Week 2: Quiz 4 Flashcards by Sara Morris

What is the recommended direction for the dynamic warm-up for UE before starting TERT?

Retro-cycling

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What are three reasons for dynamic warm up?

Inc tissue temperature
Postural muscular endurance training for posterior RTC and scapulothoracic muscles
Cardiovascular training for some patients

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What postural deformity is counter-acted by retro-cycling warm-up?

Kyphotic posture

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What is the prescriptive formula for TERT based on?

Intensity X duration X frequency

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What is the prescriptive formula for TERT used for?

To create plastic deformation

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What limits the amount of force that can be applied when utilizing the prescriptive TERT formula and how do you know the appropriate amount?

The patient’s pain tolerance - look in their eyes and watch for indication of pain

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What is the desired TERT duration?

20 minutes with tissue in stretched position

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What is the daily frequency when using the TERT formula?

3X per day

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What is the weekly frequency when using the TERT formula?

Daily

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Why do we need to exercise patients daily when using the TERT formula?

To prevent the cross-bonds, that were denatured between collagen fibers as a result of stretching exercises, from reestablishing over the course of the next 24 hours

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What is the optimum TERT time per day?

60 minutes

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Which scapulothoracic MMT’s can be done in sitting: 3

Upper traps & Levator scap
Serratus anterior

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Which scapulothoracic MMT’s should be done in prone? 3

Middle trap
Lower trap
Rhomboids

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Which glenohumeral MMTs should be done in sitting? 3

Flexion
Abduction
Scaption

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Which glenohumeral MMTs should be done in supine? 1

Horizontal adduction

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Which glenohumeral MMTs should be done in prone? 4

Extension
Horizontal Extension
IR
ER (use only 2 fingers)

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Describe the difference between the position for the original sleep stretch and the modified sleep stretch

Original Sleeper:

Side-lying on side to be stretched
90*90* and then apply IR

Modified Sleeper:

Side-lying on side to be stretched
30* scaption
45* GH elevation
Apply IR (with strap ideally, to avoid fatigue)

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Which sleep stretch position is optimal and why?

Modified sleeper is optimal - avoids creating iatrogenic impingement

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What is an additional stretch that can be done to stretch posterior capsule?

Cross-body horizontal flexion

What are the three limiting factors causing motion limitation in selective hypomobility?

Osseous (checked with CT, MRI)
Non-contractile (checked with passive mobility testing)
Contractile

Which selective hypomobility limitation can be addressed in rehab?

Noncontractile and contractile
(Osseous cannot be changed with rehab)

Give an example of each type of selective hypomobility

Osseous- Example: retroverted humerus in GIRD/ERG (not sure about this one)
- Possibly also acromion morphology
Non contractile- Example: superior capsule tightness (also not sure about this one)
Contractile (Process of elimination bc muscle flexibility tests are not well recorded in the literature)
- Example: muscle tendon unit in should

What is thixotropy?

Tissue becoming less viscous when subjected to shearing forces

What MOI causes Thixotrophy?

Eccentric deceleration

With Thixotrophy, when the MTU is involved, what two ways can we address it?

* By doing static positional stretching and/or * Contract-relax PNF

How long should stretches be held for younger vs older adults (\> 60) for the contractile unit?

* Younger - 30 seconds * Older - 60 seconds (double the time!)

What does GIRD/ERG stand for?

Glenohumeral IR deficit, ER gain.

What population is GIRD/ERG commonly seen in?

* Children who start throwing sports early, due to an anatomical change in the humerus (“[using] both MRI and CT scans, it is now well documented that the humerus of the throwing arm is more retroverted than the nondominant arm.”)

What is the total arc of motion for GIRD/ERG?

160⁰

What makes GIRD the appropriate diagnosis?

Total arc in one arm must be less than the other arm for GIRD to be the diagnosis

Other teatment techniques that can be used to try to stretch the collagen tissue and create the plastic deformation?

* Manual Therapy * Mobilizations * Myofascial Techniques * Myotherapy * Muscle Energy Techniques * ART * Graston * Strain Counterstrain Techniques

Describe the arthroscopic lavage surgery.

Washout of the joint with an inflow and outflow canula to flush out inflammatory mediators and floating pieces of articular cartilage. Only effective in individuals with incomplete lesions

According the Moseley et. al Level I RCT study (comparing lavage and arthroscopic surgery to placebo surgery), what was found regarding this surgery?

No difference in pain or function between intervention and placebo group

Name 3 of the 4 things that can help to create plastic deformation of soft tissues.

* Temperature (heat) * Temperature (cooling) * Intensity * Duration * Frequency

Which one of the requirements to create plastic deformation can we not control?

Intensity (based on patient’s tolerance)

What is the optimum amount of time (duration) for soft tissue elongation?

60 minutes per day

How many times per week (frequency) would be optimal for patients to acheive true arthrofibrotic changes?

Everyday Never manipulate on a Friday/ always manipulate at the beginning of the week to achieve greater maintained ROM

At what point of GH elevation is the subacromial space the smallest?

Between 60-120 degrees elevation (painful arc syndrome)1

What are the two surgical options for a LHB detachment/injury?

* Tenotomy * Tenodesis

Which surgery has been shown to be more effective Tenotomy or Tenodesis?

No difference in outcomes

Describe how to perform the lateral scapular slide test.

* Make a body mark at level of T7 (inferior angle) on spine * Measure from mark to inferior angle BL for all positions * Position 1- Arms at sides * Position 2- Hands on hips, thumbs posteriorly * Position 3- Arms 90 deg abduction, thumbs down * Position 4- Arms 120 deg abduction, thumbs up * Position 5- Arms 150 deg abduction, thumbs up * Normal: \<1 – 1.5 cm difference bilateral * Pathological/athlete: \>1.5 cm difference bilaterally * Roughly a 0.5 – 1cm increase in each position

Name 3 treatment options for pain and inflammation:

* Cryotherapy * Iontophoresis * Modalities * Manual therapy * Placebo effect

What is the most common reason for failure of a subacromial decompression surgery?

* If the pt also has AC DJD that does not get addressed in the surgery

What procedure can be done to address the AC DJD?

Mumford procedure: distal clavicular excision

What percentage of RTC repairs fail?

75%

What percentage of pts with an atraumatic full thickness tear were successfully treated with PT and able to avoid surgery/RTC repair?

74-75%