Please enable JavaScript.
Coggle requires JavaScript to display documents.
PHTY207 - MUSCULOSKELETAL PHYSIO FOR UPPER LIMB, Anatomy Intensives…
PHTY207 - MUSCULOSKELETAL PHYSIO FOR UPPER LIMB
Shoulder Girdle Risk Profiles, Ax Clusters, Rx
GHJ
Unstable and Painful
Dislocation
Anterior Dislocation
Posterior Dislocation
Generalised Hypermobility
SLAP Lesion
O'Brien's and Bicep Load tests
TUBS vs. AMBRI?
3 MOIs of Unstable shoulder (in Types)
Type 2 - Atraumatic structural (occupational/recreational cause)
Type 3 - habitual non-structural (neuromuscular control)
Type 1 - traumatic structural
GHJ Instability (in respective Directions)
Inferior Instability
Sulcus Sign test
Anterior Instability
Load and shift test
MDI - Multi-directional Instability
Subluxation/apprehension test
Load and shift that way there is many directions tested
Posterior Instability
Jerk test
Summary of Assessment of Instabilities
Orthopaedic Tests
Labral Pathology Tests
O'Brien's active compression test
(may also indicate ACJ pain)
Bicep tendon involvement -->
Bicep Load Test
Capsule Laxity Tests
Sulcus Sign (inferior instability)
Load and Shift (AP/PA instability)
Subluxation/Apprehension test
Relocation Test
Posterior Instability (posterior glide/jerk test)
Transverse Ligament Test : Yergason's Test (transverse ligament and biceps tendon involvement)
Weak and Painful
RCRSP/shoulder impingement/ Subacromial Pain Syndrome
RC Tendinopathy
shoulder spaces smaller and thus compressing the tendons
Sub-acromial space
Neer's EOR flexion
HK
Empty can
sub-coracoid space
HK
IR strength test?
postero-superior space
Posterior Pain Reproduction test (relieved by PA glide)
ER neutral + 90 strength test
3 Stages of tendinopathy
Other underlying pathophysiologies in RCRSP (poor HOH position, weak RC, instability, tightness, scapular dyskinesis, thoracic spine stiffness)
Assessments
Radiological Ix
PE
Biceps tendon (pathology of long head of biceps)
Speed's Test: Biceps Tendon
Pain Provocation Testing
Neer's EOR Flexion Test (forward flexion)
Subacromial contribution to pain
Hawkins Kennedy Pain Provocation Test
Subcoracoid and/or subacromial contribution to pain
Posterior Pain Reproduction Test
Posterosuperior contribution to pain??
Subjective
Impairments and Treatment
GIRD (Glenohumeral Internal Rotation Deficit
Rotator Cuff Muscle Pathology
Calcific Tendonitis
Ax
RC strength tests
Subscapularis - ER strength test in neutral & 90 Abd.
Gerber's Lift-off test: Subscapularis strength test
Abdominal Compression Test (belly press, napolean)
Empty Can Test (Jobe's): Supraspinatus strength test
Also a Pain Provocation Test - Tests subacromial contribution to pain
Teres Minor - ER strength test in 90ABD
Muscle Length Tests
Internal Rotator length assessment
ER length assessment
Stiff and Painful
OA of GHJ
Assessments
Impairments and Treatment
Frozen Shoulder (adhesive capsulitis)
Assessments
Capsule length tests
Impairments and Treatment
Phases: Freezing, Frozen, Thawing
Post Humeral #
Assessments
Impairments and Treatment
Assessment
Radiological Ix
Subjective
PE
Capsular length lests
Anterior Capsule Length test
Posteror Capsule Length Test
PAMs of GHJ
Scapulothoracic J
Scapula #
Snapping Scapular Syndrome
Scapular Dyskinesis (SICK)
Nerve injury/entrapment around shoulder
Long Thoracic N.
Subscapular N.
Axillary N.
