Shoulder/Intro

Question 1

Pathoanatomic Classification

Answer 1

• assumes that tissue pathology represents a homogenous group (i.e. Bob with RCT is the same as Fred with RCT)
• assumes strong relationship between tissue pathology and patient complaints (i.e. if Wanda has bulged disc on imaging with pain then Carla must have pain with her bulged disc)

Question 2

Classification Systems

Answer 2

• Pathoanatomic classification

- Movement system diagnosis

Question 3

Stages of Intervention

Answer 3

• Stage I: relieve primary impairment
• Stage II: Relieve movement issues at adjacent body segment
• Stage III: address global issues

Question 4

Intervention: Stage I

Answer 4

• Pain (7/10+)
• Immobility/modify activity (post op-need immobility/protection)
• Mobility (need mobility)
• Exercise/Conditioning

Question 5

Intervention: Stage III

Answer 5

• LE strength/core
• cardiovascular training
• return to work/sport

Question 6

Intervention: Stage II

Answer 6

• mechanical issues
• muscle recruitment
• adjacent structures

Question 7

Functional ROM

Answer 7

• Reach overhead: flex/abd: 148*
• comb hair: h add: 104, Abd 112, Er 54*
• Reach behind back: ext 56, h abd 69, IR 60*

Question 8

GIRD

Answer 8

• Glenohumeral IR Deficiency
• Loss IR (15-25* compared to non-dominant side)
• Loss of total ROM
• Associated with shoulder injury (SLAP)

Question 9

Total Rotation ROM

Answer 9

90* + 70=160

Question 10

Limited IR due to:

Answer 10

• tight posterior capsule
• Ant tilt of scap
• tight ER Mm (teres minor, infraspinatus)

Question 11

Limited ER due to:

Answer 11

• short IR Mm (lats, pec major, subscap)
• ant capsule
• ant lig

Question 12

Ant Scap Tilt due to:

Answer 12

-tight pec minor

Question 13

Elevate scap due to:

Answer 13

-tight levator scap, upper trap

Question 14

Adducted Scap due to:

Answer 14

Rhomboids

Question 15

ICR

Answer 15

Instantaneous Center of Rotation

Question 16

Serratus most active above:

Answer 16

90* elevation

Question 17

where to start?

Answer 17

• Scap stability before Rotator cuff

- closed chain before open

Question 18

Closed Chain

Answer 18

• promotes co-activation
• increases scapular activity
• decreases tensile stress
• improves proprioception
• start with scap stabilization

Question 19

How to progress CKC Scap stability

Answer 19

• stability of scap in static postures (scap clocks)
• stable scap with isolated GH motion (wall wash)
• large shdr ROM under controlled situations (PNF)
• loaded mobility upon stability (resistance)

Question 20

If HYPOmobile

Answer 20

work exercise through entire range

Question 21

If HYPERmobile

Answer 21

work exercise in mid to shortened ranges

Question 22

Primary Impingement

Answer 22

• older
• hypomobile
• overhead worker

Question 23

Secondary Impingement

Answer 23

• young
• athlete
• hypermobile
• (swimmer, pitcher)