210: Shoulder
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| show | Golf ball on a tee
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| _____ positions of motion are available at the shoulder | show 🗑
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| show | stability
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| what structures provide static stability for the shoulder joint? | show 🗑
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| what structures provide dynamic stability for the shoulder joint? | show 🗑
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| show | static and dynamic
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| show | supraspinatus, infraspinatus, teres minor, subscap
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| what mm ER the shoulder | show 🗑
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| show | subscap
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| show | compression and downward
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| show | inferior
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| show | stabilizing, compressive, and slight upward
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| supraspinatus functions with the ____ in humeral elevation | show 🗑
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| AC joint has a weak ____ | show 🗑
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| show | Superior and inferior AC jt ligaments
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| show | coracoclavicular ligament
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| the AC joint slides in the ____ direction the scapula moves | show 🗑
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| SC joint | show 🗑
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| show | SC ligaments and interclavicular and costoclavicular ligaments
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| what causes movement on the SC joint? | show 🗑
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| show | rotation
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| show | ligaments—no muscles cross joint for dynamic stability
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| motions of the scapula | show 🗑
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| elevation, depression, protraction, and retraction of scapula are ____ motions of the humerus | show 🗑
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| show | concurrent
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| winging of scapula | show 🗑
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| show | with internal rotation and extension
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| show | synchrony
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| Position of scapula important for _____ _____ relationship of scapulo-humeral mm | show 🗑
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| show | home base
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| how many degrees of GH motion for every degree of scapular motion | show 🗑
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| show | Decreased flexibility in pec minor, scalenes and lev scap; Position of scapula changes position of humerus in glenoid; Internal rotators tight; ER stretch weakness
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| what makes up the coracoacromial arch | show 🗑
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| show | ▫Sub deltoid bursa, Supraspinatus tendon, Long head of biceps
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| show | superior labrum
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| show | 30˚ anterior of the frontal plane; motion in this plane called scaption
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| benefits of movment in scapular plane | show 🗑
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| The deltoid causes ____ translation of humerus | show 🗑
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| show | impingement in subacromial space; need rotator cuffs to oppose
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| show | microtrauma
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| show | RA and OA, traumatic arthritis, post immobilization, idiopathic frozen shoulder
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| stage 1 frozen shoulder | show 🗑
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| duration of frozen shoulder phase 1 | show 🗑
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| show | Intense pain, even at rest, Limited motion from 2-3 wks after onset
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| show | Acute symptoms may last 10-36 wks
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| show | Pain with movement, Significant adhesions, Limited GH motion, increased substitutions, Atrophy of RC, deltoid, biceps, triceps
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| duration of stage 3 frozen shoulder (frozen) | show 🗑
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| stage 4 frozen shoulder (thawing) | show 🗑
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| show | ▫Lasts 2 - 24 months
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| frozen shoulder can be ____ _____ with spontaneous recovery BUT, Some patients never regain full motion | show 🗑
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| show | ▫PROM with progression to AAROM, AROM
▫**Must ensure quality motion over quantity**
▫ GH mobs Grade I and II in pain free position
▫Pendulum exercises for joint distraction
▫Isometrics
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| show | Hand, wrist, elbow exercises
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| show | ▫Increase time out of sling
▫Progress ROM up to point of pain
▫Instruct in self assisted ROM techniques
▫Increase joint and soft tissue mobility
▫GH mobs grade III and IV with stretching at end range motion
▫Strengthening to address mm imbalances
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| show | ER
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| treatment of shoulder hypomobility in return to function phase | show 🗑
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| what joint mob may be needed if pt lacks ER? | show 🗑
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| shoulder manipulatio | show 🗑
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| show | after 3rd decade
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| show | Repetitive use at waist level, Repetitive diagonal extension, add, IR
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| show | Land on top of shoulder, Also termed sprains or separation
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| show | faulty posture
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| tx for AC or SC joint dysfunction | show 🗑
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| show | deltopectoral
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| show | release of subscap, anterior capsulotomy, exposure of humeral head and debridement of glenoid; may include repair of deficient RC, re-attach subscap, acromioplasty, bone graft
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| show | No ER stretching, resisted IR, avoid excess extension
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| show | Humeral component is prosthesis; No joint capsule
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| show | glenoid fossa
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| show | tuberosities
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| show | no ER first 6 weeks
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| show | shoulder hemi-arthroplasty: bone healing must occur
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| show | No joint capsule, no rotator cuff
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| what allows for ER with reverse TSA | show 🗑
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| show | Need bone ingrowth into glenoid, no motion for 6 wks.
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| show | slowly, rapidly
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| what are ROM goals for shoulder based on? | show 🗑
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| TSA tx in protection phase | show 🗑
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| how to avoid stressing anterior capsule after TSA | show 🗑
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| when should pt wear sling after TSA | show 🗑
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| when does controlled motion phase begin with TSA? | show 🗑
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| how long does controlled motion phase of TSA last? | show 🗑
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| show | •90˚ of shoulder elevation, 45˚ of ER; Begin low intensity pain free stretching; Gentle mobilization techniques; Table slides; Door or dowel ER stretch; Towel stretch for IR; Cross body horiz add stretch
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| strengthening for TSA in controlled motion phase | show 🗑
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| scapular and GH stabilization exercises | show 🗑
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| TSA tx in return to function phase | show 🗑
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| criteria for return to function phase in TSA | show 🗑
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| impingement syndrome can be ____ or ____ | show 🗑
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| primary impingement syndrome | show 🗑
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| intrinsic factors that can contribute to impingement syndrome | show 🗑
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| what type of acromion in impingement can do well with conservative PT | show 🗑
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| show | type 3
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| extrinsic factors that contribute to impingement syndrome | show 🗑
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| Excessive ____ ____ engagement and ____ ____ is linked to impingement syndrome | show 🗑
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| show | strengthen scapular mm and relax the upper trap, strengthen lower trap, stretch chest mm, thoracic spine exercises
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| upper crossed syndrome | show 🗑
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| show | upper trapezius, levator scapulae, sternocleidomastoid and pectoralis muscles, and reciprocal weakness of the deep cervical flexors, lower trapezius & serratus anterior
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| show | OH activity
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| what head of biceps is involved in biceps tendonitis | show 🗑
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| show | ▫Pain with Speed's test
▫Pain can radiate down into mm belly
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| types of shoulder instabilities | show 🗑
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| show | Need strong dynamic stabilizers (RC and scap stabilizers)
- closed chain ext is good
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| ROM restrictions for TSA with intact rotator cuff 0-4 weeks | show 🗑
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| show | no GH extension past neutral
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| ROM restrictions for TSA with intact rotator cuff 6-12 weeks | show 🗑
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| show | *limit for 12 weeks or more*: no GH extension or IR, no combined GH extension, ADD, or IR
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| rotator cuff tears can be ____ or ____ | show 🗑
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| what is typically cause of rotator cuff tear? | show 🗑
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| show | •No surgery if asymptomatic
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| show | Repairs can be arthroscopic, mini open, open subacromial decompression performed
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