Shoulder

there's evidence that ________ are affective for pain control in the short term

NSAIDs and acetaminophen

what type of athletes is posterior impingement most common in

OH athletes

what are tests for extrinsic cause of impingement (3)

HK, Neer's, painful arc

what exercises are indicated to best activate rotator cuff

IR/ER, and shoulder elevation in the flexion/abduction/scaption planes

what structures are usually strengthened or need motor control

RC and scapular muscles (SA, rhomboids, lower trap)

what are the 4 treatment categories

RCD impingement syndrome; adhesive capsulitis; instability; other

kinesiotape shows immediate effects on what diagnosis

SAIS

what are the single diagnosis categories (3)

SAIS tendinopathy SAPS

what are ways to determine core strength (3)

SLS, single leg squat, single leg squat with arm mvoement

what are the 3 types of labral tears

anterior posterior SLAP

what is the special test that can determine if a patient has internal impingement

apprehension - relocation - release pain with relocation

what are equipment to use for RTW/sports progressions

body blade, lawnmower, plank with push up plus

what is included in the impingement syndrome

bursitis, tendinitis, tendinopathy, partial thickness, and full thickness RC tear

what diagonses does SAIS include (3)

bursitis, tendinopathy, and partial tear - RCT

what is posterior/internal impingement

compression of the tendons between the posterior rim of the glenoid and humeral head

what is the final piece we want to add when progressing to RTW/sport

core strengthening

how would you stretch posterior shoulder structures

cross body adduction; sleeper stretch; posterior joint mob

what are the 10 methods of treatment for acute/subacute/chronic shoulder dysfunction

decrease OH/provocative activities; AROM; stretching; strengthening; posture correction; manual therapy; modalities; MEDs; address risk factors (work/sport); patient education

what are ROM obervations for SAP impingement

decreased elevation and painful ER weak and painful

what are 2 pieces of patient education

exercise in nonprovocative ROM and avoid provocative positions/activites

true or false: scapular dyskinesis is always related to shoulder pain

false

true or false: evidence says that GH joint mobs are effective for to help SAIS

false - it is not

true or false: modalities are appropriate for low irritiability

false - pain reduction not the focus

true or false: we stretch/strengthen/increase ROM in provocative way

false - should be pain free

what are the 2 yellow flags for level 1 screen

fear avoidance; psychological factors

what positions are best for strengthening GH elevation

flexion and scaption

what are the 4 joints of the shoulder

glenohumeral; acromioclavicular; sternoclavicular; scapulothoracic

what is the focus for low irritability

high demand functional activity restoration

what irritability is activity modification most appropriate

high irritability

what is considered high irritability

high pain (7/10) consistent night/rest pain pain before end range AROM < PROM high disability

what is included in the level 1 screen for shoulder symptoms

history basic physical exam red flags

what kind of manual therapy can provide stretch to the posterior cuff and capulse

horizontal adduction - stabilize scapular medially with hand

when should you adjust PT treatment

if patient responds poorly to visits but with a likely explanation

describe the scapular assistance test

if they have a painful arc, put hand on inferior angle and other at superior angle and provide assistance in rotation as they elevate; positive if this takes their pain away

what is the definition of extrinsic cause of impingement syndrome

impingement due to compression in subacromial space

what are key positives for rotator cuff/impingement diagnosis (5)

impingement signs; painful arc; pain with isometric resistance; weakness; atrophy

what are the phrases that go with each treatment category

impingement syndrome - controls shoulder pain; adhesive capsulitis - too tight instability - too loose

what are 2 groups included in the rotator cuff disease diagnosis

impingement syndrome and labral tears

what are the 4 purposes of scapular taping

improve posture; improve shoulder ROM; decrease UT activity increase LT activity

what are considered good responses

improved pain, function/disability, patient satisfaction

where are injections usually placed

inside the SA space

what are secondary causes of SAI pain syndrome (3)

instability; labral tear; biceps tendonitis

what is the preferred method to start strengthening muscles of the RC

isotonics

what type of taping has been preferred for day to day function

kinesiotape

what type of tape has been proven to inhibit muscles

leukotape

what muscle activity (2) should we be trying to reduce

levator scap and upper trap

what is a way to stretch anterior shoulder structures (2)

lie on foam rollers and corner of door stretch

functional activities are most appropriate for what level of irritability

low irritability

manual techniques are most appropriate for what level of irritability

low irritability

what is the criteria for low irritability

low pain (3/10) no night/rest pain minimal pain with overpressure AROM = PROM low disability

what are methods to increase AROM (3)

