Shoulder Injuries and Rehabilitation

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Questions and Answers

What is the primary goal of physical therapy intervention in the frozen phase?

Interrupt cycle of pain and inflammation

Restoration of functional motion and strength

Reacquisition of GHJ ROM (correct)

Minimize capsular restrictions and tissue inextensibility

What is NOT an emphasis in the freezing phase?

Addressing systemic inflammation with sleep, diet, and mental health perspective

Thermotherapy assisted exercise in all planes (correct)

Manual therapy as a potential pain modifier

Gentle, sub-pain threshold, biomechanically correct exercise

What is the focus of postural training/awareness in the freezing phase?

To improve aerobic fitness

To increase strength and functional motion

To reduce systemic inflammation

To address global/holistic approach (correct)

What is the purpose of 'PT vacations' in the freezing phase?

To conserve visits and prioritize self-exercise Signup and view all the answers

What is the role of manual therapy in the freezing phase?

As a potential pain modifier Signup and view all the answers

What is the chief complaint in the freezing phase?

Pain Signup and view all the answers

What is the primary focus of rehabilitation in managing shoulder injuries?

Psychosocial status Signup and view all the answers

What is the common perception when a patient is told they have a 'rotator cuff' injury?

Surgery is likely needed Signup and view all the answers

What is the suggested approach for managing subacromial pain syndrome?

More education and modalities Signup and view all the answers

What is the primary benefit of thoracic spine thrust manipulation in SAIS?

Short-term benefit at 48-hour follow-up Signup and view all the answers

What is the common impairment area to address in subacromial pain syndrome?

Thoracic extension stiffness Signup and view all the answers

What is the typical stage of progression where pain at rest decreases but stiffness increases?

Frozen stage Signup and view all the answers

What is the purpose of considering the patient's job or activity demands in rehabilitation?

To incorporate specific exercises Signup and view all the answers

What is the name of the scale used to assess sleep quality?

PSQI Signup and view all the answers

What is the term used to describe the spectrum of soft tissue shoulder pain?

RC diseases Signup and view all the answers

What is the question that can help stage a patient with adhesive capsulitis?

Can you sleep through the night? Signup and view all the answers

What is the primary mechanism of traction during the treatment of a specific injury?

Applying weight in a prone position with the arm at 90 degrees Signup and view all the answers

What is a risk factor for a specific condition?

Being a younger male with a history of overhead contact activity Signup and view all the answers

What is the purpose of keeping hands and elbows in the field of view during treatment?

To ensure the patient is within a safe range of motion Signup and view all the answers

What is the effect of using ultrasound, phonophoresis, iontophoresis, or massage on pain relief and functional improvement?

Reduced chance of improvement by 19-32% Signup and view all the answers

What is a type of lesion that may be seen in a patient with a specific condition?

Bankhart lesion Signup and view all the answers

What is the primary benefit of joint mobilization for patients with pain?

Reduced pain Signup and view all the answers

What is a surgical procedure that involves the transfer of the coracoid process?

Bristow technique Signup and view all the answers

What is the most common category of anterior shoulder instability according to the FEDS classification?

Solitary, occasional, traumatic anterior displacement Signup and view all the answers

What is a potential complication of a specific surgical procedure?

Arthritis due to instability Signup and view all the answers

What is the primary goal of supervised visits at first after a procedure?

To monitor patient progress Signup and view all the answers

What is the effect of exercise therapy on functional improvement in patients with pain?

Increased likelihood of improvement Signup and view all the answers

What is the purpose of a specific surgical procedure?

To correct a bony defect Signup and view all the answers

What is a type of capsular shrinkage procedure?

Thermal assisted laser capsulorrhaphy Signup and view all the answers

What is the abbreviation for Atraumatic multidirectional instability?

AMBRI Signup and view all the answers

What is the direction of traumatic shoulder instability?

Anterior Signup and view all the answers

What is the benefit of taking pressure off the axillary nerve?

Relief of anterior shoulder instability Signup and view all the answers

What is the primary purpose of the Remplissage Procedure?

To prevent engagement of the lesion on the anteroglenoid rim Signup and view all the answers

What is the typical duration of immobilization in the post-operative rehabilitation phase?

4-6 weeks Signup and view all the answers

What is the primary focus of the rehabilitation program in the first 6 weeks?

Inflammation and pain control Signup and view all the answers

What is the purpose of the Beighton Hyper Mobility Index in the rehabilitation program?

To identify patients with hypermobile joints Signup and view all the answers

What is the recommended approach to weight training in the rehabilitation program?

Modifying exercises to avoid excessive stress on the shoulder Signup and view all the answers

What is the primary benefit of avoiding passive stretching in the rehabilitation program?

It reduces the risk of injury Signup and view all the answers

What is the purpose of the structured program of daily exercises in the non-operative intervention?

To strengthen the axioscapular muscles Signup and view all the answers

What is the average age of subjects who participated in the multi-center MOON trial?

62 Signup and view all the answers

What is the primary concern in the rehabilitation program for anterior instability?

Preventing internal rotation contractures Signup and view all the answers

What is the recommended approach to elevation exercises in the rehabilitation program?

Elevating the arm in the scapular plane Signup and view all the answers

Study Notes

Management and Treatment of Shoulder Injuries

Shoulder pathology rehabilitation involves specific intervention strategies for different injuries, including rotator cuff syndrome, anterior glenohumeral joint instability, supralabral lesions, shoulder osteoarthritis, and adhesive capsulitis.

