TherEx 2, second half

UE

shoulder mobility is related to mobility of what region of the spine?

thoracic

the lower thoracic spine _______ during bilateral _____ of the shoulder

extends, flexion

the lower thoracic spine _________ during unilateral ______ of the shoulder

sidebends contralaterally, abduction

the upper thoracic spine _______ during unilateral _________ of the shoulder

rotates contralaterally, abduction

what percentage of all shoulder issues are RCRSP?

about 60

why would a flaccid shoulder be painful?

due to weight on non-contractile structures

what is the most vulnerable position for the GHJ?

90 degrees of flexion with 90 degrees of ER

in GHJ instability, the humeral head is sliding _____ on the glenoid fossa over time, causing scapular ______ rotation

lower, downward

what is the grade A CPG for rotator cuff tendinopathy?

active rehab exercise, including motor control and/or resistance training

what are the 2 grade B CPGs for rotator cuff tendinopathy?

spinal/upper limb manipulation, and NOT using therapeutic ultrasound

what is the grade A CPG for adhesive capsulitis?

intra-articular corticosteroid injections combined with shoulder mobility and stretching exercises

what is the grade B CPG for adhesive capsulitis?

instruction in stretching exercises and activity modification

what tissues would you expect to be tight in a patient with GIRD?

posterior GHJ capsule, posterior RC muscles

what structures in the shoulder complex tend to be long and weak? (6)

rhomboids, middle trap, lower trap, teres minor, infraspinatus, posterior deltoid

when is stretching of pectoralis major contraindicated?

with anterior GHJ instability

when manually stretching pectoralis minor, how do you position the patient?

supine, humerus in ER, towel along thoracic spine

what force do you apply to stretch pectoralis minor and where?

posterior-lateral force through bilateral coracoid processes

how do you get into the right position of the head and neck to stretch the upper trap?

contralateral lateral flexion, ipsalateral rotation (look down), slight flexion (tuck chin)

how do you get into the right position of the head and neck to stretch the levator scapulae?

contralateral lateral flexion, contralateral rotation (look up), slight flexion (chin tuck)

what motion does the sleeper stretch improve? what does it stretch?

improves IR, stretches ERs and posterior capsule

the addition of ______(5 words)________ leads to improved mobilization (along with stretching)

instrument-assisted soft-tissue mobilization

what are 3 motor control exercises for the GHJ?

quadruped, humeral head centering, scapular setting with arm elevation

what are 2 compensations to the humeral head centering exercises?

use of latissimus dorsi, trunk lean

what are the 3 levels of scapular setting motor control?

first = just setting, second = add humeral elevation, third = add IR/ER

what 2 directions are you cueing for in a humeral head centering exercise?

posterior and inferior

pectoralis major contributes to (IR/ER)

IR

ER strength is approximately what percentage of IR strength?

75

what 3 exercises promote maximal muscle activity of the supraspinatus?

empty can (ABD with IR), full can (ABD with ER), prone horizontal ABD with ER

what exercise promotes maximal muscle activity of the infraspinatus?

standing ER at 0 degrees of ABD

what 2 exercises promote maximal muscle activity of the subscapularis?

shoulder flexion and push up plus

what exercise promotes maximal muscle activity of the teres minor?

standing or sidelying ER and 0 degrees of ABD

what muscle is the prime mover when pushing on the armrests of a chair?

latissimus dorsi

where does motion of the scapulothoracic articulation come from?

SC and AC joints

the SC joint provides what 4 motions of the scapula?

elevation, depression, protraction, retraction

the AC joint provides what 2 motions of the scapula?

IR and ER

the SC and AC joints together provide what motions of the scapula?

upward and downward rotation

what is the only muscle to provide protraction of the scapula?

serratus anterior

what 3 muscles perform scapular elevation?

upper trap, levator scap, rhomboids

what 3 muscles perform scapular depression?

lower trap, latissimus dorsi, pec minor

what 3 muscles perform scapular retraction?

middle trap, rhomboids, lower trap

what 3 muscles perform scapular upward rotation?

serratus anterior, lower trap, upper trap

what 2 muscles perform scapular downward rotation?

rhomboid major and minor

during elevation of the scapula, there is a _:_ ratio of GH:scap motion

2:1

when stretching the rhomboids, is it better to have the hands fixed externally or just by each other?

externally

what are 2 examples of stretching interventions for the thoracic spine?

thoracic rotation or extension

what 2 exercises are best at recruiting serratus anterior?

shoulder press and push up plus

what 2 exercises are best at recruiting lower trap?

prone abduction and prone flexion

what 3 exercises are best at recruiting middle trap?

