Requested Topics for IST Redcar April 2012
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- Jemimah Green
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1 Requested Topics for IST Redcar April 2012 Rotator Cuff Tears Management Assessment & Management of ACJ Injuries Management of loss of ROM Hypermobile Adolescents Protocols & Classes at JCUH Distension
2 Cuff tears Decreasing force required to disrupt the rotator cuff fibers with increasing age. INCEASING AGE
3 AGE The single most important factor contributing to rotator cuff failure. In ASYMPTOMATIC individuals the incidence of.... Partial thickness tears 24% in age 40-60yr Full thickness tears 50% over 70 yrs 80% over 80 yrs
4 Function of the Rotator Cuff Movement - glenohumeral Compression hh on glenoid Centering hh on glenoid Sensorimotor control
5 Force Couples of the Rotator Cuff SST & Deltoid SSC & IST
6 Dysfunctional Cuff Migration of the hh by up to 8mm on initiation of abduction Significant increase in the pressure on SST (Thompson 1996, Wuelker et al 1994)
7 Rotator Cuff Tears Conservative Vs Surgical Patient/Clinical Knowledge/Experience/Research Evidence Fatty infiltration is an important prognostic indicatior following surgery (Goutallier et al 2003)
8 Evidence Very limited RCT s poor quality methodology Observational studies with mixed populations of patients with full thickness tears (little or no mention of size of tear) but does include massive rotator cuff tears (Ainsworth & Lewis 2007)
9 Conclusion Exercise therapy may have some benefit for patients with full thickness rotator cuff tears Worthwhile to consider exercise therapy for all rotator cuff tears but. Caution - evidence supports repair of traumatic rotator cuff tears demonstrate improved outcomes if repaired early.
10 Practical Posture GHJ Neutral Bear Hug Humeral head depressors ER Vs IR (13.7mmHg Vs 35.6mmHg) Body on Arm CKC
11 Acromioclavicular Joint Functional link between trunk and upper limb Allows additional scapula ROM Facilitates transmission of forces Protects neural and vascular structures degrees posterior rotation combined with simultaneous rotation of scapula Fibres of superior AC lig blend with fibres of deltoid and trapezius mm as they attach to the clavicle and acromion Deltoid and traps thus provide dynamic stability
12 ACJ Dislocation 12% of dislocations about the shoulder girdle Peak incidence in second and third decade
13 Mechanism of Injury Sports Injuries contact sports particularly rugby & mountain biking Direct fall onto the point of the shoulder with the arm in an adducted position Clavicle is stopped by the 1 st rib Downward force on the acromion (fracture, AC ligaments stretched (mild strain), AC tear & CC stressed (moderate stain), CC tear along with deltoid & trapezius detached from distal end of clavicle (complete dislocation).
14 Examination Localised Tenderness (staplike distribution/point) Deformity Increased AP translation Document Neurovascular Status Tests O Briens test/scarfe test/high Arc of pain
15 Differential diagnosis Cuff Disease (Power/impingement signs) Slap tears (Overuse e.g. overhead activities, Obrien test) Cervical Spine (Radicular pain, Spurlings Manouever)
16 Distal Clavicular Osteolysis Rare Weightlifters presenting with non-traumatic ACJ pain Managed with activity modification
17 Management of ACJ injuries Type l & ll Conservative Type lll Jury is out but non-operative would be appropriate for most patients However for those patients with a high demand on their shoulder consider referral for surgical opinion if not showing signs of improvement. Type lv, V & Vl surgical stabilisation of ACJ
18 Treatment Pain Modulation Regain SC ROM & mobility of ACJ Deltoid and upper traps to stabilise ACJ Restore rotator cuff function and scapula stability Degenerative ACJ Steroid/LA injection - Diagnostic & Therapeutic Surgical Intervention Traumatic Surgical stabilisation Degenerative Arthroscopic distal clavicle excision
19 Managing Loss of Movement Case studies SCJ GIRD MPI posterior dislocations RCA
20 Hypermobile adolescents Laxity Vs Instability Stanmore Classification type ll/lll Beighton Index Core Stability Sensorimotor Control - Balance/proprioception Kinetic chain
21 Assessment of the SMS Isokinetics/EMG/Video Analysis or Mirrors Clinic based tests Reproduction of passive positioning (Davies & Hoffman 1993) Contralateral limb mirroring Dynamic rotary stability test Dynamic relocation test CKC- 4 point kneeling progressively less stable
22 Sensorimotor system
23 TRX System & Flexibar
24 Body on shoulder
25 Scapular stability - Cools et al (2008)
26 Shoulder Classes at JCUH Hydrotherapy class Dry land class
27 Hydrostatic Distension Arthrographic = (imaging) distension/hydrodilatation Fluid (Saline, contrast, steroid, local anaesthetic & air) Quick/LA/Out-pt procedure Physically distending the capsule Appears safe transient pain Cochrane review few studies, different OM, using different comparison interventions, poor methodology, varying reporting of results limiting data extraction further studies!!!
28 THANKYOU FOR LISTENING Lorna Goodchild MSC, MMACP.
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