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Thoracic Spine and Shoulder Tx - Coggle Diagram

- - - - SAPS TIC: 1)Hawkins-Kennedy 2)Infra Muscle strength testing 3)Painful Arc sign
      - RTC Tear: ER Lag test (infra and Supra), Drop arm 90 deg ABD (supra) and 45 ER at 90 deg (infra), Hornblower's sign (teres minor), IR Lag sign (subscap)
    - - Primary: pathology itself is result of abnormal mechanical relationship btwn RTC and coracoacromial arch.
      - Stages of Primary:
        
        1) Edema & Inflammation: greater tub and edge of acromion tenderness, painful arc ABD 60-120 deg, (+) imp sign, ROM may be restricted due to inflammation
        
        2) Fibrosis & Tendinitis: greater loss of ST crepitus in subacrom space, catching sensation with lower arm ~100 deg, limitations in A/PROM
        
        3) Bone Spurs and Tendon Rupture :red_flag: : same signs as 1 & 2 plus greater limitations in A/PROM, atrophy of infra, LHB involvement, AC joint tenderness
      - Secondary: disorder of subacromial tissue but cause is 1) relative narrowing due to GH hypermobility or 2) scapula dyskinesis
    - - Address impairments: "dumb scapula", motor control, stretch restrictions (pec minor), CKC to stabilize co-contractions, Isometric--> Isotonic
      - AVOID aggravating activities or Tx (low intensity, high frequency- eccentrics, relaxation and posture)
      - Make right Dx (Primary vs Secondary)
      - AAROM- wand, pendulums, pulley, ER/IR slight scaption
      - Joint mobs: inferior and posterior of GH
      - Posture!
  - - - Anterior Dislocation associated with:
        1) Bankart Lesion (anteroinferior labrum tear
        2)Hill-Sachs Lesion: boney impact lesion on posterior humeral head
      - Clinical Presentation Anterior Instability: Anterior pain, apprehension and/or pain in ABD & ER, Hx of anterior/inferior MOI, joint clicking/clunking, Hx dead arm
      - Examination Presentation for Anterior Instability : ER>IR and (+) Neer, (+) apprehension test
      - Examination Presentation for Bankart Lesion: ER>IR, (+) Neer
        TIC: 1) Crank test 2) Apprehension Test 3) Jobe Relocation 4) Anterior Load ans Shift test 5)Sulcus Sign
      - Clinical Presentation Posterior Instability: Deep posterior pain, apprehension and/or pain in horizontal ADD, pain in pushing activities, Hx of posterior trauma, jt clicking/clunking
      - Examination Presentation of Posterior Instability: ER>IR , (+) Neer, (+) Jerk and Kim Test
    - - Generalized Hypermobility, Beighton Signs
      - May be result of microtraumatic and/or anatomic laxity from OH activities - generally non-operative
      - SLAP Lesion: Superior Labrum Anterior to Posterior
        
        Exam Presentation: ER>IR, (+) Neer, (+) Biceps Load II
        
        Clinical Presentation: Deep shoulder pain, clicking/clunking, jt locking, pain with eccentric deceleration of UE, pain with biceps loading
  - - - Stage 1: Pain modulation, may tolerate supported pendulum, physician may choose steroids
        Stage 2: AAROM as tolerated, not pain-provoking, aggressive stretching or exercise is counterproductive
        Stage 3: Can start more aggressive with ROM and start mob if not having significant pain @ end-range, possible translational MUE or arthroscopic release
        Stage 4: Mob and ROM, stretching if not painful
        During all stages, HEP with multiple short bouts each day is best