TherEx-Chapter 17

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Author:
laneaustin
ID:
260514
Filename:
TherEx-Chapter 17
Updated:
2014-02-05 23:17:31
Tags:
shoulder girdle
Folders:
shoulder girdle
Description:
shoulder girdle
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  1. What kind of joint is the glenohumeral joint?
    triaxial
  2. The glenohumeral joint is supported by what?
    • rotator cuff tendons
    • glenohumeral ligaments
    • coracohumeral ligaments
    • glenoid labrum
  3. Describe the open packed position of the glenohumeral joint:
    • 55* abduction
    • 30*horizontal adduction
  4. Describe the closed packed position of the glenohumeral joint:
    • full abduction
    • lateral rotation
  5. Describe the capsular pattern of restriction for the glenohumeral joint:
    ER>ABD>IR
  6. The Acromioclavicular joint is reinforced by what?
    • acromioclavicular ligaments
    • coracoclavicular ligaments
  7. The sternoclavicular joint is reinforced by what?
    • costoclavicular ligaments
    • sternoclavicular ligaments
    • interclvicular ligaments
  8. How are stability and mobility of the scapulothoracic articulation achieved?
    muscular activation
  9. What can cause problems with the Scapulothoracic Articulation?
    • faulty postures
    • passive structures of associated joints
  10. What is the scapulohumeral rhythm?
    • 2:1
    • first 30* come from gh joint then the rest comes from the scapulothoracic articulation
  11. In relation to nerve impingement, what relates to the Brachial plexus?
    compression in the scalene triangle
  12. Direct compression or stretch of the Suprascapular nerve can result in what?
    • posterior shoulder pain
    • supraspinatus weakness
    • infraspinatus weakness
  13. Compression to the radial nerve presents with:
    • sensory deficits to the dorsum of the hand
    • triceps weakeness
    • wrist and finger extensor weakness
  14. Compression of the axillary nerve by anterior dislocation or forced abduction may present how?
    • anterior shoulder pain
    • weakness of the deltoid
  15. What is the proper name for Frozen shoulder?
    Adhesive Capsulitis
  16. How does Adhesive Capsulitis present?
    • decreased shoulder ROM
    • pain
    • capsular inflammation
    • fibrous synovial adhesions
    • reduction of the joint cavity
  17. What age group is frozen shoulder most common in?
    • 40-60 year olds
    • most commonly women
  18. A Primary classification of Frozen shoulder indicates….
    • that it is idiopathic
    • occurred spontaneously
    • unknown cause
  19. A Secondary classification of Frozen shoulder indicates...
    • that it came on by trauma
    • immobilization
    • RA
  20. What are the stages of Adhesive Capsulitis?
    • Gradual onset
    • Freezing
    • Frozen
    • Thawing
  21. Describe the stage of Adhesive Capsulitis:
    Gradual Onset
    • pain that increases with movement 
    • pain present at night
    • lasts <3 months
  22. Describe the stage of Adhesive Capsulitis:
    Freezing
    • intense pain even at rest
    • limited ROM in all directions
    • lasts 3-9 months
  23. Describe the stage of Adhesive Capsulitis:

    Frozen
    • pain ONLY with movement
    • significant adhesions
    • limited ROM
    • atrophy
    • lasts 9-15 months
  24. Describe the stage of Adhesive Capsulitis:

