MS II 4

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Author:
shmvii
ID:
200086
Filename:
MS II 4
Updated:
2013-02-12 21:07:50
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MS II
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Description:
spring Rosen & Pivko
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  1. post glide at GH helps w what 3 motions?
    • FF
    • IR
    • add
  2. to distract GH joint, start w pt where?
    • 90 degrees flex
    • do lat distraction by wrapping hands right into axilla
  3. GH jt inf glide details
    • pt supine, shoulder at edge of table
    • heel of PT's mobilizing hand on greater tub of pt's shoulder
    • other hand holding elbow, can add a bit of traction
    • force goes caudally
  4. GH jt post glide details
    • pt supine
    • arm in resting pos
    • heel of PT's hand on ant inf hum w other hand on elbow to guide hum to make it move as a parallel unit
    • force goes post
  5. GH jt lateral glide details
    flat surface of palm of PT's hand in axilla, facing lat, other hand on elbow
  6. GH jt ant glide in prone, details
    • twoel roll or wedge under coracoid
    • arm in resting pos
    • heel of PT's hand on post humerus, other hand under elbow
    • press ant.
  7. GH jt ant glide in supine
    • PT supports arm in resting pos by holding it btwn body and arm
    • both f pt's hands wrapped around prox hum, pull up
  8. 3 joints of shoulder that'll dislocate
    • ANT sublux or dislocate:
    • sternoclavicular
    • acromioclavicular
    • GH
    • POST:
    • GH
  9. 5 results of trauma to shoulder, and the 2 most common
    • RC impingement (cumulative trauma) biomechanical error - humerus is ramming up on things nort of it bc it's not moving correctly
    • RC tear (cumulative trauma or degen)¬†
    • biceps tendon ruputer - 2/2 huge trauma at GH jt or the tendon is super-loaded in one exercise and it ruptures
    • adhesive capuslitis - capsular irritation or inflam dud to poor osteokinematics of GH jt
    • glenoid labrum injury - usually sup & slightly ant
  10. 3 types of itis-es you can get in shoulder from overuse/cumulative trauma/overload of tissue capacity (repetition, 1-sidedness, aging)
    • RC tendinitis
    • bicipital tendinitis
    • subacromial bursitis
  11. 7 basic elements of exam/eval
    • subjective
    • structural exam
    • active movment testing
    • passive movement testing
    • resistive testing
    • special tests, other tests (neuro)
    • specific paplaption
  12. if no pain in AROM, should you do PROM?
    nah, it's moot
  13. 6 elements of active movement testign for the shoulder in an exam/eval
    • clear jts above & below
    • quick tests (tests the shoulder complex)
    • quick tests w overpressure
    • scapular motions
    • GH jt motions
    • elbow flexion and extension
  14. 3 basic things to do in passive movement testing in a shoulder exam
    • clear jts above &below
    • PROM for physiologic motions (osteokinematics) in shoulder complex, ST, and GH jts
    • joint mobility testing (aka accessory movement = arthrokinematics) ST, SC, AC, GH jts
  15. what to look for in subjective exam of shoulder?
    • HPI
    • dominant arm
    • neck/thorax problems
    • systems review - search for referred pain
    • job/sport - simulate offending mvmnts
    • PMH, PSH
    • social history
  16. what to look for in "observation & palpation?"
    • attitude of arm
    • body postures/habits
    • willingness to move
    • atrophy or hypertrophy - which muscles?
    • note edema symmetry
  17. what to palpate for?
    • temp
    • edema
    • atrophy
    • tenderness (capsule, tendon, bursa, etc)
    • analyze alignment & position
  18. how to "clear the head and neck"
    • cervical clearing:
    • have head lean to sides, rotate, turn,
    • look for pain and assymetry
  19. how to clear arms
    • check scapulothoracic rhythm & symmetry
    • hands behind back
    • run thumbs up back and look for symmetry in reach distances
    • hands behind head
    • run hands down back
    • elbows at waist and flap hands back and forth for ER and IR

    if no pain, apply overpressure
  20. pain where  in abd ROM indicates supra/infraspinatus problems?
    45-60 degrees abd, with unpainful areas on either side
  21. pain where in abd suggests acromioclavicular troubles?
    170-180 degrees
  22. "painful coin"
    • Pivko
    • supraspinatus & radial nerve
    • a circle a bit sup to deltoid groove in hum
  23. 3 areas that'll refer pain to the L shoulder
    • heart
    • diaphragm
    • spleen
  24. 4 areas that'll refer pain to the R shoulder
    • gall bladder
    • lungs
    • neck
    • elbow
  25. Pancoast tumor is where? pain from it will radiate where?
    • it's in the upper lobe of lung
    • pain in surface of shoulder crest, radiating into neck
  26. where is T3 dermatome?
    armpit - and it's big, bleeding into chest, down inf arm, down under armpit
  27. where is T2 dermatome?
    armpit and upper chest, and also inner arm
  28. where is C4 dermatome?
    shoulder, and some sup chest and neck
  29. where is C5 dermatome?
    lateral arm, if arm is abd to 90 it's the upper surface
  30. where is C6 dermatome?
    lat arm, but a wider surface, going more ant than C5 does
  31. where is C7 dermatome?
    • inner arm
    • if arm is abd to 90, it's the part that faces forward w/o getting to the top or bottom ridge
  32. where are the T4,5,6 dermatomes?
    chest, by ribs osame name?
  33. supraclavicular N dermotome is where?
    shoulder, where suprascap is
  34. axillaryN dermotome is where?
    over the body of deltoid
  35. post brachial cutaneous N dermotome is where?
    post humerus, distal to the axillary/deltoid region
  36. lower lat brachial cutaneous N dermotome is where?
    lower lateral humerus
  37. medial cutaneous N dermotome is where?
    medial distal humerus
  38. anterior apprehension test for shoulder
    • not judged by pain, just by look of nervousness on pt's face
    • pt supine, arm in 90 abd & ER w some horiz abd
    • see if pt fears the head of hum will stretch out over inf capsule
    • (shoulder & elbow at 90 degrees)
  39. jobst relocation
    • similarto ant apprehension test, but w fist under shoulder and applying pressure down w other hand
    • then press on hum head to push it back in
    • if this feels like a relief to the pt, there's laxity
  40. ant drawer test at shoulder
    • tests how much hum head goes ant
    • pt is prone, y're doing ant distraction
    • should get just scap mvmnt
    • done in neutral, while normal ant glideis in resting

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