Term
| what is the shoulder examination sequence |
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Definition
| history/interview, observation, UQS, AROM, PROM, accessory motion, MMT, palpation, special tests |
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Term
| what should be taken into consideration in examination sequence |
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Definition
| patient position: do everything in sitting at one time, do everything in supine at one time, etc |
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Term
| what things to look for in patient interview |
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Definition
| acute or chronic?; event?; prior treatment for this injury?; PMHx/PSHx/medications; radiographs; overall health; best pain -> can it get to 0?; worst pain; aggs/eases; |
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|
Term
| Name 4 commonly used outcome measures |
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Definition
| SF-12, Quick DASH, Patient Specific Functional Scale, Upper Extremity Functional scale |
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Term
| why do we need outcome measures |
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Definition
| goal writing; health care reform; research |
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Term
|
Definition
| outcome measure of difficulty of ADLs. 11 questions with optional sports and work module |
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Term
| describe Patient Specific Functional Scale |
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Definition
| Identify 5 functional activities with impairment and rate on 1-10 scale |
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Term
| describe Upper Extremity Functional Scale |
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Definition
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Term
|
Definition
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Term
| what to look for in posture |
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Definition
| forward head, rounded shoulders, kyphosis |
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Term
| what to look for in observation of scapular position |
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Definition
| elevated/depressed; protracted/retracted |
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Term
| what to look for in scapulohumeral rhythm |
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Definition
| head position, cervical asymmetry, clavicular poise, scapular position, gross thoracic asymmetry, scars, muscle wasting, swelling |
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Term
| what are the steps of the upper quarter screen |
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Definition
| upper quarter AROM with overpressure and resistance; compression/traction; myotomes; dermatomes; reflexes |
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|
Term
| what are pathologies that refer pain to the shoulder |
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Definition
| lung CA, gall bladder, cardiac |
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Term
| what are necessities for full elevatoin |
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Definition
| scapular stabilization; inferior glide of the humerus; ER of the humerus; rotation of the clavicle at SC joint; scapular abduction and lateral rotation of AC joint; straightening of thoracic kyphosis |
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Term
| how to test scapular stabilization |
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Definition
| MMT rhomboids, lower trap, middle trap; look for inhibition from levator scapulae |
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Term
| what would prevent inferior glide of humeral head in elevation |
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Definition
| weak muscles, joint capsule restriction in inferior direction |
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|
Term
|
Definition
| joint capsule restriction in posterior direction, weak muscles |
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|
Term
| check affected or unaffected side first in PROM |
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Definition
|
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Term
| what to do if ROM asymmetries exist |
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Definition
| take goniometric measurements |
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|
Term
| what are the 4 classifications in the Cyriax muscle performance scale |
|
Definition
| Strong and Pain Free; Strong and Painful; Weak and Painful; Weak and Pain Free |
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|
Term
| what is the definition of Cyriax Strong and Pain Free |
|
Definition
| normal tendon, muscle, attachments |
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|
Term
| what is the definition of Cyriax Strong and Painful |
|
Definition
| 1st degree strain - minor lesion |
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|
Term
| what is the definition of Cyriax Weak and Painful |
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Definition
| 2nd degree strain - gross lesion |
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|
Term
| what is the definition of Cyriax Weak and Pain Free |
|
Definition
| 3rd degree strain - complete rupture or neurological |
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|
Term
| is it important to look at scapular stabilizers in shoulder eval? |
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Definition
|
|
Term
| what are the scapular stabilizers |
|
Definition
| rhomboids, middle trap, upper trap |
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|
Term
| what change in muscular performance is seen in overhead athletes with impingement |
|
Definition
| decreased middle and lower trap firing, latency |
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|
Term
| when would you want to check other joints instead of just shoulder? |
|
Definition
| when patient isn't progressing |
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|
Term
| what accessory motions/mobilizations can you do at the shoulder |
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Definition
| inferior mobilization, posterior mobilization, aggressive posterior mobilization, anterior mobilization |
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Term
| what should be palpated posteriorly |
|
Definition
| upper trap, supraspinatus, AC joint, acromion, scapular spine, superior angle to inferior angle, levator, rhomboids, infraspinatus, teres minor |
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|
Term
| what should be palpated laterally |
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Definition
