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Common causes of tendonitis or bursitis of shoulder include sudden, violent __ __, __ __ of tissue, ___ produced by rotation and flexion or extension, excessive ___ loading of tissue, or repetitive ___
muscle contraction, rapid stretch, torque, eccentric, overuse
prevention for shoulder tendonitis/bursistis is to have good ____, and avoid ___ ___
posture, provoking activity
Diagnosis for tendonitis/ bursitis is based on patient ___, pain, swelling, and tenderness with ____, muscle ___ if muscle trauma, and pain is generally ___ with activity and ___ with rest
history, palpation, guarding, reproducible, relieved
medical management of tendonitis/bursitis: __ __, ___, ___ ___, and sometimes ___ removal
pain meds, nsaids, steroid injection, bursa
PT management for tendonitis/bursitis in the acute phase
modalities, rest, AROM, submax ISOM
PT management for tendonitis/bursitis in the subacute phase add ____, concentric ___, ___ISOM, __ __ mobilization, modalities prn, gentle __ __, ice, ___ for pain, ___
stretching, strengthening, max, Soft tissue, joint mobs, estim, u/s
PT management for tendonitis/bursitis in the chronic phase includes ____ strengthening, patient ___, and ___
eccentric, education, endurance
PT management for tendonitis/bursitis in the chronic inflammatory phase includes ___ prn, ___, and ___
modalities, rest, stabilization
tendons of the rotator cuff become compressed under the coracromial arch, leading to decreased blood supply, mechanical wear and tear, tendonitis, bursitis, and/or partial or full thickness tear of the RC cuff tissues
Subacromial rotator cuff impingement
common terms for rotator cuff impingement syndrome: ___ syndrome, chronic ___ syndrome, painful ___ ___, and internal ___ of the ___ space
supraspinatus, impingement, arc syndrome, derrangement, subacromial
contributing factors to rotator cuff impingement are poor rotator cuff ____, ___ ___ lifting, and ___ dysfunction
function, repetitive overhead, postural
prevention of rotator cuff impingement is ____ of __ ___
avoidance, contributing, factors
Signs and symptoms of rotator cuff impingement is that the pt always has pain with active abduction from __ to __, and active flexion above __ to __, has no loss in ___, and has poor ___ ___
60, 120, 80, 90, PROM, scapulohumeral rhythm
medical management for RC impingement includes (3)
pain meds, nsaids, steroid injections
patient education for RC impingement include ___, __ ___ focusing on ___ and __ position
posture, body mechanics, shoulder, scapula
modalities for RC impingement include ice, estim: ___ and ___; ___ (both __ and __)
nmes, ifc, ultrasound, pulsed, thermal
exercise interventions for RC impingement include (2)
RC strengthening, scapular stabilization
___ ___ in the RC result from degenerative changes in area where rupture or tears appear. Many remain small and deep and produce no symptoms, where others increase in size, inflame and can cause swelling in bursa.
Most common in the supraspinatus tendon
prevention for calcium deposits in RC is to ___ ___ ___
avoid provoking activity
Symptoms of calcium deposits in RC can be ___ or ___ onset. Tenderness at ___ part of shoulder or __ arm referred pain while sleeping, also muscle ___ and ___
gradual, quick, superior, lateral, spasm, guarding
___ ___ are visible on xray and MRI
medical mgmt for calcium deposits in RC include (4)
pain meds, nsaids, steroid injection, aspiration
Modalities for treatment of calcium deposits include ___ to heat, decrease pain, or ___ deposit; also ___ with ___ acid
ultrasound, break up, iontophoresis, acetic
Exercise interventions for RC calcium deposits include ___ to restore __, ___ ___, and rotator cuff ___, focusing on __ __ activity. Also ___.
