Shoulder complex Intervention

Question 1

T/F Often early gain or maintenance of shoulder motion is the goal with shoulder intervention.

Answer 1

True

Question 2

Examples of more “Mobility-type” shoulder injuries/disease.

Answer 2

Osteoarthropathy

Frozen shoulder

Question 3

Examples of more “Stability-type” shoulder injuries/disease.

Answer 3

Hypermobile shoulder
SLAP
Scapular dyskinesia

Question 4

What are 4 prognostic factors in regard to healing fractures?

Answer 4

1. Factors affecting healing
2. Extent of fracture
3. Type of fracture
4. Location of fracture

Question 5

Consider appropriate time frames for tissue loading for fractures by doing what two things?

Answer 5

1. Communicating with medical provider

2. Follow Medical guidelines

Question 6

T/F Patients with RA will have a constant progression.

Answer 6

False, will present with fluctuations between remission and progression

Question 7

What are 2 pain management considerations for patients with RA?

Answer 7

1. Electrotherapeutic modalities

2. Thermal modalities

Question 8

Why use Conservative strengthening/ mobility exercises for patients with RA? What should you monitor? What should you avoid?

Answer 8

1. For pain reduction/ maintenance or improvement of ROM, address muscle performance impairments
2. Symptoms may worsen; monitor response closely and error on side of conservatism
3. Avoid exacerbating inflammatory response

Question 9

What type of conservative manual therapy could you use with a RA patient?

Answer 9

Oscillatory mobs, likely beginning & mid-range

Monitor response closely if used

Question 10

While a patient with RA is in remission, what 2 things should you focus on?

Answer 10

1. Strength

2. Manual therapy

Question 11

For a patient with SC joint sprain type 1 or 2, describe the protection.

Answer 11

Typically managed conservatively

3-4 days immobilization

Question 12

For a patient with SC joint sprain type 3, describe the protection.

Answer 12

Shoulder sling or figure 8 strap 2-3 weeks f/b continued protection 2 additional weeks (more sever 2nd degree sprains as well)

Question 13

Initially, at what range should ROM exercises be performed by patients with SC joint sprains?

Answer 13

Mid range

Question 14

T/F Use manual therapy to address other joints that contribute to shoulder motion for a patient with SC joint sprain

Answer 14

True

Question 15

You can address the tendinosis of a rotator cuff tendinopathy with what two types of stressing that will facilitate healing?

Answer 15

1. Eccentrics

2. Concentric exercise (high rep/low weight/slow movements)

Question 16

What contributing 4 factors of rotator cuff tendinopathy should you address?

Answer 16

1. Posterior &/or inferior capsule hypomobility - Joint mobs, posterior capsule stretching
2. Scapulothoracic coordination impairments
3. AC/SC joint hypomobility – limit posterior tipping/upward rotation
4. Muscle-tendon unit “tightness”

Question 17

Why use eccentric loading for tendinosis?

Answer 17

• Tendinosis is a decrease in parallel organization

- Eccentric loading promotes facilitates collagen fiber alignment improving tensile loading capacity and tissue strength

Question 18

How many weeks of increased eccentric stress to a tendinosis necessary?

Answer 18

10-12 weeks

Question 19

Full can exercise focuses on what muscle? What is the anatomical implications? Biomechanical implications?

Answer 19

• Supraspinatus
• Enhances scapular position and subacromial space
• Decrease deltoid involvement

Question 20

Prone full can exercise focuses on what muscle? What is the anatomical implications? Biomechanical implications?

Answer 20

• Supraspinatus
• Enhances scapular position and subacromial space
• High posterior deltoid activity with similar supraspinatus activity

Question 21

Side-lying ER exercise focuses on what muscle? What is the anatomical implications? Biomechanical implications?

Answer 21

• Infraspinatus and teres minor
• Shoulder stability and minimal capsular strain
• Increased moment arm at 0 abduction

Question 22

Prone ER at 90 abduction exercise focuses on what muscle? What is the anatomical implications? Biomechanical implications?

