OT 520 Final Exam
What is scaption?
30 degrees anterior to the frontal plane
Name the two special tests that will test the sufficiency or insufficiency of the subscapularis (Select 2 below). Based upon the special tests that you note, which one would be most valid for (1) idiopathic/primary adhesive capsulitis and which one would be most valid for a suspected (2) lesion of subscapularis? A. Gerber Lift Off Test B. Belly Press Test C. Yerguson Test D. Speeds Test
A & B Belly Press: idiopathic/primary adhesive capsulitis Gerber Lift Off Test: lesion of subscapularis
You are performing passive scapulo-humeral ROM on your patient. You wish to move into shoulder abduction within the frontal plane. What are the corresponding passive movements (2) that you'll be providing to the scapula to recreate/facilitate/optimize normal scapular biomechanics? LIST TWO FROM THE SELECTION BELOW. (Prior to doing this, you encouraged your patient to assume cervical-thoracic extension to achieve a neutral scapula - balance between pectoralis minor and lower trapezius). A. Elevation B. Retraction/Adduction/Medial glide C. Abduction/Protraction/Lateral Glide D. Upward Rotation
A & E; Elevation and Upward Rotation
When is the upper quadrant screen performed? List ALL THREE that apply. A. To rule out anything relative to cervical spine pathology B. To determine which anatomical region of the upper quadrant is contributing to the patient's symptoms and therefore needs greater attention or evaluation C. To assist with differential assessment D. To remediate and treat divergent and convergent pain
A, B, C
Conservative management of thoracic outlet syndrome involves a number of preparatory methods, activities and occupation based interventions. When "strengthening" is indicated, what structures will you focus on? State ALL that apply. A. Middle and Lower Trapezius B. Rhomboids C. Serratus Anterior D. Tibialis Anterior
A,B, and C
When having your patient perform SCAPTION: How many degrees are they anterior to the frontal plane of abduction? A. 30 degrees B. 60 degrees C. 70-80 degrees D. 25-30 degrees of frontal plane abduction with slight forward flexion
A. 30 degrees
Jamar dynamometer grip strength testing: The average strength of 3 trials, the 5-fret method and Rapid Exchange are all assessments that collectively represent? Select the one best choice. A. An assessment battery B. A series of occupational forms C. An evaluation triad D. Performance Patterns
A. An assessment battery
Your patient has flexion and extension limitations in AROM of the Left digit two PIP joint. You wish to first work on flexion and then secondly work on extension. What forms of blocking could be used to facilitate AROM? A. Blocking and Reverse Blocking respectively B. Reverse Blocking and Blocking respectively C. Blocking and Blocking respectively D. Reverse Blocking and Reverse Blocking respectively
A. Blocking and Reverse Blocking respectively
A patient has suspected impingement syndrome of the shoulder. He complains of a "very annoying dull achy pain" in the lateral proximal upper extremity. As you test FROM, he notes considerable "catching" and painful feeling with abduction in the frontal plane. He also states that his pain is relieved by self-employed distraction. What do you suspect is the cause of his subacromial overcrowding? A. Bursitis B. Tight Posterior Cuff C. Subacromial arthritis D. Shoulder instability/hypermobility
A. Bursitis
Name a self-employed symptom management technique for bursitis as well as idiopathic frozen shoulder. A. Distraction of the glenohumeral joint B. Approximation of the glenohumeral joint C. Weight bearing D. Keep the glenohumeral joint internally rotated
A. Distraction of the glenohumeral joint
You suspect a case of Radial Tunnel Syndrome. You think back to your OT 520 course and remember this is a branch of the radial nerve (posterior interosseous nerve) that gets compressed in a compartment at the mid dorsal forearm. It leads to dorsal and radial paresthesias but rarely motor weakness of the fingers and thumb. In performing a radial neural tension test, how would you position the fingers and wrist? A. Flexion B. Extension C. Extension and flexion respectively D. Flexion and extension respectively
A. Flexion
What is a common issue with a recently healed residual digit? This individual is status post amputation surgery due to a traumatic event causing partial loss of the finger. A. Hypersensitivity B. Trigger/Ischemic points C. Tenosynovitis D. Docical points
A. Hypersensitivity
What is the one anatomical motion of the shoulder noted with most all of the impingement special tests? A. Internal rotation B. External rotation C. End range shoulder flexion D. Shoulder extension
A. Internal rotation
The position of comfort is the position of deformity/contracture given burn injuries. If someone sustains dorsal wrist and dorsal hand burns, what splint would be indicated? A. Intrinsic Plus/Burn/Safe Positioning B. Resting Hand Splint C. Thumb spica or Wrist cock-up D. All of the above
A. Intrinsic Plus/Burn/Safe Positioning
Which therapy is most important (singular) for a patient to perform when it is apparent an acute developing boutonniere deformity is occurring? A. Isolated DIP joint flexion and PIP joint extension B. Isolated PIP joint flexion and extension C. Isolated PIP joint flexion D. Composite digital flexion of the affected finger and adjacent fingers using a "digital extension apparatus"
A. Isolated DIP joint flexion and PIP joint extension
A burn to the posterior region of the knee may involve splinting in what anatomical direction/motion? A. Knee extension to anatomical 0 B. Knee flexion C. Knee flexion to 80 degrees D. Knee flexion to 110 degrees
A. Knee extension to anatomical 0
The "Codman" exercise for S/P Recent Rotator Cuff (Massive) Surgical Repair and for Shoulder Impingement Syndrome: A. Passive Codman and Active Codman respectively B. Active Codman and Passive Codman respectively C. Passive Codman and Passive Codman respectively D. Active Codman and Active Codman respectively
A. Passive Codman and Active Codman respectively
As a general statement, during the Chronic-Active stage of R.A. resistive exercises are contraindicated. True or False A. True B. False
A. True
If someone has a shoulder impingment, what kind of codman would you do (active or passive).
Active
Serratus Anterior Attachments: Actions:
Also known as: "Big swing muscle" and "Superhero muscle" Origin: -First through ninth ribs Insertion: Scapula- -Superior Part: Costal and dorsal surface of superior angle -Intermediate Part: Costal surface of medial boarder -Inferior Part: Costal and dorsal surface of the inferior angle and costal surface of the medial boarder Action: -Entire Muscle: Draws the scapula laterally forward, elevates the ribs when the shoulder girdle is fixed (assists in respiration) -Inferior Part: Rotates the scapula and draws its inferior angle laterally forward (rotates glenoid cavity superiorly), allowing the arm to be elevated above 90 degrees Innervation: Long Thoracic Nerve
Patients with hemiplegia typically have a tight _________ rotator cuff
Anterior
Trapezius- Lower Attachments: Actions:
Ascending Part (Lower):Origin: Spinous processes of T5-T12 Insertions: Scapular Spine Actions: Draws the scapulas medially downward (supports the rotating action of the descending part) Action of the entire muscle: Steadies the scapula on the thorax Innervation: Accessory Nerve (CN XI) and Cervical Plexus (C2, C4)
Following a rotator cuff operation, most individuals can begin gentle AROM when? a. At two weeks. b. At four weeks. c. At seven weeks. d. At nine weeks.
