Physiotherapy Tendonitis and Bursitis Quiz

Podcast

Play an AI-generated podcast conversation about this lesson

Questions and Answers

What is the most common limitation in range of motion (ROM) for a patient with tendonitis?

Full elevation without pain

Slight restriction in passive rotation

Elevation limited to 60 degrees (correct)

Complete loss of motion in all directions

What does the term 'empty end-feel' indicate during passive range of motion (PROM) testing?

Active movement causes no resistance

Pain or anticipation of pain occurs before the end range (correct)

An immediate stopping point due to mechanical blockage

Full range without any pain

Which special test requires differentiation between supraspinatus tendonitis and subacromial bursitis?

Shoulder compression test

Neer impingement test

Hawkins-Kennedy test

Painful arc test (correct)

What is the initial approach to treating bursitis?

Managing inflammation first Signup and view all the answers

Which of the following movements is likely to cause the most pain during resisted range of motion (RROM) testing for a patient with bursitis?

Abduction Signup and view all the answers

What is the primary cause of tendonitis?

Overuse from repetitive movements Signup and view all the answers

Which muscles are most commonly involved in tendonitis?

SITS muscles and biceps brachii Signup and view all the answers

Which activity is most likely to cause supraspinatus tendinopathy?

Overhead swimming Signup and view all the answers

What symptom is most associated with bicipital tendonitis?

Localized pain in the anterior shoulder Signup and view all the answers

How does calcific tendonitis typically present?

It is self-healing and reabsorbs over time. Signup and view all the answers

Which test is used for assessing supraspinatus strain?

Empty Can Test Signup and view all the answers

What is a common sign of bursitis in the shoulder?

Pain that is deep, constant, and intense Signup and view all the answers

Which factor is most likely to contribute to the development of tendonitis?

Repetitive strain from occupations or sports Signup and view all the answers

What is one of the most common signs of supraspinatus tendinopathy?

Pain with overhead movement Signup and view all the answers

Which of the following is NOT a characteristic of chronic bursitis?

Intense pain at rest Signup and view all the answers

What common activity is associated with the development of calcific tendonitis?

Throwing sports Signup and view all the answers

What is the primary goal during the acute phase of tendonitis treatment?

Decreasing inflammation and pain Signup and view all the answers

What can happen if bicipital tendonitis progresses unchecked?

Rupture of the biceps long head tendon Signup and view all the answers

What should be avoided if an inflamed bursa is present?

Compressing the affected area Signup and view all the answers

In Impingement Syndrome, which of the following structures is most commonly affected?

Supraspinatus tendon Signup and view all the answers

Which factor is least likely to contribute to repeated trauma in Impingement Syndrome?

Excessive shoulder flexion Signup and view all the answers

What special test is used to confirm biceps tendon involvement in Impingement Syndrome?

Speeds test Signup and view all the answers

Which type of shoulder dislocation occurs least frequently?

Inferior dislocation Signup and view all the answers

What is a common sign of an anterior shoulder dislocation?

Sulcus sign observed at the shoulder Signup and view all the answers

For a Grade II AC separation, which symptom is expected?

Partial subluxation of the clavicle Signup and view all the answers

Which of the following is a contraindication for shoulder treatment in acute stages?

Joint mobilizations if joint remains unstable Signup and view all the answers

What is a key clinical sign in Adhesive Capsulitis?

Significant reduction in both active and passive range of motion Signup and view all the answers

What is the primary function of the inferior glenohumeral ligament?

To prevent anterior subluxation and dislocation Signup and view all the answers

Which condition is characterized by an insidious onset of pain felt over the lateral brachial region?

Impingement Syndrome Signup and view all the answers

In order to prevent excess adhesion formation in shoulder conditions, what treatment approach should be taken during the late subacute phase?

Begin cross-fibre frictions Signup and view all the answers

Which phase of scapulohumeral rhythm involves scapular rotation and has a 2:1 ratio?

