Term
|
Definition
| humerus slips over the glenoid rim and relocates spontaneously without external support |
|
|
Term
|
Definition
| humeral head of the humerus actually passes through the capsular restraints and rests beside the glenoid |
|
|
Term
| most dislocations occur in what direction |
|
Definition
|
|
Term
| most common dislocation is called what |
|
Definition
|
|
Term
| mechanism for dislocation |
|
Definition
| forced external rotaiton with abduction |
|
|
Term
| a dislocation would result in tearing of what (3) |
|
Definition
inferior GH ligament
anterior capsule
possibly the labrum |
|
|
Term
| what is a Bankhart lesion |
|
Definition
| if the labrum and capsule avulsed with the inferior GH ligament |
|
|
Term
| what is a Osseous Bankhart lesion |
|
Definition
| if part of the glenoid rim avulses as well along with the labrum and the capsule with the GH ligament |
|
|
Term
|
Definition
shoulder pain
arm held at side usually slightly away from the body with the forearm turned outward
loss of normal rounded countour of the deltoid mm |
|
|
Term
|
Definition
Traumatic onset
Unidirectional (anterior/posterior most common)
Bankhart (usually present)
Surgery (success rate with nonoperative tx is <20%) |
|
|
Term
|
Definition
| may result in damage to the brachial plexus or axillary nerve. Usually a neuropraxic injury |
|
|
Term
| Dislocaiton + compression fracture is referred to as what |
|
Definition
|
|
Term
| What is a Hill-Sachs Lesion |
|
Definition
| a compression fracture to posterior humeral head in conjunction with a dislocation |
|
|
Term
| Recurrence rate for dislocations |
|
Definition
high, 50-60% overall
80% for under 20
15% over 50 |
|
|
Term
| PT mgmt of dislocations: once reduced, what must be determined |
|
Definition
| xray to see if there are any bony injuries around dislocation |
|
|
Term
| PT mgmt of dislocations: how long may a pt be immobilized for by a physician |
|
Definition
|
|
Term
| PT mgmt of dislocations: what must almost always be attempted after first dislocation |
|
Definition
|
|
Term
| PT mgmt of dislocations: PT interventions (2) |
|
Definition
treat symptomatically based on stage of injury
instruct pt in methods to avoid and prevent re-injury |
|
|
Term
| PT mgmt of dislocations: modality intervention |
|
Definition
| E-stim to control inflammation and for muscle re-education |
|
|
Term
| PT mgmt of dislocations: ROM |
|
Definition
| limited range (initially inner ranges) |
|
|
Term
| PT mgmt of dislocations: Strengthening (4) |
|
Definition
cuff mm
axioscapular mm
in limited/inner range
avoid end range external rotation |
|
|
Term
|
Definition
Atraumatic onset
Multidirectional in nature
Bilateral (usually)
Rehabilitation (success with conserveative treatment is usually >80%)
Inferior capsular cshift (procedure of choice if conservative tx fails) |
|
|
Term
| AMBRi dislocations are seen in what pt populations (2) |
|
Definition
hypermobility
(+) 9 pt ligamentous laxity test |
|
|
Term
|
Definition
previous dislocations
congentially shallow glenoid fossa
labral tears
generaly ligamentous/capsular laxity (loose jointed) |
|
|
Term
| Instability Symptom Presentaiton: history |
|
Definition
|
|
Term
| Instability Symptom Presentaiton: c/o (3) |
|
Definition
shoulder pop out and may describe transiet numbness of arm associated with popping out sensation
vague shoulder pain |
|
|
Term
| Instability Symptom Presentaiton: pt habits |
|
Definition