Rotator Cuff Syndrome

Non-operative and post-operative management strategies are used for rotator cuff syndrome.
Rotator cuff syndrome is a common condition, especially in older adults, and is often asymptomatic.

Anterior Glenohumeral Joint Instability

Anterior glenohumeral joint instability is a common condition, especially in young adults, and is often caused by traumatic injuries.
The FEDS classification system is used to classify anterior glenohumeral joint instability, considering factors such as frequency, etiology, direction, and severity.

Shoulder Osteoarthritis

Non-operative and post-operative management strategies are used for shoulder osteoarthritis.
Shoulder osteoarthritis is a common condition, especially in older adults, and is often caused by wear and tear on the joint.

Adhesive Capsulitis

Adhesive capsulitis is a common condition, especially in older adults, and is characterized by inflammation and stiffness in the shoulder joint.
Sleep disturbances are common in patients with adhesive capsulitis, and are often associated with increased pain and disability.

Holistic and Individualized Intervention

A holistic and individualized approach to rehabilitation is essential, considering factors such as biopsychosocial assessment, mental health, cognitive function, behavioral characteristics, and sleep quality.
Rehabilitation should focus on treating the whole person, rather than just the injured shoulder.

Rehabilitation Focus

Rehabilitation focus should be based on psychosocial status, patient values, goals, and outcome expectations, as well as tissue irritability, impairment findings, and imaging findings.
Tissue irritability guides the intensity of physical stress, and impairment level guides the intensity of intervention tactics.

Research Takeaways

Research has shown that patients' perceptions of treatment options vary, with "rest" and "medication" being the most common perceptions, while "exercise" is often underrated.
Saying "rotator cuff" and "surgery" is often associated with increased perceived severity of the condition.

Subacromial Pain Syndrome

Subacromial pain syndrome is a common condition, characterized by pain and inflammation in the subacromial space.
Diagnosis is often based on a combination of clinical examination, imaging, and patient history.
Treatment involves a combination of education, manual therapy, and exercise, with a focus on restoring soft tissue and joint mobility, and addressing pain modulation.

Subacromial Impingement Syndrome

Subacromial impingement syndrome is a common condition, characterized by inflammation and compression of the soft tissues in the subacromial space.
Diagnosis is often based on a combination of clinical examination, imaging, and patient history.
Treatment involves a combination of education, manual therapy, and exercise, with a focus on restoring soft tissue and joint mobility, and addressing pain modulation.

Cervicothoracic Spine

The cervicothoracic spine plays a critical role in shoulder function and rehabilitation, and should be addressed in treatment.

Glenohumeral Joints

The glenohumeral joints are a critical component of shoulder function, and should be addressed in treatment.

Acromioclavicular Joints

The acromioclavicular joints are a critical component of shoulder function, and should be addressed in treatment.

Scapulothoracic Spine

The scapulothoracic spine plays a critical role in shoulder function and rehabilitation, and should be addressed in treatment.

Common Impairment Areas

Common impairment areas that should be addressed in treatment include thoracic extensor stiffness, inadequate scapular posterior tilt, pectoralis minor tightness, posteroinferior glenohumeral joint capsular stiffness, and restrictions.

Short-Term Benefits

Short-term benefits of treatment include reduced pain and inflammation, improved range of motion, and increased strength.

Long-Term Benefits

Long-term benefits of treatment include improved functional ability, reduced disability, and increased quality of life.

Anterior Shoulder Instability

Anterior shoulder instability is a common condition, especially in young adults, and is often caused by traumatic injuries.
The FEDS classification system is used to classify anterior shoulder instability, considering factors such as frequency, etiology, direction, and severity.

FEDS Classification

The FEDS classification system considers factors such as frequency, etiology, direction, and severity to classify anterior shoulder instability.

Over 40% of Patients

Over 40% of patients with anterior shoulder instability fall into the solitary, occasional, trauma, or anterior displacement category.

AMBRI and TUBS

AMBRI (atraumatic multidirectional instability) and TUBS (traumatic unilateral Bankart lesion) are two common classification systems used to categorize anterior shoulder instability.

Risks

Risks associated with anterior shoulder instability include being a younger male, and participating in overhead contact activities.

Treatment Options

Treatment options for anterior shoulder instability include immobilization, rehabilitation, and surgery.

Rehabilitation

Rehabilitation for anterior shoulder instability should focus on restoring range of motion, strength, and function, as well as addressing pain and inflammation.

Surgery

Surgery is often necessary for anterior shoulder instability, especially in cases where the condition is severe or recurring.

Post-Operative Considerations

Post-operative considerations for anterior shoulder instability include the type of surgery, the method of fixation, and the rehabilitation protocol.

Phase 1 and Phase 2 Rehabilitation

Phase 1 rehabilitation (0-6 weeks) focuses on inflammation control, pain management, and range of motion exercises.
Phase 2 rehabilitation (6-12 weeks) focuses on strengthening, proprioception, and functional activities.

Anterior Instability Rehab Precautions

Precautions for anterior instability rehabilitation include preventing poor scapulohumeral rhythm, preventing internal rotation contractures, and avoiding active dislocation.

Weight Training Modifications

Weight training modifications are necessary for patients with anterior shoulder instability, including avoiding heavy loads, using proper form, and incorporating exercises that strengthen the rotator cuff and scapular stabilizers.

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Description

This quiz covers the management and treatment of various shoulder injuries, including rotator cuff syndrome, GHJ instability, and osteoarthritis, as well as holistic and individualized intervention strategies. It also touches on the importance of biopsychosocial assessment and mental health.