Upper Extremity - Management/Evaluation

Question 1

Subacromial Pain Syndrome

Answer 1

44-65% of all conditions that cause shoulder pain
- relative overuse (sports, manual labor)
- anterior/lateral shoulder pain worse at night
- painful arc or pain with motions at or above shoulder height
- limited GHJ mobility
- Kyphotic posture
- decreased pec minor length
- scapular weakness or motor control deficits

Question 2

tests for subacromial pain syndrome

Answer 2

Hawkins sign, neer sign, jobe test, painful arc, weakness in ER

Question 3

Grade of mobilizations for Subacromial pain syndrome

Answer 3

Gr III-IV (at end ROM if low irritability)

Question 4

Manual therapy for Subacromial pain syndrome

Answer 4

GHJ mobilizations, ST/SC/AC mobilizations, cross-friction, hold/relax

Question 5

High irritability Therapeutic exercise for SPS

Answer 5

isometrics in neutral
scapular setting exercises
table slides

Question 6

moderate irritability Therapeutic exercise for SPS

Answer 6

resistive exercises (band, isotonics, eccentrics <90)
pec stretching (low)
low rows, scap retraction
thoracic mobility exercises into extension/rotation

Question 7

low irritability Therapeutic exercise for SPS

Answer 7

Inc. load and ROM of above exercises
Pec stretching with arms abd/ER
Prone scap strengthening

Question 8

Primary impingement is

Answer 8

a structural problem
- narrowing of subacromial space
* osteophytes
* hooked acromion
* bursitis
* tendinopathy of RTC and biceps

Question 9

Secondary impingement is

Answer 9

a functional problem
- shoulder muscle imbalance
- laxity/instability
- scapular dyskinesis
- postural dysfunctions

Question 10

Full Thickness Rotator Cuff Tear MOI and Associated impairments

Answer 10

traumatic (imaging/referral possible) vs atraumatic (degenerative)
Impairments: pain with movement, point tenderness, “sling position”, atrophy, ROM restriction

Question 11

Long Head of Biceps Tendinopathy or Tendon Rupture MOI and Associated impairments

Answer 11

MOI: continuous/repetitive shoulder motions, excessive abduction with ER
For rupture: heavy lift, FOOSH
Impairments: overhead activities, pain with resisted flexion, tenderness of bicipital groove, possible popping, possible instability

Question 12

Therapeutic Exercise for Biceps tendinopathy

Answer 12

scapular setting isometric holds to scapular resistance exercises (mid, low traps, serratus)
RTC isometric
thoracic extension and rotation exercises

Question 13

Adhesive Capsulitis MOI and Associated impairments

Answer 13

Frozen Shoulder
MOI: synovial inflammation with adhesions
- primary = insidious onset
- secondary = trauma, immobilization, CRPS
Four stages: prefreezing>freezing>frozen>thawing
*loss of active and passive movements
septic arthritis, malignancy, PMR

Question 14

Therapeutic exercise for Acute Adhesive capsulitis

Answer 14

• exercises to restore ROM (wand, pulleys)
• isometrics
• pendulums

Question 15

Therapeutic exercise for Chronic Adhesive capsulitis

Answer 15

Self-stretching of the capsule
wall climbing
PNF patterns for functional ROM

Question 16

Glenohumeral Instability MOI and impairments

Answer 16

90% of dislocations are anterior
MOI: traumatic vs atraumatic
Impairments: GIRD, posterior shoulder tightness, Weakness

Question 17

Therapeutic exercise for glenohumeral instability

Answer 17

Early: RTC and scap MM activation, address proprioception
middle: resistive exercises <90, controlled AROM
Late: strengthening exercises in provocative positions

Question 18

Labral Lesions MOI and Impairments

Answer 18

MOI: repetitive OH activity, trauma
Impairments: pain, popping with rotational movements, weakness, posterior shoulder tightness
SLAP tear is “10-2 o’clock”
Bankart Lesion is “3-6 o’clock”

Question 19

exercise for labral lesions

Answer 19

stabilization, strengthening starting in midrange, ER/IR strength, thoracic extension, rotation, stretching

Question 20

Proximal humeral fracture MOI and Impairments

Answer 20

3rd most common type of fracture in adults
traumatic!
MOI: FOOSH, direct blow to the shoulder
Impairments: pain severe/sharp and radiate down upper arm
- very limited ROM

Question 21

Exercise for proximal humeral fracture

Answer 21

depends on type and grade
AROM gripping, wrist, forearm, elbow, scap pro/retraction
progress from PROM to AAROM

Question 22

Acromioclavicular Injury MOI and Impairments

Answer 22

MOI: force to top of the shoulder, FOOSH, Primary or secondary OA
- graded by ligamentous disruption and radiographic changes
Impairments: scapular depression in case of ligament injury, pain in superior shoulder, ROM limitations secondary to pain

Question 23

Exercises for AC joint injury

Answer 23

Passive to active ROM as tolerated
RTC and scapular strengthening
Deltoid/trapezius strengthening in midrange may enhance stability

Question 24

Posterior Internal Impingement MOI and Impairments

Answer 24

betweenn glenoid and humeral head
MOI: repetitive overhead activity, younger, active individuals
Impairments: pain in posterior shoulder, joint hypermobility, posterior capsule, soft tissue restriction, GIRD

Question 25

Posterior Internal Impingement manual therapy and exercises

Answer 25

mobilizations, soft tissue stretching of tight structures, strengthening of scapular retractors and RTC muscles

Question 26

Glenohumeral OA MOI and Impairments

Answer 26

MOI: degenerative changes over time (heavy labor, prior trauma) impairments: progressive stiffness and loss of ROM, CREPITUS, pain worse at night, joint compression patients > 60 years old

Question 27

Manual therapy glenohumeral OA

Answer 27

gentle ROM Gr I-II for pain Gr III-IV for mobility RS for stability and hold/relax for mobility

Question 28

Exercise for mild Glenohumeral OA

Answer 28

gentle stretching and self-mobilization RTC/scap strengthening > isometrics to theraband and isotonic thoracic ext/rot exercises