Answer 22

• Infraspinatus and teres minor
• Stability challenge and capsular strain
• High EMG activity

Question 23

ER with towel rollexercise focuses on what muscle? What is the anatomical implications? Biomechanical implications?

Answer 23

• Infraspinatus and teres minor
• Proper form without compensation
• Incorporates ADD

Question 24

IR at 0 abduction exercise focuses on what muscle? What is the anatomical implications? Biomechanical implications?

Answer 24

• Subscap
• Position of shoulder stability
• Similar subscap activity between 0 and 90

Question 25

IR at 90 abduction exercise focuses on what muscle? What is the anatomical implications? Biomechanical implications?

Answer 25

- Subscap - Position of shoulder instability - Enhances scapular position and subacromial space and less pec activity

Question 26

IR diagonal exercise focuses on what muscle? What is the anatomical implications? Biomechanical implications?

Answer 26

- Subscap - More functional exercise - High EMG activity

Question 27

Push-up plus exercise focuses on what muscle? What is the anatomical implications? Biomechanical implications?

Answer 27

- Serratus anterior - Easy position to produce resistance against protraction - High EMG activity

Question 28

Dynamic hug exercise focuses on what muscle? What is the anatomical implications? Biomechanical implications?

Answer 28

- Serratus anterior - Perfmored below 90 abduction - High EMG activity

Question 29

Serratus punch 120 exercise focuses on what muscle? What is the anatomical implications? Biomechanical implications?

Answer 29

- Serratus anterior - Combines protraction with upward rotation - High EMG activity

Question 30

The sleeper stretch is a stretch for what?

Answer 30

Stretch for subacromial pain syndrome - posterior capsule stretch

Question 31

Three things to work on with a patient with subacromial impingement (take home things)?

Answer 31

1. Sleeping position 2. Ergonomic training (posture at desk) 3. Activity modification/avoidance (regular breaks/alt tasks)

Question 32

With subacromial impingement, you want to up train what muscles?

Answer 32

1. Inferior trap 2. Serratus Anterior (posterior tipping) 3. Subscap (stop anterior migration of humerus) 4. Infraspinatus and teres minor (limit superior movement of humerus)

Question 33

With subacromial impingement, you want to down train what muscles?

Answer 33

1. Upper trap 2. Pec major 3. Posterior deltoid

Question 34

What is your goal for stage 1 of adhesive capsulitis? (pre-adhesive stage)

Answer 34

1. ROM maintenance (my job to increase their job to maintain at home) 2. pain management

Question 35

What is your goal for stage 2/3 of adhesive capsulitis? (frozen and maturation)

Answer 35

1. ROM maintenance 2. pain management 3. compensation training 4. muscle performance 5. manage impairments following medical intervention 6. Could be to educate patient/ establish independence with HEP (with instruction to return once thawing stage achieved as needed)

Question 36

What is your goal for stage 4 of adhesive capsulitis? (thawing)

Answer 36

1. Improve ROM | 2. muscle performance

Question 37

What education can you offer a patient with adhesive capsulitis?

Answer 37

1. Activity modification (sleeping, lifting/carrying tech, ergonomics) 2. activity avoidance 3. progression of pathology

Question 38

What pain modulation can you offer a patient with adhesive capsulitis?

Answer 38

1. Oscillations 2 thermal modalities 3. Ultrasound, estim with mobility/stretching

Question 39

What joints can you mobilize in for patient with adhesive capsulitis? What for?

Answer 39

- GHJ, SCJ, ACJ, STJ, C-Spine, T-Spine | - Reduce pain and increase motion

Question 40

T/F Shoulder mobility and stretching exercises alone are better in providing short term (4-6) week pain relief than shoulder mobility and stretching exercises with intra-articular corticosteroid injections.

Answer 40

False

Question 41

If a patient with adhesive capsulitis is not responding to conservative interventions, what may be utilized?