B and C- at four-six weeks
Trapezius- Upper Attachments: Actions:
Descending Part (Upper): Origin:-Occipital Bone-The spinous process of all cervical vertebrae via the nuchal ligament Insertions: Lateral third of the clavicle Actions:-Draws the scapulas obliquely upward and rotates the glenoid cavity inferiorly-Tilts the head to the same side and rotates it to the opposite side (With the shoulder girdle fixed) Action of the entire muscle: Steadies the scapula on the thorax Innervation: Accessory Nerve (CN XI) and Cervical Plexus (C2, C4)
What function of the musculotendinous cuff that becomes deficient as the rotator cuff integrity becomes compromised leading to secondary capsulitis?
Downward depression of humeral head Explanation: The musculotendinous cuff is responsible for holding the humerus against the glenoid fossa and to depress the humeral head in order to open up subacromial space. When depression of the humeral head is lost, it can lead to subacromial overcrowding and even secondary shoulder adhesive capsulitis.
What are the characteristics of referred pain?
Dull aching annoying... Explanation: Dull aching annoying discomfort experienced away from the site of the primary pathology. Shoulder bursitis and ischemic points of the levator scapulae are two such examples.
Which etiology of Impingement Syndrome was not discussed this semester? A. Tight posterior rotator cuff B. Shoulder hypermobility; instability C. Tight pectoralis major D. Bursitis E. Shape of the humeral head •The reason this is important is because it's your responsibility to figure out if possible the primary cause of impingement so you can properly treat your patient.
E. Shape of the humeral head
What are the corresponding movements of the scapula when the shoulder is flexed within the sagittal plane above shoulder level?
Elevation, Posterior Tilt, Upward Rotation. and Protraction Explanation: When going into shoulder flexion and being at least shoulder level or above the scapula will elevate via the contraction of the upper trapezius. The posterior tilt is created by the contraction of the lower trapezius. Lastly, the serratus anterior upwardly rotates and protracts the scapula as it is recruited.
Reverse Blocking is for what anatomical motion?
Extension
In an attempt to prevent hemiplegic shoulder pain (HSP), a clinician will focus on proper passive scapular mobilization, proper passive scapula-humeral mobilization and passive attempts to keep the anterior capsule nice and "supple". What are the 3 anatomical motions that the clinician will address relative to maintaining the "suppleness" of the anterior capsule?
Extension, Horizontal Abduction and External Rotation Explanation: Restrictions of the anterior capsule can be observed by noticing limitations in external rotation, extension & horizontal abduction.
If you have a tear of the subscapularis, what anatomical motion do you want to avoid both passively and actively
External rotation
Subscapularis is an anterior translator of the humeral head? True or false? Explain your answer.
False, just the opposite Explanation: The Subscapularis insertion is on the lesser tubercle of the humerus and the origin is on the subscapular fossa. When the Subscapularis is innervated it causes the humeral head to translate posteriorly, improving the communication of the humeral head with the glenoid fossa of the scapula.
The Goal Post sign is notable with a Grade II and III acromioclavicular joint sprain. True or False?
False; step-off sign is correct
Blocking is for what anatomical motion?
Flexion
What is the one anatomical motion of the shoulder noted in most all of the impingement tests?
Internal Rotation Explanation: The provocative anatomical motion of the shoulder during impingement tests is always internal rotation. This is due to the supraspinatus entering the zone of encroachment otherwise known as the subacromial space.
What two muscles within the para-scapular region are considered "hypo-responsive or hypo-dominant?" Which one is generally considered "hyper-responsive or hyper-dominant?"
Serratus Anterior and Lower Trapezius (hypo-responsive); Upper Trapezius (hyper-responsive).
Long Thoracic Nerve Injury: "Winged Scapula" -
Serratus Anterior muscle paralysis due to Long Thoracic Nerve injury.
What two para-scapular muscles might one target if the patient was experiencing pain at shoulder level and above upon reaching?
Serratus anterior and lower traps
Aside from palpation, what is one special test that may be employed to detect an AC joint grade II or III sprain?
Step Off Sign Explanation: A special test that can be employed to detect an AC joint injury of at least a grade II is evaluating for a step off sign. Due to the damage to the AC joint ligament, the lateral clavicle migrates superior. As this heals, a step off sign is present. Clinically, the therapist palpates the superior lateral portion of the clavicle and upon lateral motion, the therapist's finger "steps down" to the fixed acromion of the scapula. Thus a deformity is felt and can be visually observed as well.
What muscle(s) make up the posterior cuff muscle?
Teres Minor, Supraspinatus, Infraspinatus
Your patient has a diagnosis of carpal tunnel syndrome. Upon your evaluation, tinel's and phalen's signs are negative. You ask your patient if they have any numbness and tingling and they say "no". The main complaint is that "my hand gets cold" (especially when assuming certain postures during work). What condition/diagnosis are you suspecting that will guide your clinical reasoning relative to the selection of special testing for differential assessment?
Thoracic outlet syndrome involving pec minor and subclavian artery
A Thumb Web Spacer splint may be indicated for a more chronic moderate to severe compression of the median nerve - result is ape thumb. What is yet another potential indication for a Thumb Web Spacer splint?
Thumb/Digit 2 Web space healed burn with contracture
Trapezius- Middle Attachments: Actions:
Transverse Part (Middle): Origin: Broad of the aponeurosis of the T1-T4 spinous processes Insertion: Acromion Action: Draws the scapula medially Action of the entire muscle: Steadies the scapula on the thorax Innervation: Accessory Nerve (CN XI) and Cervical Plexus (C2, C4)
Based on research, what is the one muscle within the para-scapular region that would probably be the lowest priority regarding strengthening?
Upper Trapezius
Name one intervention that would fall under "evidence based practice" for long- head bicipital tendinitis.
Weighted Pendulum Explanation: A weighted pendulum is an intervention that is shown to decrease inflammation and maintain tissue elasticity, while preventing adverse adhesions or scarring with long head bicipital tendinitis. It is essentially "manipulating" the second and third stage of tissue repair, just as compression does to burned skin that has healed.
Firm End Feel:
When the joint goes through fill ROM, but with passive pressure, more movement is achieved.
What is the origin and insertion of the serratus anterior? a. Originates on the upper 8-9 ribs at the sides of the chest with insertion along the anterior aspect of the medial scapulae. b. Originates and inserts posterior to the spine of the scapula. c. Originates and inserts on the sternum and the clavicle respectively
a. Originates on the upper 8-9 ribs at the sides of the chest with insertion along the anterior aspect of the medial scapulae.
Once the initial immobilization and PROM stage is completed with status-post RC repair following a full massive tear, it would be a good idea to initiate AAROM (i.e. cane "exercise" for "gentle" AROM), then graded AROM. a.True b.False
a. true
How many muscles make up the rotator cuff? a. Two b. Four c. Six d. Eight
b. Four
Hard End Feel:
bone to bone; ex: elbow extension
If a patient over the age of 65 presents with a shoulder problem and two major findings include night pain, weakness of external rotation and (+) impingement tests, what is the likelihood of them having some degree of a rotator cuff tear? a. 42% b. 68% c. 91%
c. 91%
Two really important scapulothoracic and parascapular muscles relative to scapular stability include: a. Supraspinatus and infraspinatus. b. Deltoid and rhomboids. c. Teres major and teres minor. d. Trapezius and serratus anterior.
d. Trapezius and serratus anterior.