| overhead/throwing athlete with past MOI |
|
|
Term
| Instability Symptom Presentaiton: syndrome |
|
Definition
| dead arm syndrome = touch of numbness after a throw for example |
|
|
Term
| Instability Symptom Presentaiton: (+) clinical tests |
|
Definition
positive sulcus sign
or apprehension/release test |
|
|
Term
| Instability Symptom Presentaiton: additional shoulder pathology |
|
Definition
|
|
Term
| Instability Symptom Presentaiton: palpation |
|
Definition
| tenderness over the insertion of the inferior glenohumeral ligament is not uncommon |
|
|
Term
| Instability PT interventions: (3) |
|
Definition
treat symptomatically (pain and inflammation)
activity modification
aggressive strengthening of cuff and scapular stabilizer mm within an approriate ROM |
|
|
Term
| Instability PT interventions: strengthening of cuff and scapular stabilizer mm include (4) |
|
Definition
|
|
Term
| Instability PT interventions: modalities |
|
Definition
|
|
Term
| Instability PT interventions: hands on interventions |
|
Definition
| Mobs if specific capsular tightness is contributing to instability (posterior capsule tighntess with antrior humeral head position) |
|
|
Term
| Instability PT interventions: 3 surgical mgmt |
|
Definition
bankhart repair
capsulorrhapy
lasa or electrothermally-assisted capsular shift |
|
|
Term
| Instability PT interventions: surgical mgmt: bankhart repair |
|
Definition
| suturing or tacking the labrum and capsule back to the glenoid rim |
|
|
Term
| Instability PT interventions: surgical mgmt: capsulorrhaphy |
|
Definition
| tightening the capsule by cutting and folding components over one another (capsular shift) |
|
|
Term
|
Definition
repetitive shearing forces of GH jt d/t hypermobility
traction stress of the biceps tendon (SLAP lesion)
Traumatic dislocation (bankhart lesion) |
|
|
Term
|
Definition
Superior Labrum Anterior Posterior Lesion
inter-articular non contractile lesion |
|
|
Term
| Labral Tears: s/s: c/o (2) |
|
Definition
popping or catching sensation within the jt
shoulder subluxation with transiet paresthesias |
|
|
Term
| Labral Tears: s/s: pain (2) |
|
Definition
at extreme ranges of motion
poor localized |
|
|
Term
| Labral Tears: s/s: positive clinical tests (5) dependent on location of lesion |
|
Definition
Clunk
Grind
O'Brien
Bicep Load II test
Pain provocation |
|
|
Term
| Labral Tears: s/s: mobility |
|
Definition
| Associated jt hypermobility |
|
|
Term
| Labral Tears: how are they diagonsed |
|
Definition
| typically a dx by exclusion |
|
|
Term
| Labral Tears: Interventions: PT (3) |
|
Definition
treat symptomatically
strengthen dynamic stabilizers of humeral head and scapula
mobilization to decrease posterior capsule tightness if anterior labral tear |
|
|
Term
| Labral Tears: Interventions: Surgical is dependent on what |
|
Definition
| type of labral tear and extent of lesion |
|
|
Term
| Labral Tears: Interventions: Surgical (4) |
|
Definition
removal of torn tissue
suture tissue back together
stape or tack back to glenoid rim
may need to tighten capsule as well |
|
|
Term
| Subscapularis Syndrome: ROM |
|
Definition
limited passive ext rot in adduction
limited active elevation above 120 degrees |
|
|
Term
| Subscapularis Syndrome: palpation and observation (3) |
|
Definition
palpation of trigger pts within mm belly
lack of dissociations of humerus and scapula (lateral bulge) with active elevation
asymmetry of scapula height (elevation-protraction) |
