5010 - Exam 3

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Biophysical agents

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154 Terms

1

Biophysical agents

modalities, physical agents, energy applied to pt to assist rehab, heat/cold/water/sound/electricity

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2

3 categories of biophysical agents

thermal, mechanical, electromagnetic

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3

Hot packs are what mode of heat transfer

conduction

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4

Ice massage is what mode of heat transfer

convection

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5

Physiological effects of heating tissue for MMT

MMT prior to or more than 2 hours after heat application

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6

Temp of tissue for theraputic effects

104-113

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7

5 potential contraindications for biophysical agents

pregnancy, malignancy, pacemaker/electronic deivce, impaired sensation, impaired mentation

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8

When should strength testing be done for cooling tissue

only prior to cold application

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9

Adverse signs of response to cryotherapy

wheeling, syncope

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10

3 categories of biophysical agents

thermal (US, hot pack), mechanical (traction, whirlpool), electromagnetic (laser, TENS)

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11

APTA statement on physical agents

utilized only as component of patient/client management (use with other interventions and NOT alone)

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12

How long after applying hot pack should you check on the patient

10 minutes

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13

How long should a hotpack be on for

20-25 minutes

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14

How long should a coldpack be on for

15-20 min (don’t want frostbite)

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15

Vasodiliation

HR decrease and BP decrease

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16

Vasoconstriction

HR increase and BP increase

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17

Adverse response to cold

wheels, redness, swelling, face flush, decrease BP, increase pulse, fainting

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18

Hot pack amount (ex: prone)

6-8

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19

Hot pack amount (ex: supine)

10-12

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20

Scapular Dyskinesis Type I

inferior angle dysfunction — angle more prominent due to anterior tilting —> correlated with subacromial impingement or RC dysfunction

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21

Scapular Dyskinesis Type II

medial border dysfunction — border prominance —> due to IR of scap secondary to weak rhomboids and serratus

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22

Scapular Dyskinesis Type III

excessive elevation of superior border vs upward rotation of scap —> RC pathology or adhesive capsulitis

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23

Lower trap exercises

low row, lawn mower, standing W, wall slide with lift off

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24

lower trap exercise advanced

Progression

  1. prone row

  2. prone horiz ABD/prone T

  3. prone 90/90 ER

  4. superman/prone Y

** other: seated pike/press up

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25

mid trap/rhomboid exercises

Progression

  1. prone 90/90 ER

  2. prone row

  3. prone H ABD/prone T,

  4. superman/prone Y

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26

serratus anterior

prone 90/90 ER, ceiling pounch, scap plane elevation, dynamic hug 90 and 120, push up plus, wheelbarrow

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27

infraspinatus/teres minor

standing (base) ER, sidelying ER, standing 90/90 ER, prone 90/90 ER, standing 90/90 ER windshield wiper

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supraspinatus

standing (base) ER, sidelying ER, scap plane elevation 80 and 120, prone 90/90 ER, prone Y

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29

subscapularis

belly press, standing base IR, standing 90/90 IR

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30

GIRD

glenohumeral internal rotation deficit —> lack of GH IR

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31

GIRD degree loss

>20 degree of dominate side IR OR >5 degree loss total arc of motion on dominate side

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32

GIRD causes

  1. humeral retroversion

  2. post GH jt capsule tightness

  3. post RC muscle tightness/stiffness (IS and TM)

  4. acute post RC muscle stiffness (IS and TM)

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33

glenohumeral retroversion (HRV)

bony torsion (twist) in shaft of humerus — HH turned posterior on glenoid

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34

throwing exposure does what to de-rotation

slows

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35

if there is an increase in HRV, what happens to ER and IR

ER has more ROM and IR has less ROM

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36

A loss in IR for HRV means what for ER

gain in ER — bony issue only

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37

Total arc of motion is what

IR ROM + ER ROM (both supine)

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38

if total arc is = dom vs non dom

anatomic GIRD (DO NOT TREAT)

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39

if dominate shld total arc is < 5 degree

pathological GIRD (can treat)

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40

Is posterior RC tightness/stiff is a greater factor than posterior capsule tightness in pathologic gird?

