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laneaustin
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What kind of joint is the glenohumeral joint?
triaxial
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The glenohumeral joint is supported by what?
- rotator cuff tendons
- glenohumeral ligaments
- coracohumeral ligaments
- glenoid labrum
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Describe the open packed position of the glenohumeral joint:
- 55* abduction
- 30*horizontal adduction
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Describe the closed packed position of the glenohumeral joint:
- full abduction
- lateral rotation
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Describe the capsular pattern of restriction for the glenohumeral joint:
ER>ABD>IR
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The Acromioclavicular joint is reinforced by what?
- acromioclavicular ligaments
- coracoclavicular ligaments
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The sternoclavicular joint is reinforced by what?
- costoclavicular ligaments
- sternoclavicular ligaments
- interclvicular ligaments
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How are stability and mobility of the scapulothoracic articulation achieved?
muscular activation
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What can cause problems with the Scapulothoracic Articulation?
- faulty postures
- passive structures of associated joints
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What is the scapulohumeral rhythm?
- 2:1
- first 30* come from gh joint then the rest comes from the scapulothoracic articulation
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In relation to nerve impingement, what relates to the Brachial plexus?
compression in the scalene triangle
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Direct compression or stretch of the Suprascapular nerve can result in what?
- posterior shoulder pain
- supraspinatus weakness
- infraspinatus weakness
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Compression to the radial nerve presents with:
- sensory deficits to the dorsum of the hand
- triceps weakeness
- wrist and finger extensor weakness
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Compression of the axillary nerve by anterior dislocation or forced abduction may present how?
- anterior shoulder pain
- weakness of the deltoid
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What is the proper name for Frozen shoulder?
Adhesive Capsulitis
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How does Adhesive Capsulitis present?
- decreased shoulder ROM
- pain
- capsular inflammation
- fibrous synovial adhesions
- reduction of the joint cavity
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What age group is frozen shoulder most common in?
- 40-60 year olds
- most commonly women
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A Primary classification of Frozen shoulder indicates….
- that it is idiopathic
- occurred spontaneously
- unknown cause
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A Secondary classification of Frozen shoulder indicates...
- that it came on by trauma
- immobilization
- RA
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What are the stages of Adhesive Capsulitis?
- Gradual onset
- Freezing
- Frozen
- Thawing
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Describe the stage of Adhesive Capsulitis:
Gradual Onset
- pain that increases with movement
- pain present at night
- lasts <3 months
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Describe the stage of Adhesive Capsulitis:
Freezing
- intense pain even at rest
- limited ROM in all directions
- lasts 3-9 months
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Describe the stage of Adhesive Capsulitis:
Frozen
- pain ONLY with movement
- significant adhesions
- limited ROM
- atrophy
- lasts 9-15 months
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Describe the stage of Adhesive Capsulitis:
Thawing
- minimal pain
- significant capsular restrictions
- lasts 15-24 months
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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
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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
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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
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How does subluxation or dislocation occur to the acromioclavicular joint?
- direct fall on the acromion
- force transmitted from FOOSH
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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
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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
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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
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What test is used for a subluxed or dislocated Acromiclavicular Joint?
- Step Deformity
- distal end of clavicle displaces superiorly to acromion process
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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
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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
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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
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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
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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
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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
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When is a glenohumeral arthroplasty indicated?
- persistent incapacitating pain
- loss of mobility
- loss of stability
- loss of UE strength
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What are special considerations of a glenohumeral arthroplasty?
- integrity of rotator cuff
- intraoperative ROM
- Posture
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Describe the Max protection phase of a glenohumeral arthroplasty:
- control pain & inflammation
- mobility of adjacent joints
- restore mobility
- minimize guarding & atrophy
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Describe the Moderate protection phase of a glenohumeral arthroplasty:
- increase ROM
- develop strength and endurance
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Describe the Minimum protection phase of a glenohumeral arthroplasty:
- End-range stretching
- PREs
- Return to functional activities
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Describe an Intrinsic Impingement:
- tissue quality degraded-due to poor vascularity
- tissue tension
- collagen degeneration
- leads to articular sided rotator cuff tears
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Describe an Articular-sided Rotator cuff tear:
tear from under tendon in upward direction
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Describe an Extrinsic Impingement:
- tendons are compressed
- mechanical wear, stress, and friction
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Describe the tear of an extrinsic impingement:
tears from the surface in a downward direction
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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
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Describe:
Neer Stage I
- age <25 years old
- edema and hemorrhage
- pain with and >90*
- reversible
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Describe:
Neer Stage II
- 25-40 years old
- irreversible
- tendons become fibrotic
- pain with ADLs
- pain at night
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Describe:
Neer Stage III
- age >40 years old
- tendon degeneration
- tears and ruptures
- long history of shoulder dysfunction
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Describe:
Jobe's Group 1
- pure impingement
- older recreational athlete
- partial tear
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Describe:
Jobe's Group 2
- Labral tear
- secondary impingement
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Describe:
Jobe's Group 3
- Hypermobility
- multidirectional instability
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Describe:
Jobe's Group 4
- anterior instability
- due to trauma or dislocation
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Jobe's Groups classify what?
why and how the patient suffered impingement
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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
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What tests can be used for Rotator Cuff Disease and Impingement Syndrome?
- Painful Arc
- Neer
- Hawkins-Kennedy
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What does the Neer test for RC disease or I.S look like?
- internal rotation
- arm up to ear
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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
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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
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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
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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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