one-arm row, prone abduction, prone flexion

what 3 exercises are best at recruiting upper trap?

shoulder press, prone abduction, prone flexion

when is motor control exercises for the scapula indicated? why?

when there is an absence of hypomobility or muscular deficit; you need adequate mobility and strength before working on control

what are 3 scapular motor control exercises?

scapular assistance, scapular clocks, PNF patterns

define scapular dyskinesia

altered position or movement of the scapula

what are 2 ways you may see the presentation of scapular dyskinesia?

early scapular elevation and scapular winging

what are the 6 factors as for scapular dyskinesia may occur?

neurological, joint derangement, bone, inflexibility, muscular, kinetic chain

scapular motor control exercises have been shown to also help with what 3 shoulder injuries?

impingement syndrome, full thickness rotator cuff tear, superior labral tear

what does a positive scapular assistance test look like?

if symptoms are reduced when the PT helps the patient move through shoulder ABD

what does a positive scapular assistance test mean?

presence of movement coordination deficits

what 4 exercises show high activation of middle and lower trap while minimizing use of upper trap?

sidelying ER, sidelying forward shoulder flexion, prone horizontal abduction with ER, prone shoulder extension

the inferior glide exercise primarily targets which muscles?

serratus anterior and lower trap

the low row exercise primarily targets which muscles?

serratus anterior and lower trap

the lawn mower exercise primarily targets which muscles?

serratus anterior, upper trap, lower trap

the robbery exercise primarily targets which muscles?

serratus anterior, upper trap, lower trap

what are 3 reasons that you may diagnose a scapular overuse injury?

postural deficits, sedentary job, recent increase/change in activity level

tennis elbow refers to what?

lateral elbow tendinopathy

golfer’s elbow refers to what?

medial elbow tendinopathy

"tommy john surgery” is to fix what?

ulnar collateral ligament

nursemaid’s elbow refers to what?

radial head subluxation

what are the A level CPGs for lateral elbow pain?

there are none! (yet)

what is the best B level CPG for lateral elbow pain?

use of isometric, concentric, and eccentric exercises of the wrist extensors

what is a C grade CPG for lateral elbow pain?

use of shoulder and scapular stablizer muscle training exercises

what are 4 other B level CPGs for lateral elbow pain?

wrist extensor strengthening, local elbow joint manipulation/mobilization, tendon/trigger point dry needling, rigid taping for short-term relief

what do most of the lateral elbow CPGs include?

modality use

what is the primary issue with cubital tunnel syndrome?

motor issues of hand intrinsics

what nerve is cubital tunnel syndrome compressing?

ulnar

what is the primary issue with radial tunnel syndrome?

pain

what is the primary issue with pronator syndrome?

numbness/tingling

what nerve is pronator syndrome compressing?

median under pronator teres

what is the B level CPG “do this” for carpal tunnel syndrome?

wearing a neutral wrist orthosis at night

what are the B level CPGs “do NOT do this” for carpal tunnel syndrome?

laser therapy, iontophoresis, magnets

true or false: no RCTs nor SRMAs were found reporting effectiveness of physical therapy for treatment of trigger finger nor Dupuytren disease, but some was found for De Quervain’s

true

De Quervain’s Disease is of what tendons?

thumb abductors and extensors

which range of motion in the elbow is more functionally important: flexion or extension

extension

define interaction torques

torques at a joint that arise from movements at other joints

overdrive of the (extensors/flexors) can affect the elbow motor control

both

what are 2 elbow intervention ideas?

task practice and accuracy

which muscle is the agonist for elbow flexion

brachialis

the biceps brachii assists with shoulder flexion between __ and _ degrees

0, 30

where is biceps brachii the strongest supinator?

at 90 degrees of elbow flexion

which head of the triceps is active with all extension motions?

medial head

when is the torque of the triceps greatest?

at 60 degrees of elbow flexion and 80-120 degrees of shoulder flexion

which torque is greater: supination or pronation

supination

wrist extensors have approximately what percentage of wrist flexor strength?

60

wrist ulnar deviators have approximately what percent of radial deviator strength?

75

what is the angle for peak wrist flexion torque?

40 degrees of flexion

what is the angle for peak wrist extension torque?

30 degrees of flexion to 70 degrees of extension

true or false: wrist resistance training improves both motor control and strength

true

power grips are used in more _____ activities, while precision grips are used in more ___ activities

high force, fine motor

in a flexor tendon repair, what motion should you avoid in the beginning?

wrist extension

when should you use flexor tendon blocking?

as a progression of flexor tendon gliding exercises

what are the 5 positions for finger flexor tendon gliding?

straight hand, hook fist, full fist, table top, straight fist