|
|
Term
| Subscapularis Syndrome: weakness (2) |
|
Definition
weakness and pain with lift off test
weakness of supraspinatus and external rotators secondary to poor length tension of mentioned mm |
|
|
Term
| Subscapularis Syndrome: tx |
|
Definition
7 min soft tissue work to subscap
7 contract relax reps into ext rot
5 D2 PNF patterns with manual resistance
Increases in ER and overhead reach |
|
|
Term
| Fx of the Shoulder Complex: 3 areas for potential fracture |
|
Definition
|
|
Term
| Fx of the Shoulder Complex: 2 areas where the clavicle fractures |
|
Definition
juncture of middle and distal clavicle
middle 1/3 |
|
|
Term
| Fx of the Shoulder Complex: 4 areas where the scapula can fracture |
|
Definition
|
|
Term
| Fx of the Shoulder Complex: 3 areas where the humerus can fracture |
|
Definition
greater tuberosity
shaft
neck |
|
|
Term
| Clavicle fx: most common MOI (2) |
|
Definition
fall on lateral shoulder most common
fall on outstretched arm less common |
|
|
Term
| Clavicle fx: area most commonly fractured |
|
Definition
| junciton of mid and lateral 1/3 most common area for fracture |
|
|
Term
|
Definition
| immobilize 14-21 days in figure 8 brace/sling. Time frame may increase based on severity |
|
|
Term
| Clavicle fx: rehab: when to begin AROM |
|
Definition
|
|
Term
| Clavicle fx: rehab: AROM should include what (6) |
|
Definition
Elevation
Depression
Protraction
Retraction of scapula
Pendulum
Wand ex |
|
|
Term
| Clavicle fx: additional rehab considerations |
|
Definition
| address GH articulation, mm atrophy based on length of immobilization and stage of healing |
|
|
Term
| Scapular fx: most common MOI |
|
Definition
|
|
Term
| Scapular fx: good news for pt's with scap fx |
|
Definition
| most are non-displaced therefore no immobilization needed |
|
|
Term
|
Definition
| within the first few days |
|
|
Term
| Scapular fx: rehab: immobilization |
|
Definition
| if severe displacement or surgery |
|
|
Term
| Scapular fx: rehab: if prolonged immobilization |
|
Definition
| consider passive mobilization and strength training |
|
|
Term
| Scapular fx: rehab: secondary evaluation considering MOI |
|
Definition
| evaluate ribs and thoracic region as mechanism is typically a direct blow |
|
|
Term
| Fx of the humerus: greater tuberosity fx MOI |
|
Definition
|
|
Term
| Humerus fx: 2 types of greater tuberosity fx |
|
Definition
displaced/avulsed
non-displaced |
|
|
Term
| Humerus fx: non-displaced greater tuberosity rehab |
|
Definition
|
|
Term
| Humerus fx: greater tuberosity displaced/avulsed fx rehab |
|
Definition
must reduce
post-op surgery-immobilization typically 14-21 days |
|
|
Term
| Humerus fx: neck of humerus MOI |
|
Definition
| fall on outstretched arm or elbow |
|
|
Term
| Humerus fx: neck of humerus pt population (2) |
|
Definition
|
|
Term
| Humerus fx: neck of humerus fx: if impacted or non-displaced what can the pt do |
|
Definition
| pt can remove arm from sling frequently for exercise |
|
|
Term
| Humerus fx: neck of humerus: if displaced, how long is immobilization |
|
Definition
| in a sling can last 14-21 days up to 4 weeks |
|
|
Term
| Humerus fx: neck of humerus: ORIF rehab |
|
Definition
| variable time on immobilization |
|
|
Term
| Humerus fx: shaft of humerus MOI |
|
Definition
| direct blow or twisting force |
|
|
Term
| Humerus fx: shaft of humerus: nature of the fx (2) |
|
Definition
| usually involve middle 1/3 and spiral in nature |
