module 2 readings: ACL protocol, thumb artho, adhesive capsulitis, shoulder jt conditions, wheelchair measurements

Flexor tendon repair (Hand): Splint position

Distal extremity immobilized 3-4 weeks with IP joints in 30°-50° flexion.

extensor tendon repair (Hand): Splint position

DIP joints immobilized in neutral for 6-8 wk; AROM at 6 wk with PIP joints in neutral; begin

with EXT

PIP joints immobilized with wrist and digits in EXT for 4 wk

AROM and PROM in FLX with MCP joint in EXT

Full AROM at 6 wk

Posterior THA precautions

Avoid hip flexion > 90°, adduction past neutral, and internal rotation past neutral.

WOMAC Index primary use

Outcome measure used for hip or knee osteoarthritis.

ACL Rehab: Pre-op primary focus

Restore full knee extension and prevent quadriceps atrophy.

ACL Rehab: OKC extension restriction

Avoid short-sitting OKC knee extension; stay strictly within 90°-45°.

ACL Rehab Phase 1: ROM goal

Achieve 0° to 110° of knee range of motion.

ACL Rehab Phase 1 to Phase 2 transition criteria

Knee muscle strength reaches 60% of the contralateral side.

Primary anatomical function of the ACL

Resists anterior translation and medial rotation of tibia on femur.

Meniscus repair: Weight-bearing protocol

Non-weight-bearing (NWB) for 3-6 weeks post-surgery.

Cemented TKR: ROM goals

0°-90° within 2 weeks; 0°-120° within 3-4 weeks.

Cemented TKR: Weight-bearing progression

WBAT with walker initially, cane at week 3, FWB at week 4.

Cemented TKR: Resisted exercises timeline

Initiate at weeks 2 and 3.

Uncemented TKR: WBAT progression

Walker initially, cane at weeks 5-6, FWB at week 6.

Uncemented TKR: TTWB progression

TTWB immediately, WBAT with walker at week 6, cane at 8-10 wk, FWB at week 10.

ACL Rehab: Post-op CPM progression

Immediately: 0°-70° FLX; Week 6: 0°-120°.

ACL Rehab: Hinged brace settings

20°-70°; wean off around weeks 2-4.

ACL Graft: Time of peak vulnerability

Weakest at week 6 post-surgery.

Partial Meniscectomy: Rehab timeline

Day 1: AROM; Day 3: Isotonic and isokinetic strengthening.

Meniscus Repair: Mobilizations and weight-bearing

NWB for 3-6 weeks with joint mobilizations.

ACL Reconstruction: Skeletal maturity importance

Greatest influence on a young girl's candidacy; lack of maturity is a contraindication.

ACL Graft: Necrotizing process timeline

Occurs in first 2-3 weeks before revascularization; progress exercises cautiously.

ACL Graft: Healing speed comparison

Bone-to-bone healing is faster than soft-tissue-to-bone healing.

ACL Graft: Hamstring tendon precaution

Use caution with knee flexor strengthening exercises.

ACL Graft: Patellar tendon precaution

Use caution with knee extensor strengthening exercises.

ACL Rehab: CKC quadriceps restriction

Avoid CKC quadriceps strengthening between 60° and 90° flexion.

ACL Functional Brace: Timeline and purpose

Used at 11-24 weeks for high-demand sports to reduce anterior translation.

thumb arthokinematics!

The thumb is a saddle joint, so it has two different planes.

■ Radial adduction (flexion) and radial abduction (extension)

● Concave on convex: distal concave moves on proximal convex (same direction)

● Radial adduction (flexion) = ulnar glide

● Radial abduction (extension) = radial glide

■ Palmar adduction and palmar abduction

● Convex on concave: distal convex moves on proximal concave (opposite direction)

● palmar adduction = volar (anterior) glide

● palmar abduction = dorsal (posterior) glide

■ Final Frontier's Rule of Thumb: This is how we roll!

● When we think of the rolling of the 1st digit, your first digit is giving you the answers.

➤ As we go into first-digit flexion (FLX), the first digit is pointing to the ulnar side of

your arm, telling you that it's an ulnar roll.

➤ As we go into first-digit extension (EXT), the first digit is pointing to the radial side

of your arm, telling you that it's a radial roll.

If you have trouble remembering which is first-digit EXT, think back to that

anatomical snuff box. One must do first-digit EXT to get it to be prominent.

➤ As we go into first-digit abduction (ABD), the first digit is creating a "V" (first and

second digits), telling you that it's rolling volar.

Figure 11. Convex concave rule: A) Roll and Slide in opposite direction B) Roll and Slide in same direction.

Book_5566_Ch03.indd 44 18-04-2024 22:05:55

Musculoskeletal Basics 45

➤ As we go into first-digit adduction (ADD), the first digit is coming into your hanD

(so you can slap this upcoming NPTE exam), telling you that it's rolling dorsal.

➤ First-digit FLX and EXT are both concave on convex, so roll and slide (glide) are

in the same direction.

➤ First-digit ABD and ADD are both convex on concave, so roll and slide (glide) are

in opposite directions.