YES

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41

What is frozen shoulder

inflammation of shoulder from subacromial pain syndrome, small tear, or other trauma

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42

Why do people not move their shoulder with frozen shoulder?

Because of pain

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43

Frozen shoulder capsule becomes…

thickened and fibrotic — fixed to humeral head = capsular stiffness

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44

frozen shoulder capsular pattern

ER > ABD > IR (most common)

ER > FLEX > IR

EER > Elevation > IR

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45

primary frozen shoulder (idiopathic)

no known cause

insidious onset

40-65 y.o

F>M

diabetes or thyroid history

obesity

resolves in 15-24 months

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46

Risk factors for idiopathic frozen shoulder

prolonged immobilization

prolonged disuse

myocardial infarction

autoimmune disease

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47

secondary frozen shoulder

AC that “sees you”

secondary to trauma

faster prognosis

smaller capsular pattern

50% loss

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48

capsular pattern is based on what?

% loss of ER > Flex/ABD > IR

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49

frozen shoulder exam pearls

spend time with ROM —> can be false positives

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50

how many stages are there in frozen shoulder

4 stages

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51

Stage 1 frozen shoulder

inflammation in shld

painful loss of ROM - no PROM

“pre-adhesive” stage

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52

Stage 2 of frozen shoulder

“freezing” or pain stage

pain with AROM and PROM (more than AROM) with empty feel (7/8-10)

synovium red and angry

3-9 months

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53

Stage 3 frozen shoulder

“frozen” stage

very little synovitis

loss of motion/impaired function

PROM = AROM

pain @ end range with firm end feel (4-6)

4-12 months

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54

Stage 4 frozen shoulder

“thawing” stage

very little pain (0-3)

AROM = PROM

significant stiffness, firm end feel

no synovial reaction

gradual return to motion

muscle weakness

12-24+ months

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55

CPG (A level evidence)

corticosteroid injection (CSI)

pain and muscle guarding as primary limit to motion

immediate improvements in pain and ROM after injection

use in FREEZING phase

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56

CPG (B level evidence)

patient education on natural courses of disease

modify activities

match intensity of stretching protocol to irritability

do stretching exercises (diff in diff stages)

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57

Freezing stage intervention

*caution — irritable tissue will stiffen further

low grade joint mobs

maintain, don’t gain

scap mobs, soft tissue norm

modify activities: open pack position

pendulum exercises

pain relieving modalities

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58

frozen stage intervention

LLLD

— 5” for 24x up to 30” for 4x

aggressive capsular stretching

PT 1x week for 2-3 weeks

daily exercises

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59

thawing stage intervention

aggressive stretching

LLD stretching

strength more important for AROM-PROM differences

daily stretching

strength 3x week

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60

CPG (c level evidence)

modalities (estem, diathermy) to augment stretching

joint mobs

manipuation under anesthesia

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61

discharge criteria for frozen shoulder

pt is out of frozen stage

independent HEP

no improvements with manual interventions

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62

elbow traumatic injuries

MVA

collision/impact

FOOSH (fall out on stretched hand)

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63

post elbow injury consideration

overly aggressive stretch/mobs/manipulation to elbow

anterior capsule of elbow is very thin

brachialis passes over capsule = bleeding from trauma cause capsular scarring

bleeding can lead to fibroplasia, calcification, myositis ossificans

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64

outcomes of elbow injury

pain

ROM (elbow, forearm)

strength (elbow, grip)

functional ADL’s

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65

elbow injury intervention

modalities as indicated

PROM, AROM, stretching (don’t be too aggressive)

joint mobs/manipulation (when safe)

dynamic splinting

strengthening (once ROM improved and trauma healed more)

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66

instability is?

state of being unstable, lack of stability or firmness

behave in unpredictable, changeable, or erratic matter

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67

laxity is?

state or quality of being loose

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68

laxity in shoulder

one’s genetic predisposition of tissue elasticity

no pain

common: high beighton index

rare: marfan’s syndrome

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69

instability in shoulder

painful hypermobility

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70

causees for instability in shoulder

born loose: poor dynamic stability in genetic laxity

worn loose: repetitive overuse, wear out

torn loose: traumatic incident (MVA)