What phenomenon complicates some shoulder conditions, such as primary shoulder adhesive capsulitis? a. "Pain in the night" b. Constraint c. Developmental Disregard d. Forced non-use
d. forced non-use
What muscle is the scaption motion important for
supraspinatus
A patient is referred to a clinician for "evaluation and treatment, healed Colles fracture". Upon speaking with the clinician during her occupational profile, she stated "I busted my wrist as I tried to protect myself upon falling to the ground." She also notes that since that MOI, she has had pain and clicking, popping and at times "a catch" in my shoulder. The clinician should suspect what tissue is damaged? Name two special tests that he should perform on the patient.
(Superior) Labral - Sulcus, Bicep Load, Yerguson, Speeds, Clunk. Explanation: Damage to the superior labral sulcus would be suspected because this type of injury commonly occurs when some fall on an outstretched hand. This type of injury presents with deep shoulder pain in the superior portion, pain with overhead activity, and clicking, popping, catching, or locking of the shoulder. Special tests that are done to check for this type of injury are the Bicep Load test, Clunk test, Yerguson test, Speeds test, Sulcus sign, and possibly complaints of pain with flexion above shoulder level.
Physical Demand: Constant -____________ lift(s) -______________ seconds -_______________ percentage of work day: -Sedentary lbs: -Light lbs: -Medium lbs: -Heavy lbs: -Very Heavy lbs:
-1 lift -15 seconds -67-100% of the work day -Sedentary lbs: Negligible -Light lbs: Negligible -Medium lbs: 10 -Heavy lbs: 20 -Very Heavy lbs: Over 20
Physical Demand: Frequent -____________ lift(s) -______________ minutes -_______________ percentage of work day: -Sedentary lbs: -Light lbs: -Medium lbs: -Heavy lbs: -Very Heavy lbs:
-1 lift -2 minutes - 34-66% of the workday -Sedentary lbs: Negligible -Light lbs: 10 -Medium lbs: 20 -Heavy lbs: 50 -Very Heavy lbs: Over 50
Physical Demand Occasional -____________ lift(s) -______________ minutes -_______________ percentage of work day: -Sedentary lbs: -Light lbs: -Medium lbs: -Heavy lbs: -Very Heavy lbs:
-1 lift -30 minutes -33% of the work day -Sedentary lbs: 10 -Light lbs: 20 -Medium lbs: 50 -Heavy lbs: 100 -Very Heavy lbs: Over 100
Upward Rotation:
-Occurs during Shoulder Elevation.Elevation includes:Flexion, Scaption, and Abduction
Name three muscles that are part of the scapula functional stabilizers. These are very important as their collective role is to maintain optimal orientation of the humeral head with the glenoid fossa of the lateral scapula especially when using one's arms below shoulder level. Secondarily, they add strength to the shoulder complex. Active Insufficiency in this group can contribute secondarily to impingement syndrome.
-Rhomboids -Lower Traps -Mid Traps
Actions of the Rhomboids:
-Steadies the Scapulas -Draws the scapula medially upward (returns the raised arm to a neutral position)
When reviewing research studies, what is the hierarchy of evidence for "best practice" considerations? Please place the following in order, from highest to lowest level of research; expert opinion, RCT, Quasi-experimental, Descriptive, Meta-Analysis, Case Reports, Qualitative.
1. Meta Analysis 2. Randomized Controlled Trials (RCT) 3. Quasi-Experimental 4. Descriptive 5. Qualitative 6. Case Reports 7. Expert Opinions.
What is the ratio of ligamentous capsule v. musculotendinous cuff regarding tissue elongation?
13:1 Explanation: Glenohumeral joint ligamentous capsular tissue is more difficult and resistant to stretch when in comparison to musculotendinous cuff tissue. It takes more time and effort to stretch out ligamentous capsular tissue versus the cuff tissue. Therefore, individuals exhibiting any Glenohumeral ligamentous capsular restrictions should be expected to complete a home exercise program of considerable stretching.
A patient has active and passive limitations in abduction (frontal plane). The clinician therefore suspects an inferior glenohumeral ligamentous capsular restriction. What is one stretching intervention that the clinician would have the patient independently do over time to try and elongate the inferior capsule?
25-30 Explanation: Placing the arms 25-30 degrees in the frontal plane of abduction with slight forward flexion is the plane of the scapula. When performing a movement in this position the supraspinatus is isolated.
How many bones are in the hand (distal to the distal radius and ulna)?
27
How many bones are between the glenohumeral joint and proximal to the carpal bones?
3
How many primary extrinsic wrist flexors do most people have?
3; -Flexor carpi radialis -Flexor carpi ulnaris -Palmaris longus
The 1st CMC joint is the most notorious joint in the body for developing osteoarthritis. What splint would benefit this individual? Would it need to incorporate the wrist or could it just be hand-based? A. Hand-based thumb spica B. Forearm-based Dorsal Hood - "Kleinert" C. Dynamic extensor tendon hand-based D. Dynamic radial nerve splint
A. Hand-based thumb spica
If an individual has a shoulder problem, if nothing else, always assume they have some faulty scapular biomechanics or scapular dyskinesia. What are the two precautions (in addition to encouraging cervical thoracic extension to achieve a neutral scapula) that you would employ during self-ROM of flexion, scaption and frontal plane abduction if you were going to use the traditional "pulleys" as the occupational form? A. Maintain external rotation and minimize reps above shoulder level B. Maintain internal rotation and minimize reps above shoulder level C. Keep the shoulder in anatomical neutral D. None of the above
A. Maintain external rotation and minimize reps above shoulder level
An acute Grade I to II sprain of the RF/Digit 4 UCL (ulnar collateral ligament) of the PIP joint would most likely benefit from conservative treatment involving? A. Splinting/immobilization B. Immediate restoration of A/PROM C. Surgical intervention D. Tendon transfer
A. Splinting/immobilization
Where would one initially palpate to determine if a trigger/ischemic point is located within the levator scapulae muscle? A. Superior-Medial Angle of the Scapulae B. Medial Border of the Scapulae C. Inferior angle of the Scapulae D. Anterior and Inferior to the Acromion Process of the Scapulae
A. Superior-Medial Angle of the Scapulae
An individual is 4 months s/p total shoulder replacement. Your patient is able to obtain 90 degrees of active shoulder flexion however you just cannot seem to progress beyond that even though PROM in the sagittal plane is WNL. You've worked what's left of the rotator cuff and humeral flexors primarily. What might you consider refocusing on biomechanically? A. The Lower Trapezius and Serratus Anterior B. The Rhomboids and the Pectoralis Minor C. The Levator Scapulae and the Upper Trapezius D. Refocus with a sole focus on the rehabilitation frame of reference.
A. The Lower Trapezius and Serratus Anterior
The social aspect of the occupational form parallels what? A. Therapeutic use of self per the OT Framework: Domain and Process (OTFDP) B. An Area of Occupation -> Social interaction per the OTFDP C. Performance patterns per the OTFDP D. None of the above
A. Therapeutic use of self per the OT Framework: Domain and Process (OTFDP)
As an anatomical motion or even special test, placing the individuals wrist in maximal and sustained passive or active flexion, could give you information on sensory aspects involving the median, ulnar and even the radial nerve. True or False? A. True B. False
A. True
The Lateral Scapular Slide Test according to Kibler, can help identify? A.Functional stabilizer insufficiency B.Rotator cuff weakness C.Posterior capsule or cuff tightness D.Rotator cuff tear
A.Functional stabilizer insufficiency
One specific test to help identify scapular instability contributing to impingement would be? a.Lateral Scapular Slide Test b.The Kibler c.Neer's Test d.Hawkin's Test
A; Lateral Scapular Slide Test
A clinician tests scaption for suspected impingement syndrome and the anatomical motion is not only painful but weak. The clinician then asks the patient to "pinch your shoulder blades together" as he retests scaption with a MMT once again. Although still weak, scaption is now stronger. What might he want to do at this point? a. Perform a more in depth assessment of the functional stabilizers. b. Test serratus anterior. c. Test lower trapezius. d. The clinician tells the patient he is too confused and that he has to go home and rest.