|
|
Term
| Humerus fx: shaft of humerus fx: tx |
|
Definition
| may cast or reduce surgically depending on severity |
|
|
Term
| Humerus fx: which is the more common fx site: neck or greater tuberosity |
|
Definition
|
|
Term
| Humerus fx: humerus fx red flag |
|
Definition
| wrist drop indicates radial nn affected |
|
|
Term
| Humerus fx: early rehab considerations |
|
Definition
early safe remobilization importatnt
careful AAROM even while in sling |
|
|
Term
| Humerus fx: rehab progression |
|
Definition
| once fx is stable can progress in mobilizatio, ROM and strengthening as tolerated |
|
|
Term
| Typical criteria for surgical intervention include: (3) |
|
Definition
failure to respond to 4-6 month course of conservative measures
severe levels of pain that significantly limit the performance of daily activties and personal care
Gross jt instability and abnormal jt alignment with accompanying loss of function |
|
|
Term
| Surgical complications (5) |
|
Definition
infection
DVT
pulmonary embolus
poor wound heailng
excessive scarring and adhesion information |
|
|
Term
| General Post-op guidelines (7) |
|
Definition
pt education
monitor and promote tissue healing
pain relief
MD communications
Protection Phase (Max, Mod, Min)
Function |
|
|
Term
| Key factors that must be considered in post-surgical rehab are: on the pt side (4) |
|
Definition
age
physical status (weight, previous medical hx)
Social lifestyle
functional and recreational goals of the pt |
|
|
Term
| Key factors that must be considered in post-surgical rehab are: on the physician side (5) |
|
Definition
Pre-operative jt contracture or mm atrophy
Type of surgery
Method of fixation
Surrounding soft tissues involved
Degree of correction of biomechanical alignment |
|
|
Term
| Post-surgical rehab: Acute phase goals: (6) |
|
Definition
control pain and inflammation
allow healing progression of surgical site and help prevent complication
retard mm atrophy and enhance dynamic stability
minimize detrimental effects of immobilization
pt compliance with post-surgical restrictions
initiate restoration of ROM |
|
|
Term
| Post-surgical rehab: Exercise Heirarchy (6) |
|
Definition
PROM
AAROM
AROM
Sub-maximal ISometrics in pain free ranges
Sub-maximal isometric through available range
Progressive resisted exercise |
|
|
Term
| Post-surgical rehab: Restore, maintain, or improve pt's ________ status |
|
Definition
|
|
Term
| Post-surgical rehab: How do we ensure patient safety and independence (3) |
|
Definition
assisstive devices
family support
HEP |
|
|
Term
| Common Shoulder Surgeries: (5) |
|
Definition
subacromial decompression
acromioplasty
Rotator cuff repair
Surgery for shoulder instability
Total shoulder arthroplasty |
|
|
Term
|
Definition
|
|
Term
| Goal of acromioplasty (5) |
|
Definition
Resection of undersurface of AC jt
Debridement of Undersurface of AC jt
Release of Coracoacromial ligament
Subacromial bursectomy
Debridement of bursal side of RC if necessary |
|
|
Term
| Acromioplasty Rehab: days 1-10 |
|
Definition
AROM of finger, wrist, elbow
Sling
Pendulum, scapular ex
AAROM of shoulder
Pulleys
Ice |
|
|
Term
| Acromioplasty Rehab: days 7-14 |
|
Definition
AROM -avoid impingement positions
No resisitve ex
Trunk/LE condition
Ice |
|
|
Term
| Acromioplasty Rehab: Day 14-10 weeks |
|
Definition
AROM
Scapular strengthening
Isometrics
Low weight RC ex
PNF diagonals
Upper Body Ex
Isokinetics |
|
|
Term