AROM, motion, scapular stabilization, strengthening, closed chain, posture
Can be a partial or full thickness tear of RC tendons, due to ___, after ___ ___ to tissue over time, or eventual ___ secondary to ____ calcification
trauma, repetitive microtrauma, rupture, longstanding
prevention of RC tear includes avoiding ___ __ and ___ modification.
provoking activities, posture
Signs for RC tear include a positive __ __ test
Medical mgmt for RC tear includes (3)
pain meds, nsaids, sling
Surgical management of a RC tear includes repair or __ __, decision to operate depends on ___, ___ and ___.
subacromial decompression, pain, disability, age
subacromial decompression options: __ __ resection, anterior ___, ___ of lateral clavicle, ___ of glenoid and/or acromion, and ___
coracromial ligament, acromioplasty, excision, osteotomy, acromionectomy
PT protocol for nonsurgical RC tear includes ___ to decrease pain and inflammation, and ___ and biomechanics of the shoulder, also RC ___ and __ __.
modalities, posture, strengthening, scapular stabilization
PT protocol for a post surgical RC tear has a strict protocol with ___ of PROM only, and at ___ AAROM only. After ___ weeks AROM may begin, and pt spends __ weeks in a ___ brace.
6 weeks, 6-12 weeks, 12, 12, abduction
characterized by the insidious onset of pain and limited motion due to fibrous synovial adhesions. Sometimes presents initially like a chronic tendonitis, but then spreads to involve all shoulder jt motion.
Adhesive capsulitis occurs most often in ___ from age ___. Most often affects the ___ arm.
women, 40-60, non-dominant
Primary cause of adhesive capsulitis is ___
Secondary cause of adhesive capsulitis when dysfunction happens after____ or long period of __.
The first stage of adhesive capsulitis is known as the ___ or ___ stage. It may last up to ___ months, and patient is resistant to therapy because of high levels of ___.
freezing, painful, 4, pain
The second stage of Adhesive capsulitis is the ___ or ___ stage, may last ___ mos, and patient is more receptive to PT.
frozen, stiffness, 2-4
The ___ stage is ___ mos after initial presentation, and may take up to __ years. PT intervention most beneficial at this stage, but recovery of __ is very __.
thawing, 6, 2, ROM, slow
Only ___ adhesive capsulitis can be prevented, which is why ___ after any shoulder injury needs to be done ___.
secondary, ROM, ASAP
Symptoms for adhesive capsulitis include __ __ pain, ___ ___ that is tender to touch around RC or biceps tendon, __ of scapular muscles, especially ___ ___, atrophy of ___ and ___ due to decreased ROM.
lateral brachial, capsular inflammation, spasm, upper traps, deltoid, supraspinatus
Decreased shoulder ROM in adhesive capsulits happens in a ___ pattern: most limited in ___ range, then ___, then ___ and least limited in ___.
capsular, ER, ABD, IR, Flexion
Medical mgmt for adhesive capsulitis is___ __, ___ and __ ___
pain meds, nsaids, steroid injections
Surgical management of adhesive capsulitis is ___ of ___, or arthroscopic release of __ __ of __ __
tearing capsule, scar tissue, inferior capsule
Pt ed for adhesive capsulitis is ____ and education about disease process, also about ___ arm as much as possible
modals for adhesive capsulitis are ___ for __ in ___ and ___ stage
prn, pain, freezing, frozen
PT after surgery for adhesive capsulitis is every day for __ weeks for __ and ___ (type) jt mobs.
2, inferior, posterior
PT for non surgical adhesive capsulitis is 2-3 times/week, _ __ and __ __ for 2 years.
manual stretching, joint mobs
Exercise interventions for adhesive capsulitis is __, then __, then ___. Only after ROM is achieved within __ __ do you begin strengthening. Work on __ __ and ___ __ strengthening.
PROM, AAROM, AROM, functional limits, scapular stabilization, rotator cuff
a fall on an outstretched arm (laterally rotated, abducted, flexed) is the most common mechanism for __ ___/
incidence of reccurent dislocation is less if the first dislocation is immobilized for __ weeks.
compression fracture of posterior humeral head from crashing into anterior glenoid
avulsion of capsule and glenoid labrum
Superior Labrum, Anterior to posterior, can also tear biceps tendon
test for GH dislocation
Magnusun Stack, Bristow Procedure, Capsular Shift are all surgical procedures for ___ ____
Pt ed for GH dislocation is importance of ___, and how to prevent ___
Exercise interventions for GH dislocation are __ __ while immobilized; and __ __ and ___ ___ when not immobilized.