A; Perform a more in depth assessment of the functional stabilizers
The initial priority with a status-post RC cuff surgery, once active motion is indicated: a. Restore shoulder AROM b. Restore shoulder strength c. Both A and B
A; Restore shoulder AROM
It is best to use special tests with good sensitivity values but beyond that sensitivity values are only as good as the therapist performing the special test correctly. a.True b.False
A; True Explanation: This is true because if the therapist is not performing the special test correctly, the validity or sensitivity of the tests become poor. Many authors have researched the validity of special tests however that validity is only as strong as the therapist doing these as they were originally designed to be employed.
The "plane of the scapula" is used with internal and external rotation strengthening to decrease/reduce the tensile forces placed upon the rotator cuff tendon pathway. a. True b. False
A; True Explanation: By placing the arm in the plane of the scapula, it helps to reduce the forces placed on the rotator cuff tendon pathway. It is the safe position when performing transverse plane internal and external rotation.
Primary or idiopathic shoulder adhesive capsulitis is usually self-limiting, meaning the course is limited and the general prognosis of a resolution of symptoms is pretty good "even without therapy." a.True b.False
A; True Explanation: Primary shoulder adhesive capsulitis is a self-limiting condition, meaning although treatment options are available, prognosis can be positive even without seeking treatment options.
The Gerber lift off test is a special test for noting the "function" of the subscapularis. a.True b.False
A; True Explanation: The Gerber Lift Off Test is used with manual muscle testing to detect the sufficiency of the subscapularis function. This is especially sensitive when attempting to clinically detect a lesion of subscapularis. It is not especially valid for testing insufficiency of the subscapularis relative to idiopathic shoulder adhesive capsulitis. The subscapularis is an internal rotator, thus the manual muscle test is used during internal rotation of the patient.
The RENT test is a special test for rotator cuff tear. a.True b.False
A; True Explanation: True. The Rent Test is a special test used for identifying a rotator cuff tear. It is only positive, and not always the case, when one experiences a massive tear of supraspinatus.
Relative to the Upper Quadrant Screen, cervical testing is positive for Spurling's maneuver; there is C6 myotome weakness and C6 dermatome paresthesia. What anatomical motion is definitely affected per the information above? a. Wrist extension b. Elbow flexion and Shoulder abduction c. Elbow extension d. Gross digital flexion and extension
A; Wrist extension Explanation: The wrist extensors are innervated by C6.
Describe a Rehab Goal:
Address a specific area of occupation and then the condition should be very specific to an adaptive device or compensatory approach to effect some level of (in)dependence
What muscle(s) make up the anterior cuff muscle?
Subscapularis
Describe the "Plane of the Scapula". A. 30 degrees anterior to the frontal plane B. 25-30 degrees of frontal plane abduction with slight forward flexion C. 50 degrees in the unpacked glenohumeral joint D. None of the above
B. 25-30 degrees of frontal plane abduction with slight forward flexion. -This is the resting position of the scapula
To prevent Hemiplegic Shoulder Pain (HSP) per Jan Davis, passive scapula and passive scapulo-humeral mobilization is suggested in addition to making certain one maintains the suppleness of the glenohumeral joint _________________ ligamentous capsule. By maintaining its suppleness, the patient will not lose external rotation, extension or horizontal abduction and this is necessary in combating the onset of HSP. A. Inferior B. Anterior C. Posterior D. Criteria
B. Anterior
You are completing an occupational profile on your patient and based on the intake and cervical AROM screen, you're suspecting an issue involving the upper thoracic or cervical spine region. Radial forearm sensibility is indeed impaired and the wrist extensors indeed demonstrate weakness as well. Upon forward cervical flexion, a positive meningeal sign was identified. What is the suspected level of disc pathology per your clinical assessment? A. C5 B. C6 C. C7 D. C-8 E. T-1
B. C6
As a general statement, during the Chronic-Active stage of R.A. when a loss of active and passive motion is noticed (developing contracture, example: end range of elbow extension), passive stretching is contraindicated. True or False A. True B. False
B. False
After a massive tear with repair ("rotator cuff operation"), typically, no active or passive movement is allowed for the first 4-6 weeks. True or False? A. True B. False
B. False Passive: Up to week 4 Active: Week 4
You suspect your patient has a SLAP lesion based on the mechanism of injury and his subjective complaints relative to signs and symptoms. Bicep load, Speeds, Yergusons and the Sulcus sign are incidentally negative. You wish to proceed with the Clunk test. As you passively approximate the humeral head into the glenoid fossa of the affected shoulder, the patient grimaces and says "ouch"! So instead of proceeding with the compression/approximation combined with passive external and internal rotation, you instead utilize some clinical reasoning and judgment. How would you grade this special test at this point to still complete the entire Clunk test while still employing some reasonable precaution? A. Don't do this at all B. Have the patient do this actively C. Therapist should reduce the amount of approximation D. Employ the Jerk test instead
B. Have the patient do this actively
What is the Physical Demand Level? Josephine has a secretarial job which requires her to lift up to 20# on an occasional basis through her workday. A. Sedentary B. Light C. Light-Medium D. Medium E. Medium-Heavy F. Heavy G.Very Heavy
B. Light
Which treatment is contraindicated for infection, such as cellulitis, involving gross/global distal UE pitted edema? A. Antibiotic therapy B. Retrograde massage C. Immobilization, ex. Cellulitis à intrinsic plus splinting
B. Retrograde massage; don't want to massage an infection
When performing a self posterior cuff stretch given shoulder impingement syndrome: the position of the distal arm is? A. Neutral B. Supinated C. Pronated D. Inwardly rotated
B. Supinated
Even with a complete tear to the supraspinatus tendon, the patient will be able to adequately perform isolated abduction actively from approximately 0-160 degrees. a.True b.False
B; False Explanation: Considering the supraspinatus initiates abduction in the frontal plane to about 70 degrees, if there is a complete tear, the patient will be unable to abduct their shoulder without substitution.
After a rotator cuff operation, active or passive movement is not allowed for 4-6 weeks post-surgery. a.True b.False
B; False Explanation: Post rotator cuff operation, active movement is not allowed for 4-6 weeks after a massive tear with surgical repair. Per physician, passive skilled movement is acceptable.
As a general statement, the upper trapezius is so instrumental to the para-scapular muscles that one should always prioritize treatment in strengthening this muscle tissue. a. True b. False
B; False Explanation: The Upper Trapezius is typically regarded in the general population as a hyper-responsive para-scapular muscle. For this reason, strengthening this tissue is usually not needed to be the focus during treatment. The exception may be those who have experienced stroke.