Phase 2: 30 – 90 degrees abduction Signup and view all the answers

What type of joint is the glenohumeral joint classified as?

Synovial, ball & socket Signup and view all the answers

Which of the following is commonly expected as a sign in chronic shoulder dislocation?

Poor joint stability and protection Signup and view all the answers

Which manual therapy technique is often indicated for improving scapula stability?

Scapular rotation exercises Signup and view all the answers

Which ligament primarily checks excessive lateral movements in the acromioclavicular joint?

Trapezoid Ligament Signup and view all the answers

What is the primary objective when treating shoulder instability?

Stabilize and strengthen the joint area Signup and view all the answers

What defines the closed packed position for the glenohumeral joint?

Full abduction and external rotation Signup and view all the answers

What is the effect of excess thoracic kyphosis on shoulder stability?

Disrupts stabilizing 'lip' of the glenoid fossa Signup and view all the answers

Which of the following motions is facilitated by the interaction between the deltoid and rotator cuff?

Centration of the humeral head Signup and view all the answers

What is a common indicator of a frozen shoulder when moving the arm?

Lack of movement at the scapula in the first 30 degrees of abduction Signup and view all the answers

Which pair of ligaments is part of the coracoclavicular complex?

Trapezoid and conoid ligaments Signup and view all the answers

In which osteokinematic motion does the acromioclavicular joint primarily engage?

Elevation – Depression Signup and view all the answers

What is the initial area of adhesion in frozen shoulder?

Triangular area between subscapularis and biceps tendons Signup and view all the answers

What is the primary role of the glenoid labrum?

To deepen the glenoid cavity for better articulation Signup and view all the answers

What is indicated by a step deformity at the distal end of the clavicle?

AC separation Signup and view all the answers

Which is a type of secondary frozen shoulder?

Subacromial bursitis Signup and view all the answers

What characterizes the freezing phase of frozen shoulder?

Gradual onset of pain with severe night pain Signup and view all the answers

Which of the following describes the function of the rotator cuff during shoulder activity?

Provides dynamic stability and maintains congruency Signup and view all the answers

What occurs during the painful arc syndrome?

Pain only after 120 degrees of abduction Signup and view all the answers

In the thawing phase of frozen shoulder, what happens to the pain?

Pain continues to diminish and localizes Signup and view all the answers

What type of ROM examination might show a capsular pattern of restriction?

Passive Range of Motion (PROM) Signup and view all the answers

What is a common clinical impression regarding the timeline of recovery in frozen shoulder?

Recovery corresponds with the length of the painful phase Signup and view all the answers

Which treatment approach is recommended in the acute phase of frozen shoulder?

Mobilize hypomobile joints (grade 1 and 2) Signup and view all the answers

Under what condition would manipulation under anesthesia be determined applicable?

Hematomas, fractures, or dislocations Signup and view all the answers

What medication types are typically used in the treatment of adhesive capsulitis?

Anti-inflammatories and pain-killers Signup and view all the answers

What may be a contributing factor to secondary frozen shoulder?

Pulmonary disorders Signup and view all the answers

Which of the following is NOT a possibility in the treatment of adhesive capsulitis?

Aggressive manipulation early in treatment Signup and view all the answers

Which muscle's activity influences shoulder external rotation in frozen shoulder?

Subscapularis Signup and view all the answers

What is a primary complaint during phase 1 of frozen shoulder?

Severe pain at night Signup and view all the answers

Which joint mobilization technique is used to increase shoulder elevation?

