Shoulder Joint Problems

Question 1

RA mainly affects

Answer 1

synovium/joints, especially small joints

Question 2

Related GH pathologies

Answer 2

post immob arthritis or stiff shoulder (lack of movement), adhesive capsulitis

Question 3

Shoulder Hypomobility: clinical signs in acute phase

Answer 3

Pain and protective muscle guarding limit motion, Pain frequently radiates distal to the elbow and may disturb sleep, Pain to palpation just below the Acromion between the post/mid Delt

Question 4

Shoulder Hypomobility: treatments in protection phase

Answer 4

pt ed, control pain/edema/muscle guarding (modalities) avoid increasing pain

Question 5

Shoulder Hypomobility: interventions in protection phase

Answer 5

Codman’s, P/AAROM of shoulder, T/S, and C/S within the pain free ROM, gentle joint oscillations to prevent adhesions, Gentle STM of the c/s, t/c and periscapular muscles, gentle isometrics to all muscle groups of shoulder

Question 6

purpose of pendulum exercises

Answer 6

helps in fluid dynamics and pain management, essentially acts as a grade I joint mob

Question 7

Shoulder Hypomobility: clinical signs of subacute phase

Answer 7

capsular pattern, Pain at end of limited ROM, limited joint play

Question 8

Shoulder Hypomobility: treatments in the controlled motion phase

Answer 8

ROM exercises, joint mobs, teach self mobs (avoid increasing pain)

Question 9

Shoulder Hypomobility: controlled motion phase treatments: ROM exercises

Answer 9

GH and scap motions, self-assistive ROM techniques (wand exercises/hand slide)

Question 10

Shoulder Hypomobility: controlled motion phase treatments: joint mobs

Answer 10

grades 3 and 4, consider MWM

Question 11

Shoulder Hypomobility: Self-mobs techniques

Answer 11

caudal and ant/post glides

Question 12

caudal glide

Answer 12

sit on a firm surface, grasping the fingers under the edge, lean the trunk away from the stabilized arm

Question 13

anterior glide

Answer 13

sit with both arms behind the body or lying supine, patient leans body weight between the arms (on elbows in supine)

Question 14

posterior glide

Answer 14

propped up on both elbows in prone, body weight shifts downward between the arms

Question 15

Shoulder Hypomobility: exercises that can be done during early subacute stages of tissue healing?

Answer 15

wand exercises, ball rolls (on table and on wall), wall washing, pendulums

Question 16

Shoulder Hypomobility: clinical signs of chronic phase

Answer 16

progressive restriction of GH joint cap, significant loss of function-reaching up/out/behind, Often c/o pain in the delt region

Question 17

Shoulder Hypomobility: treatments in the return to function phase

Answer 17

increase flexibility and strength, prepare for functional demands

Question 18

adhesive capsulitis prevalence

Answer 18

more prevalent in people 40-65, females, higher risk if previous episode of adhesive capsulitis in contra arm

Question 19

pathophysiology of adhesive capsulitis

Answer 19

marked by the presence of multiregional synovitis (consistent with inflammation), focal vascularity and synovial angiogenesis (increased capillary growth), new nerve growth may explain heightened pain response

Question 20

stages of adhesive capsulitis

Answer 20

gradual onset of pain, freezing, frozen, thawing

Question 21

stage 1 of adhesive capsulitis

Answer 21

Gradual onset of pain that increases with movement and present at night, loss of ER with intact RTC (common), duration less than 3 months

Question 22

stage 2 (freezing stage) characterized by

Answer 22

persistent and more intense pain (even at rest), Motion is limited in all directions and cannot be fully restored with an intra-articular injection, 3-9 months after onset

Question 23

stage 3 (frozen stage) characterized by

Answer 23

pain only with movement, significant adhesions and limited GH motions, Excessive ST movement is a typical compensation, Atrophy, 9-15 months following onset

Question 24

stage 3 Muscles atrophied

Answer 24

delt, RTC, biceps, triceps

Question 25

stage 4 (thawing stage) characterized by

Answer 25

minimal pain and no synovitis but significant cap restrictions from adhesions, motion may gradually improve, 15-24 months after onset

Question 26

healing time of adhesive capsulitis

Answer 26

May take up to 2 years to recover and mild to mod mobility deficits/pain may persist

Question 27

Diff Dx for Adhesive capsulitis

Answer 27

acute calcific tendonitis/bursitis, arthrosis, impingement syndrome, radiculopathy

Question 28

outcome measures for the shoulder

Answer 28

ASES shoulder score, QDASH (Higher score is worse), SPADI (shoulder pain and disability index)

Question 29

Medical Interventions of Adhesive Capsulitis

Answer 29

coticosteriod injection, MUA, hydro-dilation, OAT procedure/trigenics

Question 30

corticosteroid injection for adhesive capsulitis

Answer 30

if done at the right time (stage 1) can be beneficial

Question 31

manipulation under anesthesia (MUA)

Answer 31

pt must be seen everyday for 10 days following

Question 32

Hydro-dilation

Answer 32

Injection of saline into the joint capsule, inflation of cap will break through adhesions and restore space (in theory)

Question 33

interventions for adhesive capsulitis

Answer 33

pt ed, modalities for pain, joint mobs and stretching, HEP

Question 34

indications for GH arthroplasty

Answer 34

intractable PAIN, late stage OA/RA, massive RTC tear, AVN

Question 35

traditional shoulder replacement

Answer 35

pt MUST HAVE INTACT RTC

Question 36

reverse shoulder replacement

Answer 36

used for pts with irreplaceable RTC, deltoid becomes lengthened

Question 37

GH arthroplasty postoperative management

Answer 37

Immob and post-op positioning

Question 38

GH arthroplasty postoperative management: post-op positioning

Answer 38

elbow 90 flex, forearm/hand resting on abdomen, shoulder in about 10-20 forward flexion, slight abd and IR

Question 39

With a tenuous RTC repair

Answer 39

if sling does not provide adequate protection, an abd splint must be worn

Question 40

outcomes of GH joint surgery

Answer 40

pain relief (primary goal), ROM and functional use of UE (secondary goals)