A patient states that the mechanism of injury (MOI) relative to his "shoulder pain" was falling from a bicycle, ultimately striking his shoulder on the pavement. He has palpable tenderness across the AC joint and a "bump" that appears to be more prevalent compared to the opposing AC joint. This is formally called a Step Off Sign and it is indicative of a sprain of what grade? a. Grade 1 b. Grade 2 c. Grade 4 d. Grade 5
B; Grade 2 Explanation: Acromioclavicular joint injuries can be classified in six different grades. This injury is classified as a grade 2 because a step off sign is present. Acromioclavicular joint injuries are given a grade 2 classification when there is inflammation and joint laxity due to tearing of the acromioclavicular joint ligament and having the presence of a step off sign.
A competitive baseball pitcher is diagnosed as having a supraspinatus impingement. All of the special tests relative to impingement are negative, ROM and strength is normal, yet the only time the pain can be reproduced is upon throwing with force. What other condition might one suspect? a. Bicipital tendonitis b. Labral tear/ lesion c. Secondary frozen shoulder
B; Labral tear/ lesion Explanation: Due to forceful dynamic angle change of the shoulder, throwing athletes are common to tear the labrum, resulting in intense pain. Severe accelerating forward forces of the arm add a strike or hit to the shoulder is a different thing. The thing here is that it has to do with the distracting forces on the glenohumeral joint.
Relative to impingement, hypermobility or joint laxity would involve what as a treatment remediation program? a. Lots of stretching b.Lots of RTC and para-scapular strengthening. c. Seven weeks of immobility to tighten the joint
B; Lots of RTC and para-scapular strengthening
Part of the Upper Quadrant Screening involves Neural Tension. During this screen, what is the position of the shoulder, elbow, and wrist? a. Shoulder flexed, elbow flexed, and wrist extended. b. Shoulder abducted (frontal plane), elbow and wrist in full and complete extension. c. Shoulder adducted, elbow extended, and wrist flexed. d.Full shoulder flexion with scapula stabilized.
B; Shoulder abducted (frontal plane), elbow and wrist in full and complete extension A simple screen for the upper quarter is the combined active motions of full shoulder abduction in the frontal plane also with elbow, wrist, and finger extension. A positive test occurs if any form of paresthesia (numbness and/or tingling) occurs, however, one should terminate the motion once this symptomatology becomes present.
A patient has suspected impingement syndrome. He complains of very annoying "dull achy pain" in the lateral proximal upper extremity. As FROM is tested, a "catching" sign is noted and painful feeling with abduction in the frontal plane. What is suspected as the cause of the sub-acromial overcrowding?
Bursitis Explanation: These two symptoms when combined are very much suggestive of bursitis. When tendons become, inflamed or agitated they may irritate the bursa sac causing it swell "bursitis". In addition, when the inflamed tendon moves through frontal plane abduction it hits the "zone of encroachment" or 70o of frontal plane abduction and as the tendon moves medially it contacts the swollen bursa sac causing the "catching" and painful feeling.
What is one symptom management technique for bursitis associated with impingement syndrome? What is one symptom management technique for idiopathic frozen shoulder?
Bursitis: Passive Self- mobilization/distraction technique in the plane of the scapula. Idiopathic frozen shoulder: passive self-distraction
The patient will perform upper body dressing using compensatory dressing techniques. What is this rehabilitative goal missing? In other words, what is it lacking? List TWO. A. Actor B. Behavior C. Condition/Measure D. Duration
C & D
GOAL: The patient will improve grip strength so that he can play a round of golf competitively in 4 weeks. What is this biomechanical goal deficient of? In other words, what is it lacking? A. Actor B. Behavior C. Condition/Measure D. Duration
C. Condition/Measure
More passive and skilled zealous/aggressive stretching becomes indicated at what phase of idiopathic/primary shoulder adhesive capsulitis? A. Freezing/Inflammatory stage B. Thawing stage C. Frozen/Receding inflammation D. All stages
C. Frozen/Receding inflammation
You have a patient demonstrating all the signs of glenohumeral joint ligamentous capsulitis involving the posterior aspect of the shoulder (chronic shoulder dysfunction). You wish to begin with a preparatory method. What 3 anatomical motions are you aiming to improve relative to the glenohumeral (GH) joint? A. Scapula upward rotation and elevation B. GH abduction C. GH Horizontal adduction, internal rotation and flexion D. GH Horizontal abduction, external rotation and extension
C. GH Horizontal adduction, internal rotation and flexion
You're attempting to assess the degree of sprain your patient experienced after playing a pick up game of tag football. Somehow he hurt his thumb and complains of pain at the thumb MP joint. You suspect an ulnar collateral joint sprain. How would you employ the collateral ligament lateral stress test? A. Move the thumb into Adduction B. Move the thumb into Flexion and Extension C. Move the thumb into Radial Abduction D. Move the thumb into Hyperextension
C. Move the thumb into Radial Abduction
What is the special test to determine the integrity of the infraspinatus muscle? A. Placing one's hand behind one's low back B. Having the patient slowly lower their arm from 90 degrees of abduction into adduction C. Placing a resistance to the posterior rotator cuff/external rotators in a gravity eliminated plane (arm adducted at side, elbow bent to 90 degrees), release the resistance then have your patient "hold" the position. D. Palpate the lesser tubercle of the humerus
C. Placing a resistance to the posterior rotator cuff/external rotators in a gravity eliminated plane (arm adducted at side, elbow bent to 90 degrees), release the resistance then have your patient "hold" the position.
The Hughston exercise program consists of 6 different anatomical motions. These motions are designed to work on what muscle groups? A. Anterior Rotator Cuff and Serratus Anterior B. Upper Trapezius, Serratus Anterior and the Lower Trapezius C. Posterior Rotator Cuff and the Functional Stabilizers of the Scapula D.None of the above
C. Posterior Rotator Cuff and the Functional Stabilizers of the Scapula
Your client is involved in a Work Hardening program. He has to return to work as a laborer who loads motor vehicle and tractor tires onto the flatbed of a semi truck. He reports that at least half of his day involves manually lifting car tires. So within your clinic, you have different sizes of car tires brought in as this will be a form of intervention. Relative to the meaningful occupational form (CFTO), this intervention would be considered? Select the one BEST choice. A. Perceived B. Affective C. Symbolic D. None
C. Symbolic
If there is anything noted as "evidence based treatment" for long head bicipital tendinitis, what would that be? A. Original Codman B. Juggernaut AROM C. Weighted Pendulum D. The Apollo Position
C. Weighted Pendulum
A clinician suspects a herniated disc based on the occupational profile of the patient, the cervical AROM assessment, a positive meningeal sign plus issues with sensation at the lateral proximal upper extremity; weakness is also detected with abduction greater than 90 degrees. From a clinical standpoint; what cervical level is suspect of a herniation or protrusion?
C5
John is now involved in a "work hardening" program, which he is literally simulating his job task as a grocery store cashier. This is considered: a.Too much "work-like" stuff for John. b.A bottom-up approach to his rehab. c.A top-down approach to his rehab
C; A top-down approach to his rehab
Jane engages in seated work as a secretary for eight hours a day. Her work space is designed requiring her to place files into horizontal bins at shoulder level. Aside from possibly evaluating for a redesign of her work space, what other interventions would be beneficial for Jane? a. Stretching b. Postural education c. Both A and B
C; Both A and B Explanation: A Symptom management strategy involves two major parts, postural management, education and stretching. With this information noted, postural education and implementation of stretching would be beneficial for Jane.