Answer 41

MUA

Question 42

What muscles should be stretched in a patient with adhesive capsulitis?

Answer 42

``` Upper trap Pectoralis Major and minor Lev Scap SCM Posterior Joint Capsule ```

Question 43

With AMBRI type shoulder instability what interventions should you focus on?

Answer 43

1. Rotator cuff coordination/ strength/ endurance 2. Peri-scapular coordination/ muscle performance 3. Dynamic stabilization & proprioceptive training 4. Activity modification as appropriate 5. Muscular stability especially in extreme functional ranges

Question 44

With TUBS type shoulder instability what interventions should you focus on?

Answer 44

1. Muscle performance 2. Address other tissue injuries as appropriate 3. Address hypomobility following immobilization period 4. Address other hypomobility as appropriate (example; posterior G-H capsule with anterior instability)

Question 45

Conservative management of SLAP lesion includes:

Answer 45

1. Address impairments 2. Common intervention strategies - Pain management interventions - Rotator cuff coordination/ strength/ endurance - Peri-scapular coordination/ muscle performance - Dynamic stabilization & proprioceptive training

Question 46

When treating a bicep tendinopathy, what interventions are used?

Answer 46

1. Pain management 2. Eccentrics 3. Other contributing factors - Posterior capsular hypomobility - ACJ/ SCJ hypomobility - Shoulder girdle coordination/ weakness

Question 47

What 3 modulations of pain are used in shoulder interventions?

Answer 47

1. Address Guarding 2. Joint Oscillations/ Thrust 3. Thermal Modalities

Question 48

What 4 things focused on for interventions of mobility of shoulder?

Answer 48

1. “Down training” 2. Joint mobs 3. Stretching 4. Soft Tissue Mobilization

Question 49

What 5 things focused on for interventions of stability of shoulder?

Answer 49

1. Coordination 2. Endurance Training 3. Strength Training 4. Dynamic Stability Training 5. Plyometrics

Question 50

T/F Massage, joint mobilization, and exercise more beneficial than exercise only for impingement syndrome

Answer 50

True, B level evidence

Question 51

T/F Joint mobilization are better than soft tissue mobs impingement syndrome

Answer 51

False, weak evidence

Question 52

T/F Higher grade mobs are better than lower for adhesive capsulitis

Answer 52

False, weak evidence

Question 53

What 5 directions for GH joint mobs?

Answer 53

Caudal (inferior) Dorsal (posterior) Ventral (Anterior) - prone Traction - arm at 0 abduction and pull perpendicular from body Long Axis Traction - arm open pack and pull caudal (inferior)

Question 54

What direction for AC joint mobs?

Answer 54

Ventral - mobilize distal clavicle and stabilize acromion

Question 55

What 2 directions for SC joint mobs?

Answer 55

Caudal (slightly lateral force) - mobilize proximal clavicle Traction - mobilize distal clavicle and stabilize manubrium

Question 56

What are the 4 goals for coordination training of the shoulder?

Answer 56

1. Improve proprioceptive function (mechanoreceptors, muscle spindles) 2. Co-activation of agonists/antagonist for improved force couples 3. Improve force dispersion in GH joint 4. Decrease time for amortization phase (time between eccentric and concentric phases)

Question 57

What are plyometrics? | Ex for shoulder:

Answer 57

Powerful eccentric deceleration followed by fast concentric contraction ex: rebounder throwing exercises (eccentric control with catch at end range)

Question 58

4 goals of mobility exercises?

Answer 58

1. Pain modulation 2. Improve guarding 3. Improve coordination - Neutral position first couple of weeks - Then move to isometric type stability 4. Address tissue “tightness” - Capsule - Muscle-tendon unit

Question 59

What muscles do you want to strengthen in shoulder interventions?

Answer 59

1. Lower Trap Ex: PNF exercises 2. Mid Trap 3. Thoracic paraspinals