Shoulder Eval & Treat Flashcards
(26 cards)
Key Elements of GH Stability
-glenoid fossa
-labrum
-ligaments
-muscles
-mechanoreceptors
Labrum
-fibrocartilage (aneural and avascular)
-doubles depth of glenoid
-chock block on sides
-negative pressure
GH Capsule Volume
Volume:
-Normal: 10-15ml
-Adhesive capsulitis: 5-10ml
-Laxity: 30ml
GH Capsule: Anterior Complex
Superior GH Lig:
-taught w/ arm at side
-supports humeral head and prevents inferior sublux
Middle GH Lig:
-poorly defined in 30% of shoulders
-secondary restraint to anterior translation
GH Capsule: Inferior Complex
Contains: anterior band, posterior band, axillary pouch
-main stabilizer during ABD
-Taut in ABD; fans out in rotation
-hammock-like axillary pouch allows reciprocal tightening on ant and post structures
-posterior band provides stability when ABD and IR
GH Capsule: Posterior Complex
-thin
-most stability from muscles
Shoulder Force Couples
-RTC and deltoid
-Traps and serratus ant
-Ant RTC and post RTC
Sub-Acromial Space
-w/ arm at side 10-11mm/1cm
-w/ elevation= narrows
Scapulo-thoracic Joint
OPP:
-arm at neutral
-scapular 30-45 IR, upward rotation, 5-20 ant tipping
RTC Pathology Factors
-50-70% of shoulder pain
Factors:
-acromion
-RTC muscles
-AC joint
-age
-capsule tightness
-posture
RTC Tear Sizes
Small: <1 cm
Medium: 1-3cm
Large: 3-5cm
Massive: >5cm (subscap involved)
Adhesive Capsulitis Staging + Tx
-12-18 month progression
Stage I: <3m; not noticed
-Tx: pain control
Stage II: 3-9m; freezing; most pain
-Tx: pain control, manual
Stage III: 9-14m; frozen; no pain
-Tx: restore motion
Stage IV: 14+m; thawing
-Tx: restore normal motion; strengthening; NM re-ed
Shoulder Instability: TUBS
Trauma
Unidirectional
Bankart
Surgery
Shoulder Instability: AMBRI
Atraumatic
Multidirectional
Bilateral
Rehab
Inferior (may need surgery)
Tx:
-ant easiest; multi hardest
-avoid end ranges initially
-avoid long lever initially
GH Traumatic OA
->45yrs
-MOI: bony morphology changes after trauma
-might need TSA/RTSA
Clavicle Fx
-most commonly Fx in CHILDHOOD
-MOI: FOOSH or blow
Proximal Humerus Fx
-most common humeral Fx in children and elderly
-MOI: FOOSH or blow
Tx:
-Conservation: immobilization
-Surgery: TSA/RTSA if severe
Scapular Fx
-MOI: Fall, MVA, blow
Principles of Conservative Shoulder Rehab
- Tx determined by stage and irritability
- Tx in scapular plan to inc function
- Stabilize scapula 1st
- Short levers are easier
- Don’t push past pain
- Mimic functional needs
- Tx proximal to distal (T-spine> Scap> Humeral head)
Acute Phase Healing Goals
-Protect healing
-dec pain
-restore ROM
-slow muscle atrophy
-maintain fitness
-global strengthening
Tx:
-table exercises
-AROM
-walking
-modalities to dec pain
To progress to subacute:
-tissue healing
-pain free ROM >120 elevation
-strength in surrounding areas >4/5
-scapular control
Subacute Phase Healing Goals
-Pain free full ROM
-muscle strength to normal
-NM control
-restore force couples
-prevent chronicity
-recategorize
-correct form> rep #
Tx:
-CKC
-functional training
Surgical Repair: RTC
-24-52 weeks
-done after 12 weeks of failed conservative Tx
Goals:
-don’t overwork RTC
BP Injuries: Spinal Accessory N.
-lesion at GH
-clavicle of scpular Fx
-CN XI and C3-4
BP Injuries: Suprascapular N.
-scapular lesion
C5-C6