When is the upper quadrant screen performed? a. To rule out anything relative to cervical pathology. b. To determine which anatomical region of the upper quarter is contributing to the patient's symptoms and therefore needs greater attention. c. Both A and B
C; Both A and B Explanation: The Upper Quarter/Quadrant Screen has three purposes. The first is to determine which anatomical region of the upper quarter is contributing to the patient's symptoms and therefore needs to be examined in greater detail. The second is to rule out gross sensory or neurologic deficits. The third is to rule in or rule out if the upper quadrant pathology could be originating from the upper thoracic or cervical region.
Given a SLAP lesion and conservative treatment through therapy, what is the one precaution that one would employ during the treatment program?
Careful shoulder level and above.
Joe sustained a deep tidy wound to his volar R digit two. The mechanism of injury was retrieving a crisp $20 bill from a customer. He has developed the cardinal signs of infection from this incident a couple nights ago. As you're assessing AROM of the digit joints, he is limited by the edema/swelling that is present. What would you document the End Feel as? A. Hard B. Medium C. Firm D. Soft E. Mild
D. Soft
Pectoralis Minor Attachments:Actions:
Superior Attachment: -Coracoid Process of the scapula Inferior Attachment: -Third through fifth ribs Actions: Draws the scapula downward, causing its inferior angle to move posteromedially (lowers the raised arm), rotates glenoid inferiorly
Your patient demonstrates 0-20 degrees of active R wrist extension (PROM of 0-55) and 0-55 degrees of active L wrist extension (PROM of 0-55) against gravity. To work on AROM of the R wrist, you decide to use a gravity eliminated plane. Based only on the information above, the question is, what did you document this individual's strength grade for R wrist extension as? A. 4/5 B. 3/5 C. 3-/5 D. 2/5 E. 2-/5
D. 2/5
After having your patient complete the Rapid Exchange Jamar Dynamometer test, you note the highest grip strength reading to be 100# and the lowest grip strength reading to be 80#. What would the Coefficient of Variation (COV) be? A. 50% B. 60% C. 10% D. 20% E. 80%
D. 20% 80/100= .8-100
To help your patient with their Performance Patterns: A. Send them to a personal trainer B. Refer them to the physical therapist C. Advise them to get a referral to see a speech and language pathologist D. Coach them on how to modify and adapt their habits and behaviors through tendon protection and even ergonomics
D. Coach them on how to modify and adapt their habits and behaviors through tendon protection and even ergonomics
An OT intervention that influences/facilitates stage 3 of tissue repair and healing, such as involvement of the skin post burn, ex. Hypertrophic scarring, includes? A. Interferential, electrical stimulation B. Pulse therapeutic ultrasound C. A bulky dressing D. Compression and movement
D. Compression and movement
If someone has tightness of the posterior cuff attributing to shoulder impingement syndrome, what "stretch" would be indicated? A. "Anterior capsule" B. "Pectoralis major" C. "Anterior cuff" D. Neither A, B or C
D. Neither A, B or C
The Hughston PRE's focus on what? a. Anterior rotator cuff (subscapularis) and the serratus anterior. b. Upper trapezius, middle trapezius, lower trapezius and serratus anterior. c. Upper trapezius, middle trapezius, lower trapezius and levator scapulae. d. Posterior rotator cuff (supraspinatus, infraspinatus, teres minor) and the functional stabilizers.
D; Posterior rotator cuff (supraspinatus, infraspinatus, teres minor) and the functional stabilizers. Explanation: Hughston focuses on Posterior Rotator Cuff & Functional Scapular Stabilizer Program. It provides a comprehensive shoulder (re)conditioning program. If one should need to focus on the serratus anterior and the internal rotators, then two additional exercises would be required to supplement this program.
The Roos test can be used within a battery of special tests to identify what condition? a.AC joint injury b.Bankart lesion c.Total shoulder replacement d.TOS
D; Thoracic Outlet Syndrome (TOS)
Take a look at the scapula in an individual with stroke. It may rest in what position(s) causing an orientation problem with the head of the humerus and thus influencing HSP?
Depressed and Downward Rotation Explanation: According to Davis (2012), due to this phenomenon, proper passive scapular mobilization would be indicated, followed by proper passive scapula-humeral mobilization followed by maintaining the suppleness of the anterior ligamentous capsule. This may help prevent or reduce hemiplegic shoulder pain.
A patient with idiopathic frozen shoulder, in the "frozen stage." A clinician wishes to stretch the subscapularis utilizing the "subscapularis stretch". This is effective yet the clinician is thinking he may have more success using the principles of reciprocal inhibition/contract-relax. Given the transverse plane, one 'fires' the antagonist external rotators and then one passively stretches the GH joint in what anatomical motion?
External Rotation Explanation: The Subscapularis is responsible for internal rotation, so in order to stretch it, you would want to stretch the shoulder in external rotation. Most tissues are stretched in the opposite anatomically motion that they create. In order to get the agonist internal rotators to relax, the antagonist external rotators need to be recruited according to these principles.
You suspect some neural tension at the elbow. The patient complains of ulnar forearm and ulnar hand/finger parasthesias. You have ruled out any nerve compression at the wrist. What nerve is probably involved and how would you go forth to try and trigger a positive neural tension test. In other words, what is the position of the fingers, wrist and elbow?
Flexion with the extension of the wrist and finger; observe for ulnar forearm and hand parasthesias
A patient works on an automobile assembly line of which there is a lot of arm use below shoulder level. After each day for the past several months, he has complained of shoulder fatigue, generalized pain and discomfort unilaterally and even bilaterally. What collective group of muscles might a clinician want to direct his attention to relative to strengthening and endurance retraining? Name the muscles.
Functional Stabilizers, including the Lower Trapezius, Middle Trapezius and Rhomboids
Name one of two special tests that will test the sufficiency or insufficiency of the subscapularis. Based on the special test noted, would it be most valid with idiopathic/primary adhesive capsulitis or a lesion of the subscapularis?
Gerber Lift Off; a Lesion of Subscapularis Explanation: The Gerber Lift Off Test is a special test to employ given a suspected lesion of Subscapularis. It helps to determine the sufficiency or insufficiency of the muscle. To perform this test, the patient places their hand of their back and attempts to lift it off. Furthermore, to test the sufficiency or insufficiency of this tissue given primary shoulder adhesive capsulitis (SAC), the belly press test would be more valid. The Gerber Lift Off test would be invalid for primary SAC since the posterior capsule also becomes tight which would further restrict the Gerber Lift Off position of internal rotation.
Kibler's Lateral Scapular Slide test: Pathology can be detected on the side that demonstrates the greater or the lesser measurement? If the scapula did rest laterally, what three muscles would one target?
Greater measurement on the affected side, functional stabilizers. Explanation: If the measurement taken showed that the scapula was resting laterally that may indicate that the functional stabilizers (Rhomboids, Middle Trapezius, and Lower Trapezius) are collectively hypo-responsive or insufficient. Should this be identified, a strengthening intervention would need to be implemented in order to increase the active sufficiency of the functional stabilizers.
When performing anterior capsule stretching in CVA or Adhesive Capsulitis - what 3 anatomical motions would one be working on?
Horizontal Abduction, Extension, and External Rotation Explanation: Given spasticity from stroke, this is one of three phenomenons that lead to hemiplegic shoulder pain (HSP). Therefore, it is imperative immediately post stroke, that the suppleness of the anterior ligamentous capsule be maintained through skilled PROM.
What 3 anatomical motions are you aiming to improve relative to the anterior glenohumeral (GH) joint?