| Acromioplasty Rehab: 6-8 weeks what can be reintroduced |
|
Definition
| sport specific skills as tolerated |
|
|
Term
| RC Repair Rehab: Days 1-7 |
|
Definition
AROM of fingers,wrist, elbow
PROM in flexion/scaption below 90 |
|
|
Term
| RC Repair Rehab: 1-3 weeks |
|
Definition
PROM
Active scapular ex
Pendulum ex |
|
|
Term
| RC Repair Rehab: 1-3 weeks avoid what ($) |
|
Definition
horizontal adduction
Extension
IR
ER |
|
|
Term
| RC Repair Rehab: 4-6 weeks |
|
Definition
PROM
AAROM (pulleys, wand)
Shoulder flexion below 90
Abduction in scapular plane
No heavy objects lifting |
|
|
Term
| RC Repair Rehab: 6-8 weeks |
|
Definition
PROM
AAROM
Initiate AROM shoulder flexion and scaption below 90
Gravity eliminated IR/ER
Isomterics |
|
|
Term
| RC Repair Rehab: 8-12 weeks |
|
Definition
continue stretching
Upper Body Exercises
Wall pulleys
Resistive tubing
PRE (progressive resistance exercise) |
|
|
Term
|
Definition
isokinetics
formal weight training
light throwing
functional progression |
|
|
Term
| Surgical Stabilizing Techniques: (3) |
|
Definition
bankart repair
capsular shift
thermal/laser capsulorraphy |
|
|
Term
| Surgical Stabilizing Techniques: what is a bankart repair |
|
Definition
| suture anterior capsule to anterior glenoid rim |
|
|
Term
| Surgical Stabilizing Techniques: what is a capsular shift |
|
Definition
|
|
Term
| Surgical Stabilizing Techniques: what is thermal/laser capsulorraphy |
|
Definition
| thermal shrinkage of capsular collagen tissue |
|
|
Term
| Surgical Stabilizing Techniques: red flag in rehab |
|
Definition
| pt gaining too much ROM too quickly |
|
|
Term
| Capsular Shift rehab: 0-3 weeks |
|
Definition
sling
AROM fingers, wrist, and elbow
Submax isometrics except IR secondary to subscapularis reattachment |
|
|
Term
| Capsular Shift rehab: 3-6 weeks |
|
Definition
PROM
AAROM
active scapular ex
Submax isometrics except IR |
|
|
Term
| Capsular Shift rehab: 6-8 weeks |
|
Definition
PROM
AAROM
AROM
resistive tubing |
|
|
Term
| Capsular Shift rehab: 8-12 weeks |
|
Definition
continue stretching
initiate isotonic strengthening (sidelying ER, prone arm raises at 90 and 120 degrees, elevation in plane of scapula, prone ER)
Functional progression: full pain free motion, adequate strength (90%) contralateral shoulder |
|
|
Term
| Thermal capsular shift problems |
|
Definition
| treated tissue can stretch up to 8 weeks after application, recommend later inititaion of active ex and gentle stretching |
|
|
Term
| Thermal/Laser Capsular Shift Rehab: Phase 1 (1-4 weeks) |
|
Definition
Sling
Pendulum ex at 3 weeks
Submaximal isometrics at 3 weeks |
|
|
Term
| Thermal/Laser Capsular Shift Rehab: Phase II (weeks 5-9) |
|
Definition
controlled restoration of ROM
Proprioceptive training
AROM for ER in sidelying
Rhythmic stabilization
Closed chain quadruped ex and core strengthing
All ex done below 90 degrees elevation |
|
|
Term
| Thermal/Laser Capsular Shift Rehab: Phase III (Weeks 10-16) |
|
Definition
Restoration of full ROM
Light plyometric drills
Resisitve ex progressing overhead
Unstable closed chain exercises on gym ball or balance board |
|
|
Term
| Thermal/Laser Capsular Shift Rehab: Phase IV (weeks 17-22) |
|
Definition
Emphasize restoration of normal neuromuscular control
Rhythmic stabilization and plyometrics in provocative position preparation of phase V |
|
|
Term
| Thermal/Laser Capsular Shift Rehab: Phase V (weeks 23-26) |
|
Definition
| functional progression for return to previous level of activity |
