Term
| define adhesive capsulitis |
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Definition
| fibrosis of GHJ capsule with a chronic inflammatory response |
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Term
| is adhesive capsulitis more common in men or women |
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Definition
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|
Term
| patient's experience with adhesive capsulitis |
|
Definition
| pain, limited ROM, disability |
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Term
| how long does adhesive capsulitis last |
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Definition
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|
Term
| capsular pattern in shoulder as seen in adhesive capsulitis |
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Definition
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Term
| what is primary adhesive capsulitis |
|
Definition
| has no precipitating event. Probably from chronic inflammatory response with fibroblast proliferation |
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Term
| what is secondary adhesive capsulitis |
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Definition
| occurs after surgery or injury. May be associated with diabetes, RC injury, CVA, cardiovascular disease, thyroid |
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Term
| what is chronic regional pain syndrome |
|
Definition
| autonomic pain syndrome that can be a differential diagnosis for adhesive capsulitis. |
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Term
| what to look for in chronic regional pain syndrome |
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Definition
| autonomic changes in affected arm: sweating, goosebumps. Also shoulder girdle tumors |
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Term
| what are the 3 stages of adhesive capsulitis |
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Definition
| painful, stiffness, recovery |
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Term
| describe painful stage of adhesive capsulitis |
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Definition
| limited ROM, irritability and pain following treatment |
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|
Term
| describe stiffness stage of adhesive capsulitis |
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Definition
| longest stage. Still not comfortable when you stretch them, but not as uncomfortable for as long. |
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Term
| pathologies with adhesive capsulitis |
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Definition
| shrug sign with GH elevation; PROM limitations; elevated and anterior humeral head; shortening/fibrosis of joint capsule; contracture of shoulder ligaments decreases capsule volume; fascial restrictions, muscle tightness, trigger points all come from joint disuse |
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|
Term
| patient presentation with adhesive capsulitis |
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Definition
| constant dull ache in shoulder with gradual onset; posture changes; gradual limitations in motion; painful to lie on affected side; limited accessory motion; capsular pattern ER>Abd>IR |
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Term
| non-operative treatments for adhesive capsulitis |
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Definition
| benign neglect; NSAIDs; oral corticosteroids; GH intraarticular steroid injection; PT |
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Term
| what PT treatments are good for phase 1 adhesive capsulitis |
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Definition
| ultrasound, pain-free motion, light stretching, grade 1/2 mobilizations, postural positioning, manual techniques to relieve muscle involvement; maintain existing ROM |
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Term
| what PT treatments are good for phase 2 adhesive capsulitis |
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Definition
| more stretching, AAROM, capsular stretching, aggressive ROM as tolerated, home exercise program throughout the day |
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Term
| what PT treatments are good for phase 3 adhesive capsulitis |
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Definition
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Term
| what are operative options for adhesive capsulitis |
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Definition
| manipulation under anesthesia; arthroscopic capsular release; open surgical release |
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Term
| at what age are proximal humeral fractures more common |
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Definition
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Term
| what is a hemi arthroplasty |
|
Definition
| half a shoulder replacement (ball only) |
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Term
| what is a humeral head depression defect |
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Definition
| due to instability, the humeral head slides out and the rim of the glenoid has caused an indention on the humeral head |
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|
Term
| what is a Hill-Sachs lesion |
|
Definition
| impression defect in the posterolateral humeral head from contact with the glenoid rim associated with anterior dislocation |
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|
Term
| what is a reverse hill sachs |
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Definition
| someone dislocated posteriorly. Intentation on anterior humeral head. |
