UE notes

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Author:
amills1
ID:
253063
Filename:
UE notes
Updated:
2013-12-13 22:15:51
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UE exam
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Cards from KC and PP notes
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  1. Before progressing to overhead exercises pt needs to be able to
    perform active shoulder flexion and abd against gravity without elevating scap
  2. Common shoulder impingement position
    • mid range abd with IR
    • end range positions
  3. Precautions for max protection following shoulder arthroplasty
    • low reps
    • only prom for ER 
    • no hyperextension or H abd beyond neutral
    • no combo of extension, add, and IR
    • ADLs only with elbow at waist
  4. TSO SnS
    • Pain
    • Paresthesia
    • Numbness
    • Weakness
    • Swelling
    • Neural signs not consisten with myotome or dermatome
  5. Throacic plexus through and around...
    • thru scalenes
    • under clavicle
    • over 1st rib
    • under coracoid posterior to pec minor
  6. Drop arm
    checks for mod/severe RC tears
  7. Hawkins
    • Passively move 90 abd 
    • Passively move 90 elbow flex
    • Passively move 90 IR
    • Pain indicates impinge patho of long bicep head and/or RC
  8. Neers
    • Full shld flexion with IR
    • pain at lateral shld indicative of bicep tendon impinge or supraspin tendinitis
  9. O'Briens
    • 90 shld abd 
    • 15 H add
    • full IR pronation resist flexion, repear with full ER and supin
    • Indicates labral tear or slap lesion
  10. Yergasons
    • Elbow at 90
    • Resist supin and flex
    • feel grove to see if transverse humeral ligament is holding down bicep tendin
    • + means bicep tendonitis
  11. Speeds
    • Start elbow extension and supinated
    • resist flexion
    • feel over bicep groove for grating/inflam
    • + means bipital tendinitis or labral tear
  12. SLAP lesion repair precautions
    • limit passive or assisted shld flex 60-90 for 2-4 wks
    • only passive rotation (ER to 15, IR to 45) in scap plane 2-4 wks
    • Avoid bicep stretch position 4-6 wks
    • Avoid bicep active contract 6-8 wks
    • Avoid combined max ER and abd
  13. Precautions after anterior GH stabilization and/or bankart repair
    • Limit motions with anterior arthrokinematics
    • 4-6 ks limit ER to no further than neutral while in abd
    • if bony procedures, limit rom 6-8 wks
    • avoid activities, specificly er, at 90 or more of abd
  14. indications for surgery for stabilization of GH
    • recurrent sublux or dislocation
    • significant inherent joint laxity
    • irreducible dislocation
  15. closed reduction of anterior dislocation precaution and contra
    • ER rom is performed in loose pack
    • extension beyond 0 is a contra
  16. Precaution for ADLs TSA
    • perform activities with elbow at waist line
    • no reaching behind back
    • no weight bearing
  17. distal radioulnar loose pack
    10 supination
  18. proximal radioulnar loose pack
    • 70 flexion
    • 35 supin
  19. elbow loose pack
    • 70 flexion
    • 10 supin
  20. shoulder loose pack
    • 50 abd in scap plane
    • slight er
  21. radial carpal loose pack
    • slight flex
    • slight ulnar deviation
  22. elbow close pack
    full ext with supination
  23. ROM precautions for TSA
    • 0-6 wks no shoulder extension past neutral
    • limit shoulder flexion to 120 in scap plane up to 12 wks
    • only 20 of ER allowed
    • no combined IR, abd, extension up to 6-12 wks
  24. indications for TSA
    • persistent and incapacitating pain secondary to GH joint destruction
    • loss of ROM and strg leading to inability to perform functional tasks with UE
  25. strengthening precautions for TEA
    • no resisted elbow ext 6-12 wks
    • when strging shld place resistance above elbow
    • no mod or high resistance
  26. ROM precautions for TEA
    • avoid end range flexion
    • if questionable stability limit full extension and rotation of forearm
    • if ulnar nerve compression SnS avoid prolonged flexion
  27. TEA indications for surgery
    • debilitating pain and loss of functional use of UE
    • gross inability of elbow
    • acute comminuted, intra-articular, and non-union fx of distal humerus

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