submax ISOM, scapular stabilization, RC cuff strengthening
Compression of the neurovascular bundle in the cervical thoracic region (C8-T1 nerve roots, subclavian artery and vein)
Thoracic outlet syndrome
4 common causes of TOS
Cervical rib syndrome, scalenus anticus syndrome, costoclavicular syndrome, hyperabduction syndrome
prevention of TOS is avoid heavy ___ or ___ or ___ and correct ___
backpacks, purses, straps, posture
Symptoms of TOS include (5)
pain, numbness, weakness, discoloration, or swelling of UE
Medical management of TOS is __ ___, ___ and ___ ___
pain meds, nsaids, muscle relaxors
Surgical management for TOS is reattaching ____ to ___ __
scalenes, second rib
PT ed for TOS is avoiding __ __ and __ __; also not wearing __ __ across shoulder, and ___ arms while seated or on ___ while sleeping. Also teaching __ __.
provoking activities, overhead reaching, heavy items, supporting, pillow, diaphragmatic breathing
For TOS, stretch ___, ___, ___, and __
scalenes, occipital muscles, levator, and pecs
For TOS, strengthen scapular __, __ rotators, head __ and __ extensors
retractors, upward, extensors, thoracic
Most common causes of injury to the AC joint are ___ on outstretched arm, or overuse with ___ ___.
falling, weight lifting
Partial tear of AC ligament, localized pain, but no instability
Grade I sprain
Rupture of AC ligament and partial tear of CC ligament. Increased pain with some instability
Grade II sprain
Complete rupture of AC and CC ligaments, also includes joint capsule. Lots of pain and loss of motion
Grade III sprain
Medical management for AC sprains is ___, ___ and ___ (grade I: __weeks, grade II: ___ weeks, grade III: ___ weeks)
rest, ice, sling, 3, 3-6, 6
Surgical management for AC sprain is for __ __ only.
Pins used to approximate and stabilize, sutures used to approximate, screws, hook plate, and excision
Surgical management of grade III AC sprain
medical treatment for impacted humeral fracture
sling 2-3 weeks
medical treatment for humeral shaft fracture
surgical treatment for humeral shaft fracture
plates, screws, external fixation
surgical treatment for proximal complex humeral fracture
total shoulder replacement
PT management for impacted humeral fracture is gentle ____ ASAP
PT management for humeral shaft fracture
early AROM, avoid ABD for 5-8 weeks
PT management for total shoulder: wait for dr's ok, then begin AROM and RROM, and __ __. If RC repair also follow protocol for 1-6 weeks ___, 6-12 weeks ___ and 12+ weeks until ___
scapular stabilization, PROM, AAROM, AROM
Medical mgmt for medial and lateral epicondylitis includes (4)
pain meds, NSAIDs, RICE, and bracing
PT ed for medial/lateral epicondylitis includes advising pt to use special equipment with ___ ___, pens with bigger ___, and prevention of ____.
oversized handles, grips, reinjury
modalities for medial/lateral epicondylitis include ___, ___ ultrasound, ____, and ____.
ice, thermal, estim, STM
Exercise interventions for acute medial and lateral epicondylitis include ____ and ___ ___ in a ___ ___.
AROM, submax isom, shortened position
Exercise interventions for subacute med/lat epicondylitis includes ___ ___ ISOM in a ____ position, add ____, and ___ strengthening.
full effort, neutral, stretching, concentric
Exercise interventions for med/lat epicondylitis in the chronic phase includes muscle ____ and ____ strengthening to target tissues
heterotrophic ossification in a muscle, usually from a blow, dislocation, or microtrauma from aggressive stretching.
myositis ossificans is common after elbow ____, a blow to the ___ muscle, or in patients who are ___ or ___.
dislocation, brachialis, unconscious, paralyzed
to prevent myositis ossificans, avoid aggressive ____ to the elbow, especially if signs of ____ increase
Diagnosis of myositis ossificans is done via ___
medical management for myositis ossificans is rest with sling in the position of ___ (__ degrees) until pain subsides; and ___
function, 90, NSAIDs
PT management for myositis ossificans is avoid ___ during active pathology, and ____ because patient is self-limiting
portion of subchondral bone undergoes avascular necrosis. This part of the bone and articular cartilage may separate from bone and become a loose body.