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Term
| how are hill sachs lesions treated |
|
Definition
| immobilizer, grafting, hemiarthroplasty |
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|
Term
| PT for proximal humeral fractures? |
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Definition
| per MD protocol; pain-motion-strength-control |
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Term
| what static factors contribute to GH stability |
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Definition
| GH congruence, glenoid labrum, GH ligaments (esp IGHL), joint capsule, negative intra-articular pressure |
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Term
| what dynamic factors contribute to GH stability |
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Definition
| rotator cuff, biceps long head tendon, scapular stabilizing muscles |
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|
Term
| are men or women more likely to have GH instability |
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Definition
|
|
Term
| what are the 2 types of GH instability |
|
Definition
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|
Term
|
Definition
| traumatic unilateral instability caused by Bankart lesion usually needing Surgery |
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|
Term
|
Definition
| Atraumatic, Multidirectional unstable patient with Bilateral involvement in whom Rehab is first treatment, may need Inferior capsular shift and tightening of rotator Interval |
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|
Term
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Definition
| damage to labrum. Usually needs surgery |
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|
Term
| what is the usual direction of force in traumatic GH instability |
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Definition
|
|
Term
| what are some MOI's for traumatic GH instability |
|
Definition
| 31% from seizure, fall from a height, MVA |
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|
Term
| what are risk factors for traumatic GH instability |
|
Definition
| ligamentous laxity, inadequate glenoid concavity, glenoid hypoplasia, muscular imbalance, poor neuromuscular control |
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|
Term
| what is glenoid hypoplasia |
|
Definition
| posterior sloping of glenoid rim |
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|
Term
| do you do special tests for glenohumeral instability post-op? |
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Definition
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|
Term
|
Definition
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|
Term
|
Definition
|
|
Term
| what are special tests for instability |
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Definition
| sulcus, rockwood, anterior load and shift, apprehension/relocation, push-pull, jerk test |
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|
Term
| what are treatments for glenohumeral instability |
|
Definition
| maintain motion, SH rhythm, RC strengthening, control exercises, strengthen for muscle balance, follow MD protocols, avoid stressing into direction of instability |
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|
Term
| example of rhythmic stabilization exercises |
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Definition
| perturbate the joint and see if they can stabilize |
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Term
| examples of neuromuscular control exercises for GH instability |
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Definition
| rhythmic stabilization, closed kinetic chain exercises |
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|
Term
| do patients under 20 with traumatic GH instability injury have a good chance of recurrence |
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Definition
|
|
Term
| what to do for patients under 20 with traumatic dislocation/subluxation |
|
Definition
| educate on how to prevent |
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|
Term
| do patients over 40 with traumatic GH instability injury have a good chance of recurrence |
|
Definition
| no. they have increased risk of RC pathology |
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|
Term
| what is an engaging Hill Sachs lesion |
|
Definition
| large hh deficit causing hh to drop over glenoid rim with GH ER |
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|
Term
| are hh depression defects common |
|
Definition
|
|
Term
|
Definition
| Superior Labrum Anterior Posterior |
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|
Term
|
Definition
| fraying and degeneration, normal biceps |
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|
Term
|
Definition
| labrum and biceps detached |
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|
Term
|
Definition
| bucket handle tear of labrum (flops over) |
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|
Term
|
Definition
| bucket handle tear of labrum and biceps tendon (both flop over) |
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|
Term
| what causes acute traumatic SLAP |
|
Definition
| FOOSH, GH traction injury |
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Term
| what causes chronic repetitive SLAP |
|
Definition
| overhead throwing motion, high eccentric activity of biceps, "peel back" mechanism in late cocking phase of throwing (abductoin + max ER) due to torsional force on biceps tendon insertion |
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|
Term
| what is lost in a SLAP lesion |
|
Definition
| vacuum pull of glenoid and hh |
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Term