| AC - acromion joint space, deltoid, subscapularis, serratus |
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|
Term
| what should be palpated anteriorly |
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Definition
| SC joint, clavicle, AC - acromion, coracoid process, coracoacromial/coracoclavicular ligaments, pec major/minor/short head, subacromial structures, bicipital groove |
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|
Term
| when do you consider impingement |
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Definition
| when you're pretty certain there isn't a massive rotator cuff or labral tear |
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|
Term
| what is the prevalence of impingement |
|
Definition
| 1/3 of all physician visits for shoulder pain |
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|
Term
| prevalence of impingement in occupations with repetitive motions |
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Definition
|
|
Term
| most common patient age for impingement |
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Definition
|
|
Term
| most common history of patients with impingement |
|
Definition
| occupational or athletic activity with overhead use of arm |
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|
Term
| most common age for primary impingement |
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Definition
|
|
Term
| what usually causes primary impingement |
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Definition
| stress overload, degenerative changes |
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|
Term
| degenerative changes in what structures lead to impingement |
|
Definition
| rotator cuff, acromion process, coracoid process, anterior tissues |
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|
Term
| most common age for secondary impingement |
|
Definition
|
|
Term
| what are the muscle dynamics of secondary impingement |
|
Definition
| force couple disturbance linked to instability |
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|
Term
| what is anatomical instability |
|
Definition
| loosening or tearing of the capsule. |
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|
Term
| what causes anatomical instability |
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Definition
| Someone has a trauma to their arm. OR someone has a tear and never gets treatment. |
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|
Term
| what is translational instability |
|
Definition
| muscles controlling the joint are weak |
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|
Term
| why is secondary impingement called secondary impingement |
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Definition
| scapular stabilizers aren't working as they should, and this leads to secondary problem of impingement. |
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|
Term
| what is outlet impingement |
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Definition
| impingement occurs at supraspinatus outlet. Anterior impingement |
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|
Term
| how is impingement graded |
|
Definition
|
|
Term
| what is grade I impingement |
|
Definition
| pure impingement, no instability |
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|
Term
| what is grade II impingement |
|
Definition
| secondary impingement and instability caused by chronic capsular and labral microtrauma |
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|
Term
| what is grade 3 impingement |
|
Definition
| secondary impingement and instability caused by generalized hypermobility or laxity |
|
|
Term
| what is grade 4 impinement |
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Definition
| primary instability with no impingement |
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|
Term
| who usually gets nonoutlet impingement |
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Definition
|
|
Term
| what is the location of nonoutlet impingement |
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Definition
|
|
Term
| what happens in nonoutlet impingement |
|
Definition
| contact between undersurface of rotator cuff with posterior superior glenoid labrum when the arm is abducted to 90 deg and full ER |
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|
Term
| how many Neer clinical stages are there |
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Definition
|
|
Term
| what is Neer Clinical Stage I |
|
Definition
| a benign, self-limiting, overuse syndrome |
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|
Term
| what is Neer Clinical Stage II |
|
Definition
|
|
Term
| what is Neer clinical Stage III |
|
Definition
| bony changes lead to increased contact pressure, which then lead to rotator cuff damage/tears |
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|
Term
| what can you do to prevent fibrosis in the shoulder |
|
Definition
| MICE (movement). Need to know how to move correctly and safely. |
|
|
Term
| what is the cycle of barriers to healing |
|
Definition
| initial injury/decreased blood supply - disuse - weakening of rotator cuff - faulty biomechanics with elevation - continued stress - decreased blood supply |
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|
Term
|
Definition
| true positive rate: proportion of subjects who have the test that the test finds positive. Snout |
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|
Term
|
Definition
| true negative rate: proportion of subjects who do not have the test that the test findes negative. Spin |
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|
Term
| do you want a high or low positive likelihood ratio |
|
Definition
|
|
Term
| do you want a high or low negative likelihood ratio |
|
Definition
|
|
Term
| what are special tests for impingement |
|
Definition
| Neer, Hawkins-Kennedy, IRRST, |
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|
Term
| what does IRRST stand for |
|
Definition
| internal rotation resistance strength test |
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|
Term
| what is a positive Neer test |
|
Definition
|
|
Term
| can you use one test to diagnose impingement |
|
Definition
| no. best to determine impingement using a cluster of tests, such as Hawkins-Kennedy + painful arc sign + infraspinatus test |
|
|
Term
| State how the following things are for the typical impingement patient |
|
Definition
|
|
Term
| PROM with overpressure in elevation and IR |
|
Definition
|
|
Term
| posterior joint mobilization |
|
Definition
|
|
Term
|
Definition
| flexed thoracic spine. Forward head. Rounded shoulders |
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|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| flexibility of upper trap |
|
Definition
| less on affected side than unaffected |
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