Unit 7 Shoulder and 8.9-8.10 Congenital Muscular Torticollis

-Hum ER -Hum Flexion -Scap Up rot -Scap Elev

Match the joint mobilization with the treatment outcome. -Glenohumeral Posterior glide -Glenohumeral inferior glide -Scapulothoracic upward rotation -Scapulothoracic elevation

Left; Right

For L CMT: You would expect that in all positions infant would position head in __?__ lateral flexion and __?__ rotation.

Right, Left

For L CMT: You would perform a combined stretch into __?__ lateral flexion and __?__ rotation. Right, right Left, right Left, left Right, left

right

For L CMT: You would perform a stretch into __?__ lateral flexion. Right Left

left

For L CMT: You would perform a stretch into __?__ rotation. Left Right

Right

For L CMT: You would perform strengthening into __?__ lateral flexion. Right Left

Left

For L CMT: You would perform strengthening into __?__ rotation.

L>R

For L CMT: Your patient would demonstrate __?__ > __?__ cervical lateral flexion PROM.

R>L

For L CMT: Your patient would demonstrate __?__ > __?__ cervical rotation AROM.

R>L

For L CMT: Your patient would demonstrate __?__ > __?__ cervical rotation PROM.

Right

For L CMT: Your patient's __?__ posterior occiput is most likely to be flat.

Pathoanatomic diagnosis, classification, impairment (body/structure/function), limitation (activity)

Match the following terms with the appropriate diagnosis or classification. -Labral pathology -Sh stability with movement coordination impairments -Sh flexion ROM loss -Reaching behind back

-Selectivity targets the external rotators isotonically -Strengthens the rotator cuff how it is used in function

A patient presents with a glenohumeral external rotation muscle performance deficit. You choose to strengthen the rotator cuff. Match the specific intervention with the rationale. -Standing isolated external rotation at 0° abduction -Standing side step external rotation isometric at 0° abduction

1. Standing wall slide 2. supine resisted protraction 3. Standing table plank protraction 4. modified plank protraction 5. Plank protraction

Arrange the following exercises in an order of progression with 1 being the lowest demand and 5 being the highest demand. -Modified plank protraction -Supine resisted protraction -Standing table plank protraction -Plank protraction -Standing wall slide with protraction

Inferior and Posterior GH glide Scap Mobilization into upward rotation, and also CKC Shoulder flexion with Scapular Assist

Based on Bruce Melnyk's objective findings, which joint mobilization techniques would be appropriate as a treatment? Objective findings: Inadequate scapular upward rotation at end-range flexion Decreased posterior tilt at end-range flexion Hypomobile glenohumeral glide (inferior and posterior) Your answers may be discussed during the Live Session

T-spine STM and stretch Pec minor STM and stretch

Based on Bruce Melnyk's objective findings, which soft tissue mobilization techniques and stretches would be appropriate as a treatment? Objective findings: Inadequate scapular upward rotation during shoulder flexion Hypomobile glenohumeral inferior glide Hypomobile T2-T12 thoracic mobility

Glenohumeral Instability

Based on the subjective and objective exam, what is the most likely pathoanatomical diagnosis hypothesis for this patient? Adhesive Capsulitis Glenohumeral Instability Brachial Plexus Traction Injury Facet Syndrome [**excessive range, lack of scap control]

Adhesive capsulitis

Based on the subjective and objective exam, what is the most likely pathoanatomical diagnosis hypothesis for this patient? Labral pathology Rotator cuff pathology Biceps pathology Adhesive capsulitis

yes, but reassess once starts walking

Is this 9-month-old child ready for discontinuation from direct PT? 1. Cervical PROM within 5° of nonaffected 2. Symmetrical active movement throughout the cervical PROM 3. Age-appropriate motor development 4. No visible head tilt 5. Parents understand what to monitor as the child grows No, continue PT Yes, no further need to follow up with PT Yes, but reassess once starts walking No, needs referral back to MD

Scapular Assist: to fix inadequate scapular upward rotation by providing upward rotation and posterior tipping Scapular reposition: to fix excessive scapular winging (IR and/or anterior tipping), and provide scapular ER and posterior tipping

Match the scapular alteration test with its intended function. -Scapular Assist -Scapular Reposition

Type IV: parallelogram shape and facial assymetries ; IF has temporal buldging (need a side view) then Type V!

Refer to the Argenta clinical classification of plagiocephaly and the attached picture to report your classification for this pediatric patient with regard to his plagiocephaly. Describe why you placed the child in your choice of classification. [ see next question for the picture/diagram classification]

Left congenital muscular torticollis

Review the attached picture: A 4-month-old boy is referred to physical therapy for torticollis. How would you describe his torticollis? [Right or Left Congenital Muscular Torticollis]

improve mobility and ROM, and likely decrease irritability and pain--improved scapulohumeral rhythm

What impact would these interventions potentially have on Mr. Melnyk's overall function?

b. Instruct in repositioning, monitor head shape until 12 months of age, then refer to pediatrician for craniofacial screen, and if indicated a cranial helmet assessment.

What is the most appropriate course of action to address Mike's plagiocephaly? a. Refer to pediatrician immediately for craniofacial screen, and if indicated a cranial helmet assessment. b. Instruct in repositioning, monitor head shape until 12 months of age, then refer to pediatrician for craniofacial screen, and if indicated a cranial helmet assessment.

Me: skeletal., vertebral, vestibular, proprioception, vision,auditory.,endocrine.. Answer: Answers: Cardiorespiratory, gastrointestinal, integumentary, musculoskeletal, neurological (including vision)

What systems would be most appropriate to screen for non-muscular causes of asymmetry and conditions associated with CMT?

Stretching of cervical musculature

Which is 1 component of the first choice intervention for CMT? a. Soft foam collar for symmetry b. Cervical manipulation c. Stretching of cervical musculature d. Kinesiotaping for facilitation of weak cervical musculature

pec minor

Which muscle flexibility deficit would lead to an internally rotated and anterior tipped scapula? Pectoralis major Latissimus dorsi Subscapularis Pectoralis minor

Painful arc, empty can, Hawkins Kennedy Crank = labrum; drop arm = full thickness tear; ER Lag sign = full tear

Which of the following test clusters would have the highest likelihood of diagnosing subacromial pain syndrome? Drop arm, painful arc, empty can External rotation lag sign, Hawkins, Neers Painful arc, empty can, Hawkins Kennedy Crank, painful arc, lift off

With 90 degrees of abduction and 90 deg of elbow flexion, the capsule is in a more taut position...because symptoms are reproduced in AROM and PROM, this could indicate both contractile tissues as the pathoanatomic source of symptoms in AROM and also non-contractile structures which may be either compressed or stretched in PROM.

Why are symptoms reproduced with both active and passive range of motion into internal rotation while in a position of 90 degrees of abduction and 90 degrees of elbow flexion?

Grade 3: Early severe

Your patient is a 4-month-old boy demonstrating a left-sided torticollis with an SCM mass. How would you classify the severity of these findings? Grade 7: Late extreme Grade 2: Early moderate Grade 4: Late mild Grade 1: Early mild Grade 6: Late severe Grade 5: Late moderate Grade 3: Early severe