Inferior glide Signup and view all the answers

Study Notes

Glenohumeral Joint

Joint Type: Synovial, ball and socket
Articulating Surfaces:
- Humeral head: Medial, slightly posterior, and superior.
- Glenoid fossa: Lateral, forward, and superior; pear-shaped, narrow superiorly, wider inferiorly.
Capsular Strength/Coaptation: Weak and lax, especially inferiorly (axillary pouch).
Ligaments:
- Superior/Middle/Inferior Glenohumeral Ligaments: Anterior thickening/reinforcement, limits external rotation, provides anterior stability. Middle ligament limits lateral rotation up to 90 degrees abduction. The inferior is the thickest and prevents anterior subluxation/dislocation.
- Coracohumeral Ligament: Strengthens superior capsule, resists gravity.
- Transverse Humeral Ligament: Holds long biceps tendon in groove. Rupture = unstable biceps tendon.
Extras:
- Dynamic ligaments: Rotator cuff tendons blend with joint capsule fibers.
- Glenoid labrum: Deepens glenoid cavity for better articulation.

Acromioclavicular Joint

Joint Type: Synovial, modified gliding
Articulating Surfaces: Medial surface of acromion, incomplete articular disc, acromion facet of clavicle. Compression force = clavicle overrise acromion—AC separation.
Capsular Strength/Coaptation: Weak and lax.
Ligaments:
- Superior/Inferior Acromioclavicular Ligaments: Prevents AC separation.
- Coracoclavicular Complex:
  - Trapezoid Ligament (horizontal, lateral): Limits excessive lateral movements.
  - Conoid Ligament (vertical, medial): Limits excessive superior movement and scapuloclavicular angle widening.
Extras: Incomplete intra-articular disc, dangles from superior part of inside the synovial joint capsule.

Sternoclavicular Joint

Joint Type: Synovial, modified gliding
Articulating Surfaces: Clavicular notch of manubrium, sternal end of clavicle.
Capsular Strength/Coaptation: Weak and lax, inferiorly.
Ligament:
- Anterior/Posterior Sternoclavicular Ligaments: Stabilizing.
- Interclavicular Ligament: Limits excessive medial movement.
- Costoclavicular Ligament: Limits elevation with medial movement and elevation with lateral movement.
Extras: Complete intra-articular disc to prevent medial separation.

Glenohumeral Joint Biomechanics

Osteokinematics: 3 degrees of freedom (flexion/extension, abduction/adduction, external/internal rotation).
Arthrokinematics: Humeral head (convex), glenoid fossa (concave).
Resting Position: 55–70 degrees abduction, 30 degrees horizontal adduction.
Closed-Packed Position: Full abduction and external rotation.
Capsular Pattern of Restriction: External rotation > Abduction > Internal rotation.
ROM & End Feel:
- Flexion: 180°, firm.
- Extension: 60°, firm.
- External Rotation: 90°, firm.
- Internal Rotation: 70°, firm.
- Abduction: 180°, firm/hard.
- Horizontal Abduction: 45°, firm.
- Horizontal Adduction: 135°, firm/soft.

Acromioclavicular Joint Biomechanics

Osteokinematics: 3 degrees of freedom (elevation/depression, protraction/retraction, anterior/posterior rotation).
Arthrokinematics: Acromion (concave), acromial end of clavicle (convex).
Resting Position: Arm by side.
Closed Packed Position: Arm abducted to 90 degrees.
Capsular Pattern of Restriction: Full elevation with associated pain.
ROM & End Feel: Elevation/Depression: 30°, Protraction/Retraction: 50°, Rotation: 50°, all with capsular firm end feel.

Sternoclavicular Joint Biomechanics

Osteokinematics: 3 degrees of freedom (elevation/depression, protraction/retraction, anterior/posterior rotation).
Arthrokinematics: Clavicular notch of manubrium (ant/post-convex, sup/inf-concave), sternal end of clavicle (ant/post-concave, sup/inf-convex).
Resting Position: Arm by side.
Closed Packed Position: Arm maximally elevated.
Capsular Pattern of Restriction: Full elevation with associated pain.
ROM & End Feel: Elevation/Depression: 15°, Protraction/Retraction: 10°, Rotation: 50°, all with capsular firm end feel.

Joint Mobilization: Sternoclavicular Joint

Inferior/Superior Facets: Convex on concave (superior roll, inferior glide).
Anterior/Posterior Facets: Concave on convex (posterior roll, posterior glide).

