DPT 754 Shoulder pathology and assessment 3

Most common MOI for clavicular fx

Typically a fall

Most common area of clavicle for fx

Midshaft

Associated injuries w clavicular fx (3)

Scapular or rib fx

Pneumothorax

Neurovascular compromise

Therapeutic goals for clavicular fx

Minimize risk of nonunion and malunion of bone

Typical population for proximal humeral fx (2 groups)

Children (skeletally immature): Traction of epiphyseal plate

Elderly pts, esp those w osteoporosis

Common MOI for proximal humeral fx (2)

FOOSH

Direct blow to lateral shoulder

Define adhesive capsulitis

Condition w thickening and inflammation in shoulder joint capsule

Classic symptoms of adhesive capsulitis (3)

Positive shrug sign

Decreased ER ROM

Painful to move

Prevalent populations for adhesive capsulitis (3)

Women

Ages 40-65 yo

Diabetics

Symptoms of adhesive capsulitis (4)

Night pain

Pain w movement

Discomfort lying on affected shoulder

Loss of PROM and AROM

Define primary adhesive capsulitis

Adhesive capsulitis independent of all other pathologies

Define secondary adhesive capsulitis

Adhesive capsulitis that occurs after trauma or another condition.

Divided into 3 groups

Causes of systemic adhesive capsulitis (2)

Diabetes

Hypothyroid disease

Causes of extrinsic adhesive capsulitis

Things outside shoulder joint, like CVA, MI, cervical disc disease, etc

Causes of intrinsic adhesive capsulitis

Things within shoulder joint, like RTC tear or labral tear

What is the capsular pattern for shoulder loss of ROM d/t adhesive capsulitis?

Greatest loss in ER -> abduction -> IR

Name the phases of adhesive capsulitis (just names) (4)

Pre-freeze

Freezing stage

Frozen stage

Thawing phase

Symptoms + timeline for pre-freeze stage of adhesive capsulitis

0-3 mos

Pain and early ER loss

Symptoms + timeline for freezing stage of adhesive capsulitis

Pain and loss of ROM

3-9 mos

Symptoms + timeline for frozen stage of adhesive capsulitis

Motion restrictions

9-15 mos

Symptoms + timeline for thawing stage of adhesive capsulitis

Resolving pain w stiffness

15-24 mos

Effect of aggressive PT in freezing stage of adhesive capsulitis

May prolong course of recovery

How to control pain sensations in adhesive capsulitis?

Central sensitization

How is bursitis different from adhesive capsulitis? (2)

Bursitis has more PROM

Palpation of subacromial space causes pain in bursitis

How is Parsonage-Turner syndrome (acute brachial radiculitis) different from adhesive capsulitis? (2)

PTS causes inflammation of brachial plexus

PTS causes neuro problems (atrophy, weakness, numbness)

How are RTC tears different from adhesive capsulitis?

RTC tears don't show ROM restrictions in a capsular pattern

How are posterior dislocations different from adhesive capsulitis?

Posterior dislocations involve a specific, traumatic event