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MDs may ask for a specific protocol. Here's a basic one, 3 phases, Goldestein's - the aims for each phase ...
- Phase I: restore alignment & muscle balance
- Phase II: good alignment + functional integration
- Phase III: good alignment, functional integration, + total body ("real life"activities and problem solving)
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4 ways a pt can do auto-mobilization (specifically on the shoulder) - name the motion, and then a method of doing it
- distraction: wrap a scarf around your foot, hold it in your hand, pull (pulley, strap)
- elevation: fingers climb up a wall - can bend knees for more stretch when arm's already up
- rotation: hold a towel behind your head, one arm pulls the other down
- DTM: bicipital tendon friction (to break up scar tissue and help it flow freely)
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2 intervention modalities in her notes
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things to focus on in the education portion of an intervention
- in the acute/painful stage: activity modification
- later: maintain the exercise program!
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hematoma/large bruise - should last how long?
4-7 days
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sprain should last how long?
24-72 h
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acute muscle strain (grades 2-3) w huge inflam + muscle tears, how long?
4-7 days
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bone break or torn tissue - how long?
- 21-45 days, up to 9 weeks
- (you can have pt do exercise at site or at least at prox + distal points)
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what's the sole bony strut connecting the shoulder girdle to the trunk?
clavicle
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SC joint is close packed where?
full elevation and shoulder protraction (per dutton & magee)
abd to 90 degrees (per Pivko)
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AC joint close packed pos
- 90 degrees abd
- (per dutton & magee)
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superior transverse ligament - where? does what?
- converts the scapular notch (medial to the base of the coracoid) into a foramen
- the suprascapular nerve runs thru this foramen
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costoclavicular lig - where?
holds the clavicle to the first rib, which is just inf to it, at their medial ends
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interclavicular lig - where?
connecting the sternal ends of both clavicles, and also attaching to the sup end of the manubrium
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two pars of the coracoclavicular lig
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basic dif btwn two parts of the coracoclavicular lig?
- conoid: is more medial, and tapers down to a narrow end
- trapezoid: lat to the conoid, guess its shape
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sternoclavicular ligament
connects the clav to the stern, running inferomed - it looks as tall as the clavicle
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subclavius attachments & action
- first rib & cartilage --> inferolat clavicle
- runs almost horizontally
- draw clavicle down
- elevate first rib
- stabilize SC jt
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pec major attch
Medial Half Of Clavicle, Sternum, Cartilage Of Ribs One Thru Six --> hum greater tubercle
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actions of pec major
- As A Whole: Adduct, Medially Rotate The Shoulder Joint,
- May Assist In Elevating The thorax in forced inspiration
- Upper Fibers: Flex, Medially Rotate, Horizontally Adduct The Shoulder Joint
- Lower Fibers: Extend, Adduct The Shoulder Joint
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sternohyoid muscle attch & act
- post med clavicle --> up to the hyoid bone
- depress the hyoid
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2 big players that pass right behind the clavicle, and therefore are at risk of damage if the clavicle gets jarred?
- brachial plexus
- subclavian artery
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what kind of joint is the SC? anatomically, mechanically, functionally?
- anatomically: complex - bc it has a disc!
- mechanically: bi-axial saddle jt
- functionally: ball and socket bc of a lax capsule & flexible disc
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__ subdivides the SC jt into 2 secondary cavities
the disk
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attachments of the SC jt disk?
- upper & post borders of the articular surface of the clavicle
- -->
- cartilage of the first rib, and circumferentially to the fibrous capsule
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describe the articular surface of the sternal end of the clavicle
and the cavicular facet of the manubrium?
- clavicle
- sup/inf: convex
- ant/post: concave
- manubrium
- sup/inf: concave
- ant/post: convex
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what surrounds the sternal end of the clavicle, with some fibers from SCM reinforcing it?
- jt capsule
- but it's lax enough to allow motion
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attachments of ant sternoclavicular lig
upper ant sternal end of clavicle --> upper part of manubrium & first costal cartilage
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attachments of posterior sternoclavicular lig
post aspect of sternal end of lig --> down and med to --> back of sup manubrium
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which SC lig has two laminae?
what are they?
which way do they run?
what's between them?
- costoclavicular
- anterior fibers: run superolat
- posterior fibers: run superomed
- there's a bursa between them
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degrees of freedom of the SC jt?
3
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what motions are usually paired in the SC jt?
- elevation & retraction
- depression & protraction (the slump)
debated btwn her and magee - she says it's the opposite of above, but that we're not looking at conjoint motions for now anyway
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clavicular elevation - how many degrees?
clavicular depression?
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pro/retraction at the SC jt - how many degrees?
15 in each direction
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rotation of clavicle about its own longitudinal axis - how many degrees?
30-50
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what kind of rotation do you get of the clavicle when you elevate your arm in any direction?
posterior
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SC jt restion pos?
arm at side
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capsular pattern at SC jt?
pain at extremes of range/motion
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what joints to include in passive movement testing?
- the joint, and
- the joints above and below the affected joint
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hand placement for passive movement testing, be cautious around what 3 areas?
- areas of tenderness
- unstable bony segments (recent fractures, ORIF, etc)
- osteoporosis
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strictly speaking, when you're doing inferior glide on the SC jt, what's the direction?
infero-lat
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how to do a SC sup glide
- thumb on inf clavicle, index on sup, press up and med
- other hand's thumb is medial to the first, on the joint line
- yr standing beside the pt, pushing up
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how to do SC mobs w pt seated
- pt's head resting against your arm & chest (else SCM will hold clavicle)
- pt seated in a "semi-reclined" position
- do thumb-on-thumb clavicular depression
- AP & PA glides w someone else holding the head
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what monitors the movement in the SC glides?
index finger
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angel btween scapular plane and clavicle?
should be 90 degrees
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