    Thawing
    • minimal pain
    • significant capsular restrictions
    • lasts 15-24 months
  25. What is involved in the Acute rehab phase for Adhesive Capsulitis?
    • PROM-->AAROM
    • muscle relaxation techniques
    • grade I and II Joint mobs
    • Codman's pendulum
    • submaximal isometrics
    • Modalities for pain reduction 
    • Prevent Reflex Sympathetic Dystrophy
  26. What is involved in the Subacute rehab phase for Adhesive Capsulitis?
    • self-stretching ROM up to point of pain
    • Grades I-III joint mobs
    • exercise to restore scapular stability
    • exercise to restore postural control
    • exercise to restore shoulder joint mechanics
  27. What is involved in the Return to Function phase of Adhesive Capsulitis?
    • stretching and strengthening with correct mechanics, multiple planes, 
    • include perturbations in exercise
    • dynamic exercises
  28. How does subluxation or dislocation occur to the acromioclavicular joint?
    • direct fall on the acromion
    • force transmitted from FOOSH
  29. What is a First degree or Grade I of a subluxed/dislocated AC joint?
    • partial tear of AC ligament
    • minimal/no instability of ligament
    • minimal loss of function
  30. What is a Second degree or Grade II of a subluxed/dislocated AC joint?
    • complete rupture of AC ligament
    • partial tearing of coracoclavicular ligaments
    • moderate pain
    • dysfunctional shoulder abd/add
    • visible and palpable gapping between acromion and clavicle
  31. What is a Third degree or Grade III of a subluxed/dislocated AC joint?
    • dislocation between acromion and clavicle
    • AC, coracoclaviular ligaments are ruptured
    • distal clavicle displaces superiorly
    • marked pain
    • severe shoulder limitations
  32. What test is used for a subluxed or dislocated Acromiclavicular Joint?
    • Step Deformity
    • distal end of clavicle displaces superiorly to acromion process
  33. What does a grade I of the rehab process of a Subluxed/dislocated AC joint consists of?
    • symptom relief
    • protection from direct/indirect forces
    • resumes activities in 2 weeks
  34. What does a grade II Maximum phase of protection phase of the rehab process of a Subluxed/dislocated AC joint consists of?
    • 3-6 weeks of immobilization
    • symptom relief
    • sub max isometrics
    • active & resistive exercises to uninvolved joints
  35. What does a grade II of the moderate protection phase of the rehab process of a Subluxed/dislocated AC joint consists of?
    • AFTER IMMOBILIZATION
    • AROM using pulley or rope
    • RESTRICT INFERIOR loading
  36. What does a grade II of the minimum protection phase of the rehab process of a Subluxed/dislocated AC joint consists of?
    • progressive resistive exercises for:
    • scapular stabilization
    • deltoid
    • rotator cuff
  37. What does a grade III operational phase of the rehab process of a Subluxed/dislocated AC joint consists of?
    • clavicle may be resected 
    • maintain mobility & strength of distal joints
    • progression per protocol
  38. What does a grade III nonoperational phase of the rehab process of a Subluxed/dislocated AC joint consists of?
    • longer duration of immobilization
    • delayed motion and resistive exercises
  39. When is a glenohumeral arthroplasty indicated?
    • persistent incapacitating pain
    • loss of mobility
    • loss of stability
    • loss of UE strength
  40. What are special considerations of a glenohumeral arthroplasty?
    • integrity of rotator cuff
    • intraoperative ROM
    • Posture
  41. Describe the Max protection phase of a glenohumeral arthroplasty:
    • control pain & inflammation
    • mobility of adjacent joints
    • restore mobility
    • minimize guarding & atrophy
  42. Describe the Moderate protection phase of a glenohumeral arthroplasty:
    • increase ROM
    • develop strength and endurance
  43. Describe the Minimum protection phase of a glenohumeral arthroplasty:
    • End-range stretching
    • PREs
    • Return to functional activities
  44. Describe an Intrinsic Impingement:
    • tissue quality degraded-due to poor vascularity
    • tissue tension
    • collagen degeneration
    • leads to articular sided rotator cuff tears
  45. Describe an Articular-sided Rotator cuff tear:
    tear from under tendon in upward direction
  46. Describe an Extrinsic Impingement:
    • tendons are compressed
    • mechanical wear, stress, and friction
  47. Describe the tear of an extrinsic impingement:
    tears from the surface in a downward direction
  48. What presentations may lead to an impingement or rotator cuff tear?
    • thoracic kyphosis, forward head, protracted & forward tilted scapula
    • tightness of pec minor, levitator scapulae, internal rotators
    • rotator cuff overuse and fatigue
    • hypomobile posterior capsule
  49. Describe:
    Neer Stage I
    • age <25 years old
    • edema and hemorrhage
    • pain with and >90*
    • reversible
  50. Describe:
    Neer Stage II
    • 25-40 years old
    • irreversible
    • tendons become fibrotic
    • pain with ADLs
    • pain at night
  51. Describe:
    Neer Stage III
    • age >40 years old
    • tendon degeneration
    • tears and ruptures
    • long history of shoulder dysfunction
  52. Describe:
    Jobe's Group 1
    • pure impingement
    • older recreational athlete
    • partial tear
  53. Describe:
    Jobe's Group 2
    • Labral tear
    • secondary impingement
  54. Describe:
    Jobe's Group 3
    • Hypermobility
    • multidirectional instability
  55. Describe:
    Jobe's Group 4
    • anterior instability
    • due to trauma or dislocation
  56. Jobe's Groups classify what?
    why and how the patient suffered impingement
  57. What is the clinical picture for Rotator Cuff Disease or Impingement?
    • Anterior shoulder pain
    • worse pain with overhead activities
    • pain with medial rotational forces
    • nocturnal pain
  58. What tests can be used for Rotator Cuff Disease and Impingement Syndrome?
    • Painful Arc
    • Neer
    • Hawkins-Kennedy
  59. What does the Neer test for RC disease or I.S look like?
    • internal rotation
    • arm up to ear
  60. What does the Hawkins-Kennedy test for RC disease or I.S look like?
    • internal rotation 
    • 90* elbow flexion
    • 90* shoulder flexion
    • arm compressed by therapist in and anterior to posterior direction
  61. What is involved in the protection phase of rehab for Rotator Cuff disease or Impingement Syndrome?
    • control inflammation
    • modification of compromising activities
    • NO overhead >80-90* abduction or flexion
    • PROM, AAROM, self stretching
    • isometrics
    • postural awareness/correction
  62. What is involved in the Controlled Motion phase of rehab for Rotator Cuff disease or Impingement Syndrome?
    • pt education
    • develop strong mobile tissues
    • joint mobs
    • strengthen scapular stabilizers
    • strengthen external rotators
    • strengthen GH on closed chain
  63. What is involved in the Return to Function phase of rehab for Rotator Cuff disease or Impingement Syndrome?
    • endurance training of repetitive loading
    • plyometrics
    • specificity training
    • increase of speed activities

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