Primary vs Secondary Adhesive Capsulitis

Primary is insidious (ages 40-60); Secondary follows RA, OA, trauma, or immobilization.

Adhesive Capsulitis: Stage 1 (Initial onset)

Gradual pain increase (present at night), loss of ER with intact rotator cuff (<3 months).

Adhesive Capsulitis: Stage 2 (Freezing)

Persistent intense pain at rest, motion limited in all directions (3-9 months).

Adhesive Capsulitis: Stage 3 (Frozen)

Pain only with movement, scapular substitution, deltoid/cuff atrophy (9-15 months).

Adhesive Capsulitis: Stage 4 (Thawing)

Minimal pain, no synovitis, capsular restrictions slowly improve (15-24+ months).

Adhesive Capsulitis Phase 1: Key interventions

Sling for rest, PROM in pain-free range, Grade I-II glides, pendulum exercises.

Adhesive Capsulitis Phase 1: Preferred glides

Posterior-inferior glide is best; posterior glide improves external rotation.

Adhesive Capsulitis Phase 2: Key interventions

Self-assistive ROM (wand/slides), Grade III-IV mobilizations, manual stretching, GH rotation strengthening.

Adhesive Capsulitis Phase 3: Key interventions

Stretching and strengthening exercises are progressed as the joint tissue tolerates.

▪ If capsular tissue is still restricting ROM, vigorous manual stretching and joint mobilization techniques are applied.

Adhesive Capsulitis: Highly irritable joint mobilization rule

If restriction-direction glide is intolerable, glide in opposite direction until irritability decreases.

stretching of the levator scapulae vs scalene vs SCM

levator: opp side flexion and rotation

scalene: extension, side bend of neck opp side and rotation to same side

SCM: opp side bend and same side rotation

rotator cuff tendinitis: what is it, common in age, what are charac?

Inflammation of RC tendons

due to impingement by

acromion

- Acute- 20-40 yrs

- Chronic - 30-70 yrs

Painful overhead

movements and Resisted

abduction

- Limited active abduction

(chronic- abduction &

flexion limited)

- Chronic- pain on passive

MR and LR at 90°

abduction

Rotator Cuff Rupture: Special tests, common age, and charac

Drop arm test and Empty can test. 40+

Pain with arm elevation

- Limited active abduction

and pain with/without

restriction depends on

partial or full tear

- Pain with resisted

abduction

- Passive range is full

without pain

Bicipital Tendinitis: Special tests, common age, charac,

Speed test and Yergason test.

- Age 20-45

- Repetitive overhead activity

- long head gets impinged

between bicipital groove

and anterior acromion

pain with overhead

movements

- pain with full extension to

flexion

- active LR is limited when

arm is at 90° abduction

- Passive shoulder and

elbow extension

combined painful

- Resisted elbow flexion is

painful

Subacromial Bursitis: Painful arc range,special tests

Painful arc occurs between 60° and 120° of abduction.Active abduction and MR

is limited

- Passive MR with 90°

shoulder abduction is

painful

hawkins kennedy and neer

Acromioclavicular Joint Sprain: Key sign & test

how does it usually happen?

Step deformity (3rd degree) at shoulder tip; Shear test.

- Fall on tip of shoulder or

outstretched arm

SICK Scapula: Special tests

SICK stand for and common in what age

Scapular assistance test and Scapular reposition test.

Scapular malposition

- Inferior medial border

prominence

- Coracoid pain and

malposition

- Kinesis abnormalities of

scapular movement

20-40 yrs

what muscles are strong vs weak for a swayback posture

inc pelvic inclination to 40

strong:hip extensors, lower lumbar extensors, upper abs

weak:hip flexors, lower abs, lower thoracic extensors

Wheelchair Posture (Sagittal): Pelvis position

Neutral to slight anterior tilt.

Wheelchair Posture (Sagittal): Hip flexion angle

Flexed 80° to 90°.

Wheelchair Posture (Sagittal): Knee and ankle angle

Flexed near 90°.

Wheelchair Posture (Frontal): Pelvis (ASIS) alignment

Level.

Wheelchair Posture (Frontal): Thigh position

Slight abduction.

Wheelchair Posture (Frontal): Lower leg orientation

Vertical with neutral hip rotation.

Wheelchair Posture (Transverse): Pelvis and trunk alignment

Not rotated.

Wheelchair Posture (Transverse): Knee alignment

Pointing forward with mild symmetrical abduction.

Wheelchair Measurement: Seat Height

How to measure: Heel → Popliteal fold + 2". Average: 19.5-20.5".

Wheelchair Measurement: Seat Depth

How to measure: Buttock → Popliteal fold − 2". Average: 16".

Wheelchair Measurement: Seat Width

How to measure: Widest buttocks/thighs + 1.5-2". Average: 18".

Wheelchair Measurement: Back Height

How to measure: Seat → Axilla − 4". Average: 16".

Wheelchair Measurement: Armrest Height

How to measure: Seat → Olecranon + 1". Average: 9".