Signs and sxs for osteochondritis dissecans include ___ onset, dull aching pain often associated with ___, occasional ___ ___, limited ___, local ___
gradual, stiffness, joint locking, ROM, tenderness
cause is unknown, but can be precipitated by trauma. For example, in young males, excessive pitching can lead to little league elbow
xrays indicate that the capitulum is most involved
medical mgmt for osteochondritis dissecans is ___
surgery for osteochondritis dissecans is only when __ __ fail, and consists of removal of ___ ___
conservative measures, loose bodies
Acute PT mgmt for osteochondritis dissecans is ___ prn, ___ ___ and ____
modalities, submax isom, AROM
subAcute PT mgmt for osteochondritis dissecans is ____, ___ __ ____, and ___ strengthening
stretching, full effort isom, concentric
Chronic PT mgmt for osteochondritis dissecans is ___ ___ about ___ ___ ___.
patient ed, rest activity balance
head of radius becomes subluxed beneath the annular ligament. Mechanism of injury is longitudinal pull with elbow extended and forearm pronated
radial head subluxation
ulnar dislocation usually due to fall on outstretched hand. Usually involves injury to median, radial and ulnar nerves as well as brachial artery. A common complication is myositis ossificans.
lifting child by hand or wrist can cause
radial head subluxation
diagnosis of radial head subluxation includes an____ ___ or pop, an obvious ___, being in a ___ and protected position, and it is very sore with ___ to radial head.
audible snap, deformity, flexed, palpation
medical management for redial head subluxation is manual ____ by long __ __, and a ___ for immobilization after ____.
reduction, axis distraction, cast, reduction
surgical management for radial head subluxation happens only if it includes a ___
PT management for radial head subluxation is lots of elbow ____ for ___, but no over____ to protect joint
stretching, extension, stretching
prevention of elbow dislocation includes ___ ___for at-risk population
diagnosis for elbow dislocation is an obvious ____ and loss of ____
medical management for elbow dislocation is manual ____ and casting at ___ or ___ degrees
reduction, 60, 90
PT management for elbow dislocation is ____ weeks immobilized to reduce risk of ___ __. ___ ___ is used to initiate long, low load stretch. Contracture management is ___ __ as tolerated. Also ____ and ___ to soften tissue.
8-10, myositis ossificans, dynamic splinting, aggressive stretching, modalities, STM
3 types of radial head fractures
displaced, non-displaced, comminuted
A type 1 radial head fracture is immobilized for ___ weeks
A type 2 radial head fracture is medically treated by ____ or ___, and a type 3 is treated by ____
ORIF, excision, excision
PT management for radial head fracture is early ____ after ___, and ___ to regain ____. Appropriate joint mobs would be for ___ and ___.
AROM, immobilization, stretching, extension, pronation, supination
A type 1 supracondylar fracture is when the distal humeral fragment is displaced ____ and a type 2 is when it is displaced ____
medical mgmt for supracondylar fx is ___ or ___ in elbow ____ for ___weeks
ORIF, casting, flexion, 4-6
PT mgmt for supracondylar fx is ____ in the acute stage and ____ occuring as bone heals
A type 1 intercondylar fx is ___ ___, type 2 is ___ without ___ rotation, type 3 is ___ with ___ rotation, and type 4 is severely ____
non displaced, displaced, humeral, displaced, humeral, comminuted
medical mgmt for intercondylar fracture is ___ if there are too many small pieces to initiate healing, or ___
an olecranon fracture can be an ____, ____ fracture, or ___
avulsion, oblique, comminuted
Possible complication of elbow fractures is ___ ___ ___: where the brachial artery and median nerve are ___ between fractured ends. It causes loss of ___ in that hand and it can also be caused by ___ ___ ___.
volkmann's ischemic contracture, impinged, function, thoracic outlet syndrome
The symptoms of volkmann's ischemic contracture are the 5 P's:
pallor, pulselessness, poikilothermia, paresthesia, pain
medical management for olecranon fx is ___, or an ORIF with __ and __
casting, pins, wires
PT management for intercondylar fx is ____ for longer period of time before initiating ___.