Thoracic Outlet Syndrome
Assessments
Neurovascular Changes
Tinel's Sign
Positive Neurovascular changes in sustained postural positions
Neurodynamic Tests (median, radial, ulnar)
Breathing Pattern Dysfunction
Impairments and Treatments
{Pain}
decreased Cervical and Shoulder AROM
Breathing impairment
Therefore treatment is:
Improve positional support and muscle strength
Bracing/Taping
Shoulder girdle strengthening and kinetic chain
Improve Neurodynamic Tolerance
Sliding --> Tensioning Neurodynamics
Improve breathing
CV fitness training
Education + retraining breathing pattern
Decrease pain
POLICE + PEACE-LOVE
Encourage lifestyle changes and educate on ergonomics and occupational modifications
General Assessments
MMT, Observation of muscle wasting,
Ax Muscle Strength Tests for Scapular movement
Lower Trapezius strength test
Serratus Anterior Strength test
Upper Trapezius strength test
SCJ
SCJ Dislocation & Subluxation
Assessments
Radiological Ix
Deformity of joint
lack of ROM
Passive Accessory assessment and functional Ax
Impairments and Treatments
Pain and decreased ROM
Instability
Therefore treatments are:
Decrease Pain and promote healing
POLICE + PEACE-LOVE
Increase Stability: Bracing
Increase ROM: gentle PAM glides
Strengthen surrounding muscles
OA of SCJ
SCJ instability
ACJ
ACJ sprain (leading to dislocation)
Osteolysis of distal clavicle
OA w ACJ
Assessments
Accessory Movements {in prac manual}
Observation and Palpation - step deformation, TOP
Other Examinations: Shoulder dyskinesia and scapulohumeral rhythm, pain in shoulder movements, Radiological Ix
Special Orthopaedic tests: Hawkins-Kennedy test?, O'brien's test
Impairments and Treatment
Pain
Instability
Loss of ROM
Therefore Treatments are:
decrease pain:
PAM glides (Caudal, AP)
POLICE + PEACE-LOVE
Increase stability:
Taping/Bracing
Promote Healing: POLICE + PEACE-LOVE
Increase ROM
PAM glides
Symptom modification
Increase motor control: Train scapulohumeral rhythm
Clavicular #s
Elbow Ax & Conditions, Risk Profiles, Rx {need to add in Rx today!!}
Lateral Elbow
lat elbow tendinopathy (tennis elbow)
Radial Tunnel Syndrome
RH Bursitus
Synovitis of RHJ
Osteochondritis Dissecans
Radial Head #
RCL (LCL) sprain
Medial Elbow
Flexor Tendinopathy (Golfers elbow)
UCL (MCL) sprain
MCL instability
Ulnar Nerve Compression
Avulsion # of Medial Epicondyle
Apophysitis ??
Referred Pain
Posterior Elbow
Olecranon bursitis
Triceps Tendinopathy
Posterior Impingement
Gout
Olecranon #
ACUTE CONDITIONS & Mx
Radial Head #
Radial Head Subluxation (nursemaids)
Dislocations (simple vs. complex)
Classifications: lateral, medial divergent
MCL +PCL Sprains + Medial Instability
Assessments
Impairments & Rx
Olecranon Bursitis
Elbow # and avulsions
Terrible Triad: post. elbow dislocation + radial head # + ulna coronoid process #
Wrist and Hand
Traumatic
Fractures of Distal Radius, Carpals, Metacarpals, Phalanges
Ligament Injuries
Carpal Instability (Scapholunate, TFCC)
Skier's thumb
Interphalangeal
Nerve Lacerations
Tendon Lacerations
Chronic
De Quervain's Tenosynovitis
Carpal Tunnel Syndrome
Ulnar Nerve Compression
Radial Nerve Compression
Dupuytren's Disease
OA of 1st CMC
Systemic
Rheumatoid Arthritis
MUSC concepts and Clinical Reasoning
Symptom Modification
MWMs
PPMs
PAMs
Assessments
Subjective
Objective
EPAs
Electrical Stimulation
Interferential
TENS
Therapeutic Ultrasound
Low-level Laser
general Guidelines, contraindications/precautions for EPAs
Neurological and UL Neurodynamic Tests
Orthopaedic, Medical and Surgical Mx
Sub acromial decompression
Rotator Cuff Repair
Arthroscopic vs open surgery
Corticosteroid use
Shoulder stabilisation
Shoulder Replacement (hemiarthroplasty, TSR, Reverse TSR)
Ax
Physical Examination (Objective)
Functional (Physiological) Testing
AROM
Muscle Length
Muscle Strength
Joint Testing
HOH placement
Capsule length tests
Passive Accessory Movement
Orthopaedic Tests for (INSTABILITY)
Orthopaedic Tests for Labral injuries
Observation Ax and Palpation Ax
Pain provocation testing
Symptom modification
Patient interview (Subjective)
Rx
Physical Devices
Taping
EPAs
Manual Therapy
Joint Mobilisation
Advice and Education
Therapeutic Exercise
Stretches
Strengthening
Proprioceptive training & Posture & Kinetic Chain & Activation and Control
Anatomy Intensives Material
Function of Rotator Cuff
Supraspinatus
Infraspinatus
Teres Minor
Subscapularis
Shoulder spaces & acromion morphology
Sub Acromial space
Sub coracoid space
Posterosuperior space
Capsule Length Tests and Ligaments they test
Readings:
Speed's Test: Bicep Tendon
Yergason's Test (transverse ligament test as well)