appropriate response to the phase of healing. Early on, maximal protection is required. How about intermediate and advanced stages of healing?
Moderate protection and return to function respectively.
Where in the available ROM are joint mobilizations done? How many oscillations and how long for treatment?
At the end of range.
If oscillating use 2-3 oscillations per second for 30-60 seconds, rest one minute, reassess, repeat until maximum gain or patient fatigue (change position, grade, and/or technique if not providing expected benefits)
There are only 3 grades of Kaltenborn mobilizations. What are they?
I: very slight distraction
II: up to the first tissue stop
III: past the first tissue stop into the plastic range
T of F. Oscillations are used all the time?
No, only with treatment.
Does a grade II Maitland go up to the 1st tissue stop? What about a grade IV?
No, II is below the first tissue stop. A grade IV oscillates above first tissue stop.
When doing mobilization with movement, describe the procedure you would take with GH ER and the parameters.
Patient in prone, working on anterior GH capsule. Put arm into maximal ER and apply anterior glide moving in and out of ER as you mobilize.
-30 to 60 seconds of movement
-stop, break and reflect
-did the patient react well?
-is it affecting movement?
-after 2/3/4 times there should be some advancement or gain in motion
-start at the end of the range
What glide direction does active ABD take the shoulder in?
When approaching interventions, what is the most common angle biomechanist take? What's another approach?
Body structure and function (impairment level)
You could approach intervention from an Activity (function) level. Either the exercise used for body structure and function will help regain their function of the actual intervention is functionally (task or part task) based.
Ultimately, participation level gains are what people want. How would you reflect this in your goals?
By stating that the job isn't done until the patient has regained x,y,z in participation level need.
What is practice pattern 4A and give an example of an impairment, joint mob, STM, TherEx and modality.
Young female athletes: amenorrhea
-AAROM > AROM > PROM
What is practice pattern 4B and give an example of an impairment, joint mob, STM, TherEx and modality.
-spasm of SCM creating a spasms with flexion and side rotation of the neck
-thoracic outlet syndrome
-Gr III and IV glides, III distractions
-Superficial and deep MFR
-flexibility > open chain
What is practice pattern 4C and give an example of an impairment, joint mob, STM, TherEx and modality.
With prolonged immobilization
-decreased tissue moisture
-increased cross linkages
What is practice pattern 4D and give an example of an impairment, joint mob, STM, TherEx and modality.
1. Joint subluxation or dislocation
2. Ligamentous sprain
What is practice pattern 4E and give an example of an impairment, joint mob, STM, TherEx and modality.
-Cryotherapy, phonophoresis, electrotherapy
What is the typical progression (rough outline) for TherEx?
1. AAROM ,AROM, RROM
2. SHRC/AI/RS, SRH, Agonist Reversals/PRE/Tband,Isokinetic ex
3. Open and closed chain activities
4. Stretch - Shortening Activities leading to muscle power gains
5. Concentric and eccentric control
6. Functional Activities
What would a generic intervention template for hypomobility look like?
Joint mobilization techniques
All glides (Gr. III &IV) & Distrx (Gr. III)
Self mobilization techniques
Soft tissue techniques
STM – superficial and deep techniques
PROM and AAROM ® AROM
Flexibility techniques - HRAC, CR, CRAC
Open and closed chain mobility exercises
Concentric and eccentric control throughout ROM
Thermal – continuous US, HP
Preparation/compliance of tissue
What would a generic intervention template for hypermobility look like?
AAROM ® AROM ® RROM (SHRC/AI/RS SRH/agonist reversal/Tband/PREs ® Isokinetic exercise
Use closed and open chain techniques
Supported and unsupported positions
Orthotic, Protective, Supportive devices
What would a generic intervention template for muscle weakness look like?
Reinstitution of correct scapulohumeral rhythm and control
Address posture dysfunction
TherEx (performed in straight and diagonal planes of movement)
AAROM ® AROM ® RROM
SHRC/AI/RS ® SRH, Agonist Reversals/PRE/Tband ® Isokinetic ex
Open and closed chain activities
Stretch - Shortening Activities
Concentric and eccentric control
Home, avocational, recreational training
Small components into full action/motion
Slower to faster speeds
During intervention, it's possible to give different types of feedback. What are they?
1. Manual correction
2. Tactile feedback
3. Verbal Cues
4. Fade feedback progression
What is practice pattern 4G and give an example of an impairment, joint mob, STM, TherEx and modality.
In clinical decision making, what must occur before anything else?
Identify the problem: PIP and nPIP.
-Next, impairments must be prioritized and interventions planned for each
What is practice pattern 4H and give an example of an impairment, joint mob, STM, TherEx and modality.
Most important factors: prosthetic components
-prosthetic fixation methods
With proximal humeral fractures (PHF), healing of what is predictive of the outcome following a hemiarthroplasty?
Healing of the greater and lesser tubercles.
What is practice pattern 4I and give an example of an impairment, joint mob, STM, TherEx and modality.
Bony or soft tissue surgery
-Connective tissue repair or reconstruction
ISSUES TO CONSIDER
-Post-op tissue integrity
-Time since surgery