|
|
Term
| Shoulder Arthroplasty: 3 types |
|
Definition
hemi-arthroplasty
total shoulder arthroplasty
reverse total shoulder |
|
|
Term
| Shoulder Arthroplasty: hemi-arthroplasty |
|
Definition
| replacement of humeral head only (used when insufficient glenoid bone to support glenoid component, or RC deficiency) |
|
|
Term
| Shoulder Arthroplasty: total shoulder arthroplasty |
|
Definition
| replacement of humeral head and glenoid |
|
|
Term
| Shoulder Arthroplasty: reverse total shoulder arthroplasty |
|
Definition
primary indication is severe OA with torn RC
Improves deltoid mechanical advantage to assist with shoulder ROM |
|
|
Term
| Shoulder Arthroplasty Rehab: 0-4 weeks |
|
Definition
AROM of fingers, wrist, and elbow
PROM shoulder
Pendulum ex
AAROM in flexion and ER |
|
|
Term
| Shoulder Arthroplasty Rehab: 4-6 weeks |
|
Definition
scapular strengthening
Isometrics
Active flexion in supine |
|
|
Term
| Shoulder Arthroplasty Rehab: 6-10 weeks |
|
Definition
AROM in sitting
Resistive IR/ER |
|
|
Term
| Shoulder Arthroplasty Rehab: 8-12 weeks |
|
Definition
| progression of strength and function |
|
|
Term
| 4 functional assessment tools for the shoulder |
|
Definition
Disabilities of the ARM, Shoulder, and Hand (DASH)
Simple Shoulder Test (SST)
Shoulder Pain and Disability Index (SPADI)
Upper Extremity Functional Rating Index |
|
|
Term
| Cervical Apophyseal Jt Referral Patterns: C2-C3 |
|
Definition
|
|
Term
| Cervical Apophyseal Jt Referral Patterns: C3-C4 |
|
Definition
|
|
Term
| Cervical Apophyseal Jt Referral Patterns: C4-C5 |
|
Definition
|
|
Term
| Cervical Apophyseal Jt Referral Patterns: C5-C6 |
|
Definition
| medial to upper scapula into lower cervical spine |
|
|
Term
| Cervical Apophyseal Jt Referral Patterns: C6-C7 |
|
Definition
|
|
Term
| Thoracic Spine and Rib Cage Red Flags: (7) |
|
Definition
MI
Cholecystitis
Liver/gallbladder pain
Peptic Ulcer
Stomach/Duodenum
Breast Referral Pattern
Pancoast Tumor |
|
|
Term
| Thoracic Spine and Rib Cage Red Flags: Cholecystitis (3) |
|
Definition
Colicky pain in right upper quadrant with accompanying right scapular pain
Symptoms may worsen with ingestion of food
Symptoms not increased by activity nor relieved by rest |
|
|
Term
| Liver and gall bladder pain will refer where |
|
Definition
| right shoulder, interscapular, or subscapular area |
|
|
Term
| Thoracic Spine and Rib Cage Red Flags: Peptic Ulcer presentation (4) |
|
Definition
dull gnawing pain or burning sensation in the epigastrium, mid back, or supraclavicular regions
symptoms relieved with food
localized tenderness at the right epigastrum
constipation, bleeding, vomiting, tarry stools, coffee ground emeses |
|
|
Term
| Stomach and duodenum pain referral areas |
|
Definition
| right shoulder and upper trap or the lateral border of the right scapula |
|
|
Term
| where is a pancoast tumor located |
|
Definition
|
|
Term
| Thoracic Spine and Rib Cage Red Flags: pancoast tumor may affect what in terms of the nn system |
|
Definition
lower cords of brachial plexus creating paresthesis into C8-T1
cervical sympathetic chain affected results in Horner's syndrome |
|
|
Term
| What is Horner's syndrome |
|
Definition
Ptosis
recessed eye
unilateral facial sweating
trophic changes |
|
|
Term
| pt with a pancoast tumor will have this hx (4) |
|
Definition
smoking
persistent cough
red flags for cancer such as weight loss and decreased appetite |
|
|