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71

instability spectrum

born loose = AMBRI - congenital

worn loose = SLAP tear - repetetive stress

torn loose = TUBS - traumatic

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72

anterior dislocation clock position

3-6

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73

posterior dislocation clock position

6-9

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74

SLAP tear clock position

10-2

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75

classification of shoulder instability

direction: anterior, posterior, inferior, MDI

etiology: traumatic vs atraumatic

degree: dislocation, subluxation, apprehension

frequency: acute, recurrent, chronic

volition: voluntary vs involuntary

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76

anterior shoulder instability (direction)

90% cases is anterior instability

cause anteroinferior translation

MOI traumatic, FOOSH in ER+ABD, forced position

may cause boney bankart (anteroinferior glenoid rim) or hill sachs (posterior humeral head impaction fracture)

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77

posterior shoulder instability (direction)

1-5%

MOI repetetive or traumatic

forceful axial loading

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78

multidirectional shoulder instability (direction)

2 directions of instability

pain w/2+ directions

inferior instability

atraumatic, overuse

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79

superior shoulder instability (direction)

SLAP tear, superior labrum insufficient

worn loose

MOI quick traction overload

peel back

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80

arthrokinematics for shoulder instability (caution with)

anterior: ER, EXT, HOR ABD, combo of movements

posterior: IR, hyperflex, flex w/axial load, UE weight bearing

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81

AMBRI

atraumatic, multidirectional, bilateral, rehabilitation, inferior capsular shift

“born loose”

high beighton index

genetic collagen disorder

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82

TUBS

traumatic, unilateral, bankart, surgery (indicated)

“torn loose”

traumatic injury

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83

repetetive overuse

“worn loose”

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84

shoulder dislocation degree

humeral head displaced completely from glenoid rim

may cause bony injury to HH or glenoid

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85

shoulder subluxation degree

HH partially displaced from glenoid

shifting or clunking at injury

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86

shoulder apprehension degree

reservations about putting arm into certain positions

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87

frequency of shoulder instability

acute: recent traumatic incident

recurrent:" has history, or another event, <20 yo = 90% and >40 yo 10%

chronic: history with no recent events, pain or secondary dysfunction

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88

shoulder instability volition

voluntary: hypermobile, no trauma history, born loose

involuntary: dislocate/sublux at night, serial recurrent, bone loss

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89

shoulder instability examination

initial injury: MOI, DOI, direction, degree

pain: location, intensity

medical management: ATC/MD reduce, past history

current symptoms (SINSS): severity, irritability, nature, stage, stability

goal setting: preference, experience

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90

examination: observation

clinical assessment: med screen

functional test: beighton, 5 item hypermob history (yes to 2 or more = extra point for beighton)

observation: scar, skin extensibility

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91

examination: tests

AROM: guarding, side to side, scap dyskinesia

strength: RIMS, MMT, dynamometry

PROM: track and measure over time, tolerance

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92

examination: special tests

anterior instability: apprehension, relocation, load and shift

MDI: sulcus sign

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93

examination: diagnostic imaging

x-ray, CT, MRI

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94

evaluation: shoulder instability

diagnosis: ex - connective tissue issue, poor strength/stability

prognosis: ex: low likelyhood, bony, pain, inflammation, recurrent, neuro

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95

shoulder instability: surgery or no

15-25: acute repair best to decrease chance of recurrence

25-40: conservative care

40+ conservative care (10-15% recurrence)

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96

shoulder instability: conservative treatment

phase 1: tissue protection and ROM

phase 2: muscular endurance, rhythmic stabilization, beginner strength

phase 3: progressive strengthening, stability, motor conrol

phase 4: plyometric and advanced programming

phase 5: return to sport

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97

the big 4 exercise programming

RC strength

periscapular strength

advanced proprioceptive training

core strengthening

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98

SAPS is…

subacromial pain syndrome

  • non-traumatic, unilateral, pain around acromion w/lifting

  • bursitis, tendinosis, supraspinatus tendinopathy, partial tear of RC, biceps tendinitis, etc.

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99

stages of SAPS

stage 1: tendinitis - acute inflammatory condition

stage 2: tendinosis - repetitive impingement

stage 3: partial or full thickness RC tear

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100

slop of acromion process

type 1: flat

type 2: curved

type 3: hooked

**leads to acromial plasty to make acromion more flat

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