Horizontal abduction, external rotation and extension
Upon helping your patient complete a Right Levator Scapula stretch as a component of your thoracic outlet syndrome home program: -Explain what direction you'd have your patient look toward and then downward. In other words RIGHT or LEFT? Then you'll have to help them get that optimal opposite side forward tilt to obtain the stretch. A. RIGHT B. LEFT
Left
What muscle is most responsible for posterior tilt of the scapula?
Lower Trapezius
A clinician completes the scapular reposition test. After recreating the normal biomechanics of scapular elevation, upward rotation and protraction, the patient states that she still has pain at shoulder level and above in the sagittal plane of flexion. The clinician then recreates the same actions but adds a posterior tilt of the scapula. The patient comments, "That definitely helps and takes the pain away". What muscle will the clinician direct his focus on?
Lower Trapezius Explanation: Given this scenario, the lower trapezius is responsible for scapular posterior tilt. By providing active assistance to the posterior tilt of the scapula given the repositioning, in this case, the individual's pain complaints were reduced. The Lower Trapezius should be the focus because it is responsible for the movement that helped relieve the patient's pain.
Given an Upper Quadrant Screen, one has obtained negative result for cervical testing, as well as dermatome and myotome testing. The joint scan is also negative regarding all aspects of the shoulder. At the elbow, a positive result (pain) is obtained when the joint is passively moved into full extension, flexion and rotation. At the medial epicondyle, a positive result was obtained, with a negative result at the lateral epicondyle. This may be indicative of what?
Medial elbow epicondylitis
In order to improve strength of the functional stabilizers and to assure proper pain free arm use below shoulder level, what three para-scapular muscles would one target?
Middle Trapezius, Lower Trapezius, Rhomboids
Your patient demonstrates moderate to severe compression of the ulnar nerve at the wrist (chronic handlebar palsy/ulnar neuritis). You observe the hypothenar eminence and there indeed is atrophy. You'd like to collect some quantitative data relative to pinch strength. Aside from doing the traditional pad to pad, tripod and lateral pinch, how else might you use the prehension gauge to get additional valuable information?
Modified tripod (4th and 5th finger)
Describe place and hold
Move patient's finger into position you want it to be in and ask them to hold it there
Describe a Biomechanical Goal:
One client factor affecting a specific area of occupation. DO NOT put two or more client factors into one goal. -Client factor precedes specific area of occupation NOT area of occupation preceding a client factor.
Pectoralis Major Attachments: Actions:
Origin: -Clavicular Part: Medial Half of the Clavicle -Sternocostal Part: Sternum and the second through sixth costal cartilages -Abdominal Part: Anterior layer of the rectus sheath Insertion: Crest of the greater tubercle of the humerus. Actions: -Adduction and internal rotation (Entire Muscle) -Extension of the flexed and externally rotated arm (Entire Muscle) -Horizontal Adduction (Entire Muscle) -Flexion (Clavicular and Sternocostal parts)
Infraspinatus Attachments: Actions: *Posterior Cuff Muscles*
Origin: Infraspinatus fossa of the scapula. Insertion: Greater tubercle of the humerus. Actions: External Rotation, Horizontal Abduction
Teres Minor Attachments: Actions: *Posterior Cuff Muscles*
Origin: Lateral boarder of the scapula Insertion: Greater tubercle of the humerus. Actions: External rotation, Horizontal abduction, weak adduction
Supraspinatus Attachments: Actions: *Posterior Cuff Muscles*
Origin: Supraspinatus fossa of the scapula. Insertion: Greater tubercle of the humerus. Actions: Abduction
Subscapularis Attachments: Actions: *Anterior Cuff Muscle*
Origin: Supscapular fossa of the scapula Insertion: Lesser tubercle of the humerus. Actions: Internal rotation, weak adduction
Given shoulder impingement syndrome, what is the safe or protected position of the shoulder when reaching at shoulder level and above?
Outward Rotation Explanation: The safe or protected position of the shoulder when reaching at or above shoulder level is to remain in outward rotation. This will allow for the supraspinatus to avoid overcrowding in the sub-acromial space. Two additional precautions for those with shoulder conditions would be to encourage thoracic cervical extension (creates a good balance between the pectoralis minor which anterior tilts the scapula and the lower trapezius which posteriorly tilts the scapula). Additionally, limiting repetitions above shoulder level may be warranted since many of these individuals' have some degree of scapular dyskinesia.
If someone has a rotator cuff injury with surgical repair, what kind of codman would you do (active or passive).
Passive
What muscle is most responsible for anterior tilt of the scapula?
Pectoralis minor
Long Thoracic Nerve Injury: "Winging Scapula"
Posture of medial border and/or inferior angle prominence. No nerve injury.
Describe the clinical test that would be employed to possibly pick up on the infraspinatus being problematic (i.e. lesion or tear).
Resisted External Rotation, gravity eliminated plane. Explanation: The clinical test of placing an individual in resisted external rotation in a gravity eliminated plane may potentially detect a lesion of the infraspinatus. Since the infraspinatus is the most integral musculotendinous stabilizer of the shoulder, this special test is testing for the stabilizing qualities of this tissue.
Upon helping your patient complete a Right upper trapezius stretch as a component of your thoracic outlet syndrome home program: -Explain what direction you'd have your patient look toward and then downward. In other words RIGHT or LEFT? Then you'll have to help them get that optimal opposite side forward tilt to obtain the stretch. A. RIGHT B. LEFT
Right
What is one traditional strengthening exercise of the rotator cuff that should no longer be employed per muscle EMG studies?
Scaption thumb down (empty can). Explanation: The supraspinatus is equally recruited in scaption and "thumb down" scaption. Traditionally some therapists have used the "thumb down" scaption as a PRE. This is an intervention that is no longer indicated since it draws the tendon of supraspinatus into the zone of encroachment, otherwise known as the subacromial space. This motion therefore puts this tendon in a volatile and tenuous position, possibly subjecting it to further trauma.
One wishes to improve above shoulder reaching/AROM. What para-scapular muscle would one target?
Serratus Anterior
Pain and/or compromised motion at shoulder level or above; scapular winging is also noted. What muscle would one target as a priority during treatment?
Serratus Anterior Explanation: The action of the Serratus Anterior is upward rotation of the scapula along with abduction-protraction of the scapula in the sagittal plane of flexion above shoulder level and works as an upward rotator in the frontal plane.
A clinician has done several open chain humeral and rotator cuff strengthening with a patient, yet obtaining AROM at shoulder level and above is a tedious and a seemingly hopeless goal. Before the clinician gives up, they should probably focus on what para-scapular muscle?
Serratus Anterior Explanation: The serratus anterior is responsible for upward rotation and protraction of the scapula in the sagittal plane of flexion over shoulder level and upward rotation in the frontal plane of abduction over shoulder level.
If there were one single priority relative to conservative intervention with a SLAP lesion, what would that focus be? For a Bankart lesion, what would that focus be?
Stretch posterior and inferior capsule to maintain or improve Internal Rotation provided a SLAP lesion; strengthen the internal rotators in the plane of the scapula to help compensate for the weakened portion of the anterior capsule, given a Bankart lesion.
Levator Scapula Attachments: Actions:
Superior Attachment: -Transverse Processes of C1-C4 Inferior Attachment: -Superior Angle of the Scapula Action: -Draws the scapula medially upward while moving the inferior angle medially (Returns the raised arm to a neutral position) -Inclines the neck towards the same side (when the scapula is fixed)
A patient has suspected impingement syndrome. After a clinician's evaluation he interpreted the findings and decided that she has limitations in horizontal adduction, internal rotation and maybe flexion of the shoulder. What should be suspected as the reason for the sub-acromial overcrowding?