Scapular Plane & Scaption

Scapular Plane: Requires 20 degrees of horizontal adduction.
Scaption: Horizontal abduction in frontal plane, good for muscle balance of all rotator cuff muscles.

Shoulder Stabilization

General: Shoulder capsule is relatively lax; muscles provide active stabilization. Some passive stability if joint is correctly oriented.
Passive Stability (neutral): Glenoid fossa lip (superior, anterior, lateral), superior glenohumeral ligament, coracohumeral ligament. This position tightens the superior joint capsule and coracohumeral ligament, pulling humeral head against glenoid cavity.
Active Stability (raised arm): Rotator cuff maintains dynamic congruency and stability.
Compromised Stability: Excess Thoracic Kyphosis (downward scapular rotation) → lax superior capsule and coracoacromial ligaments; rotator cuff overworks to provide active stability, possible impingement syndrome. Muscle paresis (partial paralysis) → forward scapular rotation → possible inferior dislocation or subluxation (neurological injury).

GH Joint Capsule & Movement

GH joint capsule fibers face anteriorly and medially. Abduction twists the capsule, which increases tension and pulls the humeral head into the glenoid cavity. Medial fibers become taut further aiding abduction. Capsule pulls the humerus into external rotation to prevent greater tubercle collision with acromial arch. Capsule important for lateral rotation.

Force Couples

Deltoid & Rotator Cuff: Deltoid pulls up and out, rotator cuff pulls down and in for humeral head centration.
Serratus Anterior & Upper Trapezius: Allow scapular upward rotation during arm movements.
Long Head of Biceps Tendon: During lateral rotation, acts as a pulley depressing the humeral head for centration.

Abduction Biomechanics

Scapulohumeral Rhythm:
- Phase 1 (0–30°): Scapular setting, no scapulohumeral rhythm, minimal scapular movement, 0–5° clavicular elevation.
- Phase 2 (30–90°): Next 60° elevation, 2:1 scapulohumeral rhythm, scapula starts rotating (20°), clavicle elevates further (15°).
- Phase 3 (90–180°): Last 90° elevation, 2:1 ratio, clavicle elevates, rotates posteriorly, humerus laterally rotates 90° to clear acromial arch. Requires thoracic spine movement too.
Reverse Scapulohumeral Rhythm: Scapula moves more than humerus, often indicative of frozen shoulder, especially visible in first 30 degrees.
Clavicle – SC & AC – Movement:
- SC joint: Clavicle moves on manubrium, sternal clavicular facet: 'apple-core' shape (ant/post = concave, sup/inf = convex). Concave/convex movements = same direction of glide. Convex/concave movements = opposite direction of glide.
Axial Skeleton Movement: Thorax function critical, hyperkyphosis limits abduction.

Observation

Step Deformity: Distal clavicle, AC separation indication.
Sulcus Sign: Sagging/flattening below acromion, dislocation/deltoid paralysis indicator.
Mal-alignment of clavicle: Often due to fractures.
Scapular Winging: Medial border moves away from posterior chest wall (not spine). Dynamic (serratus anterior injury) or static (structural deformity).
Scapular Tilting: Superior/inferior angles tilt away from chest wall, weakness/instability or pec minor tightness.
Painful Arc: 0–45° painless, 60–120° pain (impingement). Last 10–20° pain (impingement, potentially AC/SC joint involvement).
Apley's Scratch: Quick function scan, not an orthopedic test.

Other Sections (Conditions, Treatment, etc.)

(Detailed summaries of various shoulder conditions, special tests, treatment approaches, precautions, and considerations are provided in the original text snippet.)

Studying That Suits You

Use AI to generate personalized quizzes and flashcards to suit your learning preferences.

Description

Test your knowledge on the common limitations and clinical evaluations related to tendonitis and bursitis. This quiz covers important concepts such as range of motion assessments, special tests, and initial treatment approaches. Perfect for students and professionals in physiotherapy.