PT management for olecranon fracture is is AROM for ___ weeks, but if displaced, no ROM until ___ weeks
risks for CTS include ___, ___ ___, and women in __ trimester of pregnancy
fractures, rheumatoid arthritis, 3rd
signs and symptoms of CTS is ___, ___ or ___ in the first ___ digits.
pain, numbness, weakness, 4
Tests for CTS include a nerve ____ test, ____ test, and ____ sign
conduction, phalen's, tinel's
med mgmt of CTS includes ___, ___ and ___ ___
NSAIDs, brace, steroid injection
Pt ed for CTS is ___, ___ and prevention of ___
posture, ergonomics, reinjury
modalities for CTS includes ____, ____, __ __, __ ___, ___ ___, and ___
iontophoresis, ultrasound, friction massage, ice massage, joint mobs, estim
Excercise interventions for CTS includes stretching and strengthening the wrist and finger ____, and sometimes the ___ to prevent __ __
flexors, extensors, lateral epicondylitis
3 types of wrist fractures
colle's fracture, smith's fracture, scaphoid fracture
___ __ is a dinner fork deformity, caused by falling on outstretched hand, ___ displacement
colle's fracture, posterior
__ __ is sometimes called a reverse colle's fracture, caused by falling on back of hand, with ___ displacement
smith's fracture, anterior
A ___ __ is caused by falling on a _____ outstretched hand. ___ __ is common due to poor circulation, and it is often an __ or ___ fracture.
scaphoid fracture, hyperextended, avascular necrosis, malunion, nonunion
diagnosis for a scaphoid fracture includes increased pain in the ___ ___ area
diagnosis for wrist fractures includes ___ and ___ ___
xray, bone scan
medical management for wrist fractures includes ___ ___, and ____ for ___ weeks
manual reduction, immobilization, 4-6
surgical management of wrist fractures includes ___, __ ___, and ____ of scaphoid if nonunion or malunion
ORIF, external fixator, excision
PT mgmt for acute wrist fracture includes thumb and finger ____, ____ and gentle ____, and __ ___
AROM, PROM, AROM, submax isom
PT mgmt for subacute wrist fracture is initiate ___, begin ___ strengthening, and __ ___
stretching, concentric, joint mobs
contracture of the ulnar MCP joints, usually of the 3rd and 4th fingers. This disease affects the palmar fascia that leads to nodules and cords.
Typically affects men over 40 and higher than avg incidence in those with diabetes.
diagnosis of dupuytren's contracture is is a ____ loss of ___ for ___.
visual, ROM, extension
surgical mgmt for dupuytren's is a ___
PT mgmt for dupuytren's is ___ ___ and ___ ___. After surgery:___ ___ and ___.
dynamic splinting, friction massage, wound care, debridement
Exercise interventions for dupuytren's contracture is ____ ASAP, especially for ___ and ____, followed by ___ when Dr says its ok.
AROM, extension, hyperextension, stretching
Inflammation of the tendons and/or tendon sheaths of abductor pollicus longus and extensor pollicus secondary to repetitive motion
Prevention of dequervain's is ____ and __ ___
ergonomics, job modification
test for dequervains
medical management for dequervain's is ___ ___, ___, and ___ ___
spica splint, NSAIDs, steroid injection
surgical mgmt for dequervain's is to ____ tendon sheath to make more room
modalities for dequervain's are prn for pain, ____ to soften tissue prior to ____ ___, and ___ ___ to wrist
ultrasound, friction massage, joint mobs
patient education for dequervain's is about ___ ___ balance and __ modification
Exercise interventions for dequervain's in acute are ___ ___ in a ___ position, and ____
submax ISOM, shortened, AROM
exercise interventions for dequervain's in subacute are ___, ___ ___ ___ in a __ position, and ___ strengthening
stretching, full effort isom, neutral, concentric
Exercise interventions for chronic dequervain's includes ___ ___ and ____ exercise
patient education, eccentric
Test for TOS
Test for RC injury
drop arm test
test for bicipital tendonitis
test for supraspinatus trauma
Tests for CTS
Phalen's test, Tinel's sign
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