| what are SLAP special tests |
|
Definition
| O'Brien, Crank, SLAPrehension, Biceps load |
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|
Term
| should you try conservative treatments for SLAP first? |
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Definition
|
|
Term
| what are conservative treatments for SLAP |
|
Definition
| protection, restore motion, scapular strengthening, RC/trunk/core strengthening, return to throwing after 3 months |
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|
Term
| are conservative SLAP treatments usually successful |
|
Definition
| no, especially not with instability or RCT |
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|
Term
|
Definition
| glenohumeral internal rotation deficit (less than 70-90) |
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|
Term
| what are surgical options for SLAP |
|
Definition
| depends on surgeon/patient: debride Types I/III, Repair Types II/IV |
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|
Term
| what joint is injured in separated shoulder |
|
Definition
|
|
Term
| what is the MOI for separated shoulder |
|
Definition
| trauma: FOOSH out to side; fall directly on shoulder; direct blow to top of shoulder with arm adducted |
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|
Term
| how many types of AC joint separation are there |
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Definition
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|
Term
| which types of AC joint separation need surgery |
|
Definition
|
|
Term
| for the next 6 questions, say what tye types of AC joint separation are |
|
Definition
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|
Term
|
Definition
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|
Term
|
Definition
| AC ligament torn, CC ligaments intact |
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|
Term
|
Definition
| both AC/CC ligaments torn |
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|
Term
|
Definition
| both AC/CC ligaments torn and posterior dislocation of clavicle |
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|
Term
|
Definition
| both AC/CC ligaments torn and deltotrapezial fascia torn causing scapula to droop inferiorly |
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|
Term
|
Definition
| both AC/CC ligaments torn and clavicle dislocation inferior to coracoid |
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|
Term
| how to manage Types 1 and 2 |
|
Definition
|
|
Term
|
Definition
| start conservatively. May need surgery |
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|
Term
|
Definition
| surgically. After surgery, will get restrictions/protocol from MD |
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|
Term
| what are the long thoracic nerve's roots and what muscle does it innervate |
|
Definition
| C5, C6, C7, serratus anterior |
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|
Term
| what can injure the long thoracic nere |
|
Definition
| compression, distraction, laceration |
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|
Term
| what is the most common injury to LTN |
|
Definition
| neuropraxia after blunt or stretch injury |
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|
Term
| what are common MOI to LTN injury |
|
Definition
| falls from a height, MVA, athletics, sudden depression of the shoulder and twisting of neck, positioning during surgery |
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|
Term
| what is evident in LTN injury |
|
Definition
|
|
Term
| how is abduction with LTN damage |
|
Definition
|
|
Term
| how to reduce scapular winging |
|
Definition
| stabilize lower trap, eccentric rhomboids, middle trap |
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|
Term
| treatments for LTN damage |
|
Definition
| stabilize scapula, strengthen serratus anterior without over-fatigue, check for c-spine involvement |
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|
Term
| what are the nerve roots for suprascapular nerve |
|
Definition
|
|
Term
| how to determine suprascapular nerve damage |
|
Definition
| look at patient's back for atrophy of rotator cuff muscles |
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|
Term
| what causes injury to suprascapular nerve |
|
Definition
| compression or distraction |
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|
Term
| what are common MOI to suprascapular nerve |
|
Definition
| overhead throwing overuse, entrapment at suprascapular notch from stenosis, compression from bone tumor |
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|
Term
| symptoms of suprascapular nerve damage |
|
Definition
| pain and weakness in flexion and ER. May cause impingement. Alters SH rhythm |
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|
Term
| how to assess suprascapular nerve damage |
|
Definition
| note muscle atrophy. Diagnosis of exclusion |
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|
Term
| how to treat suprascapular nerve damage |
|
Definition
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|
Term
| what are the nerve roots for axillary nerve |
|
Definition
|
|
Term
| what does the axillary nerve innervate |
|
Definition
|
|
Term
| what are the nerve roots for radial nerve |
|
Definition
|
|
Term
| what does the radial nerve innervate |
|
Definition
| triceps and anconeus (56); brachioradialis and forearm extensors (567) |
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|
Term
| what are the nerve roots of the subscapular nerve |
|
Definition
|
|
Term
| what muscles does the subscapularis nerve innervate |
|
Definition
| subscapularis, teres major |
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