pulleys; codman's/pendulummss wall walks

what exercises specifically work on serratus anterior

punches, push up pluses, dynamic hugs

what is level 3 screen for shoulder sx

rehab diagnosis determining irritability

what are tests to determine tension to cuff

resisted ER, full/empty can, painful arc

what are major clues to acute phase injury (6)

resting pain; pain prior to end range; stiff with rest; weak decrease P/AROM posture deficits;

what is the rule when working on improving AROM

rotate before elevate

what are the 7 categories for shoulder diagnoses

rotator cuff disease; instability; adhesive capsulitis; GH arthritis/OA; AC joint sprain; fractures; s/p surgery

what is secondary impingement

rotator cuff is irritated because of another cause - GH instability

what is primary impingement

rotator cuff itself is irritated

what exercises work on lower trap

rows, down and back of scap, T's

what are examples of exercises to work on scapular muscle strengthening (5)

rows; supine punches, I's Y's T's, shoulder W, ball hugs

what's the difference between acute, subacute, and chronic treatment of shoulder SAIS

same but as you move farther into the stages you're more progressive and applying RTW/sport exercises

what are methods to test scapular dyskinesis/test scapular muscle control

scapular assistance test and scapular reposition test

what is the lack of smooth scapular humeral rhythm

scapular dysrhythmia/winging

for scapular dyskinesis what muscles are we targeting to get normal function

serratus anterior and lower trap

what exercise minimizes upper trap activity

shoulder W

what can dysrhythmia look like in the scapula

shrug or dump

what are the key negatives for rotator cuff/impingement diagnosis (2)

significant loss of motion; instability signs

what is the level 2 screen

specific physical exam

what are key positives for frozen shoulder (3)

spontaneous progress pain; loss of motion in multiple planes; pain at end range

what type of impingement will you see anterior/lateral shoulder pain with OH activities

subacromial pain impingement syndrome

what is the meaning of intrinsic cause of impingement

tendon breakdown

what are key positives for GH instability (4)

<40 yo; hx of d/l or sublux; apprehension - relocation - release test; general laxity

what are the red flags for a shoulder diagnosis (5)

acute trauma; tumor; infection; referred pain; neurological

what are the key aspect of history for shoulder sx (9)

age; occupation/sport; hand dominance; onset/duration of sx; hx of trauma/dislocation; pain; neurological sx; self report; function disability

what does the specific physical exam help determine

medical diagnosis rotator cuff/impingement frozen shoulder GH instability

what manual therapy has been effective when coupled with exercise for RC (tendinopathy and SA pain)

mobs and manips to shoulder girdle, cervical and thoracic spine

AAROM and AROM is appropriate for what level of irritability

moderate

what is criteria is considered moderate irritiability

moderate pain (4-6/10) intermittent night/rest pain pain at end range moderate disability AROM ~ PROM

what usually happens in the LE when there are shoulder isses

most likely see opposite leg instability motor control issues

what are the impingement signs (3)

neer's; HK; horizontal adduction

what are key negatvies for GH instability (2)

no hx of d/l; no apprehension

what does level 1 screen help determine

non-shoulder or shoulder origin of sx

what are key negatives for frozen shoulder (2)

normal motion; <40 yo

what is a part of the basic physical exam

observation; posture; upper quarter screen - r/o c spine and neuro; AROM/PROM; strength; special tests

what population is tendon breakdown most common in

older populations

what kind of ROM is appropriate for high irritability

pain free P/AAROM

what do we focus on with high irritability

pain reduction

what is the focus with moderate irritability (3)

pain reduction, impairments, and basic function

what is subacute-chronic shoulder pain characterized as (4)

pain with provocative maneuvers only, weakness, decreased AROM, potential loss of PROM

what are considered 3 causes of compression in subacromial space

pec minor; posterior capsule; thoracic spine

when is leukotape appropriate to use instead of KT

postural issue/non-activity

what is major difference in treatment of different shoulder diagnoses

prognosis and when to start certain exercises

what manip is preferred for shoulder pain - thoracic or cervical

thoracic

what are the 2 types of instability

traumatic (TUBS) atraumatic (AMBRII)

true or false: shoulder dysfunctions are multiple pathologies

true

true or false: taping can be useful for all levels of irritability

true

what motions do you test scapular dyskinesis

weighted abduction and flexion

when do sx occur for internal impingement

when position of OH stress

describe scapular reposition test

with the arm at 120 degrees, you resist elevation, if this causes pain provide an inferior medial force tot he scapular spine; positive test if this relieves sx