Tight Posterior Cuff Explanation: The condition is indicated as having sub-acromial overcrowding due to subtle superior migration of the humeral head caused by tightness of the posterior rotator cuff. Restrictions of shoulder internal rotation, flexion, and horizontal adduction are indicative of this impingement etiology
A clinician is tasked a consultant to give his input relative to a high school softball pitcher who is experiencing long head bicipital tendinitis. The young athlete will not stop participating in pitching or her favorite sport of softball despite the pain she is experiencing. Her athletic trainer is kinesio-taping her shoulder strategically and performing an ice massage as indicated. What is the one additional singular intervention that he should suggest she do?
Weighted Pendulums Explanation: Weighted pendulums are a common intervention used with individuals experiencing long head bicipital tendinitis. Performing a weighted pendulum helps to maintain and improve tissue elasticity. It also helps to prevent scarring and adverse adhesions from occurring. With this intervention, attempts are made to positively impact the second and third stage of wound and tissue healing.
If an individual has a shoulder problem, if nothing else, always assume they have some faulty scapular biomechanics or scapular dyskinesia. What are two precautions that one would employ during self-ROM of flexion and scaption if someone was going to employ the traditional "pulleys" as an occupational form? Select the one best answer. a. Maintain external rotation and minimize reps above shoulder level. b. Maintain internal rotation and minimize reps above shoulder level. c. Keep the shoulder in anatomical neutral. d. None of the above
a. Maintain external rotation and minimize reps above shoulder level. Explanation: Maintain external rotation and minimize repetitions above shoulder level. It is important to follow these precautions since many patients with adverse shoulder symptomatology have some degree of faulty scapular biomechanics, otherwise known as scapular dyskinesia.
A SLAP lesion can occur from? a.Falling on an outstretched hand "cramming" the head of the humerus into the Glenoid fossa. b.Raising one's arm up into forward flexion and elevation. c.None of the above
a.Falling on an outstretched hand "cramming" the head of the humerus into the Glenoid fossa.
A Bankart lesion is often associated with? a.Throwing athletes b.Line workers c.Marathon runners d.Physical and occupational therapist
a.Throwing athletes
Relative to muscular performance, in general, the most advanced role of muscle performance includes what type of muscular contraction? a. Concentric b. Eccentric c. Isometric d. Isotonic
b. Eccentric
Idiopathic or primary shoulder adhesive capsulitis implies? a. Problem as a result of rotator cuff surgery. b. Etiology that has no known or identified cause. c. Status post "turf shoulder". d. A condition that one will never overcome.
b. Etiology that has no known or identified cause There is no known etiology or identified cause, although there is a definite population that may be more prone to developing this condition
The "MOI" refers to: a. MOI or more...shoulder abduction, shoulder flexion, etcetera. b. Mechanism of injury. c. Impingement syndrome. d. Modern operating instruction
b. Mechanism of injury.
How many shoulder complex muscles actually have an attachment to the humerus? a. Seven b. Eleven c. Five d. Fifteen
b. eleven
What muscle/tendon is often involved in shoulder impingement syndrome? a. Teres Minor b. Supraspinatus c. Deltoid d. Infraspinatus
b. supraspinatus If the clinician deals within the medical model (adult population), regardless of the setting, whether it be a neurological or orthopedic venue, shoulder impingement syndrome is the number one most commonly seen condition in upper quadrant conditions. The supraspinatus is the implicated tissue involved with impingement syndrome.
Using the actual task, activity, or occupation that one is having difficulty with as the form of therapy is considered a: a. Bottom Up Approach b. Top Down Approach c. Remedial Approach d. Biophysiological Approach
b. top down
Thoracic Outlet Syndrome can involve structures that are: a.Neurological b.Vascular c.Both A and B
c. Both A and B
Speeds test is used to screen for? a. How fast one can get through this book. b. How fast one can use their upper extremity with coordination tasks. c. For biceps tendinopathy. d. None of the above
c. For biceps tendinopathy. This test can also be used for superior labrum lesions since the long head of the bicep attaches to the superior rim of the labrum.
One critical aspect of treating shoulder conditions involves more than "protocols" and "best practice". What is that? a. Having a colleague that is good at treating the shoulder. b. Having a physician that you can call upon for help. c. Keen critical reasoning and critical thinking skills.
c. Keen critical reasoning and critical thinking skills.
Insidious onset implies: a. Immediate and abrupt b. Traumatic. c. Slow, symptoms begin to slowly become apparent sometime after the initial pathological course has started. d. What happens after exercise
c. Slow, symptoms begin to slowly become apparent sometime after the initial pathological course has started. Slow, insidious is onset that creeps up on client. As what occurs with primary/idiopathic shoulder adhesive capsulitis (different from secondary shoulder adhesive capsulitis)
For the treatment of bicipital tendonitis, symptom reduction is key, which should be followed by "exercises" that involve what type of contractions of the bicep. a.Concentric b.Isometric c.Eccentric
c. eccentric
AC Joint palpation is achieved where? a. Superior and Lateral to the Sternum. b. Lateral Aspect of the Elbow. c. Superior and Lateral Aspect of the Shoulder. d. Superior and Medial Aspect of the Shoulder
c. superior and lateral aspect of the shoulder
You have your patient complete the Hughston 6 shoulder exercise program. [(S)He is doing well after being diagnosed with a Type I SLAP lesion 4 weeks ago. Due to the employment of precautions, you omitted Hughston #2 and #4]. You are having your patient work into phase I ___________________ and phase II ___________________ of Hughston. (Fill in the blanks relative to the type/role of muscle contraction that is taking place [not isotonic or isometric]) Choices: Isometric, Eccentric, Concentric, Isokinetic
concentric; eccentric
Referred pain implies? a. Giving the pain to someone else. b. Something in the past. c. Discomfort. d. Pain that occurs away from the primary site of pathology.
d. Pain that occurs away from the primary site of pathology.
One primary muscle that one is trying to elongate and stretch relative to the condition of primary shoulder adhesive capsulitis is? a. Supraspinatus b. Deltoid c. Trapezius d. Subscapularis
d. Subscapularis One of three structures implicated in primary shoulder adhesive capsulitis, otherwise known as primary frozen shoulder.
As we age, it is not uncommon that a more anterior tilt of the scapula results from a tight _______________ _____________ anteriorly and a hypo-responsive ________________ _________________ posteriorly. The above blanks should be filled in with the name of two separate muscles.
pec minor anteriorly and lower trap
What muscle gives you the first 70 degrees of frontal plane abduction
supraspinatus
Muscles that Produce Elevation
•Levator scapula •Rhomboids (major and minor) •Upper Trapezius
Muscles that Produce Depression
•Lower Trapezius •Pectoralis Minor
Muscles that Produce Retraction (Moving towards the midline)
•Rhomboids (major and minor) •Middle Trapezius
Muscles that Produce Downward Rotation:
•Rhomboids (major and minor) •Pectoralis Minor •Levator scapula
Muscles that Produce Protraction (Moving away from the midline)
•Serratus Anterior •Pectoralis Minor
Muscles that Produce Upward Rotation:
•Upper Trapezius •Serratus Anterior •Lower Trapezius (eccentric)
