CHAPTER 20 Shoulder

Question 1

Repetitive overhead lifting. Stress and friction result from crowding and compression of RTC tendons under the subacromial arch.

Answer 1

Rotator Cuff (RTC) Impingement

Question 2

____ joint has a lot of mobility and is unstable.

Answer 2

Glenohumeral

Question 3

Compression primarily of supraspinatus tendon as pass under coracoacromial ligament between acromion and coracoid process.

Answer 3

Primary Impingement

Question 4

GH instability creates reduced subacromial space because humeral head elevates.

Answer 4

Secondary Impingement

Question 5

___ most commonly affected tendon in impingement.

Answer 5

Supraspinatus

Question 6

Rehab of Primary and Secondary RTC Impingement

Answer 6

Decrease overhead activity. Control pain and swelling (ice massage). Stretching (Posterior Shoulder Capsule). Strengthening (External Rotators, Scapular Stabilizers). Strengthen, Stabilize Scapulothoracic Musculature First. Address RTC Weakness Next (External Rotators).

Question 7

Degenerative changes decrease subacromial space. Bony osteophyte formation occupy space under anteroinferior surface of the acromion decreases space.

Answer 7

Other causes of Subacromial Rotator Cuff (RTC) Impingement

Question 8

Early or Acute Phase. 6 weeks. Codman’s (Pendulum) Exercises within first weeks to restore mobility and stimulate mechanoreceptors. With small tears - submax isometrics as tolerated. PROM - pulleys.

Answer 8

RTC Repair Rehab Phase 1

Question 9

Intermediate Phase. 7-12 weeks. Progressive ROM with caution of repetitive shoulder abduction and forward flex above 90 degrees. Scapular stabilization exercises. Resistive theraband for progressive strengthening of RTC below 90 degrees.

Answer 9

RTC Repair Rehab Phase II

Question 10

No AROM or active strengthening for 3-4 months. Immobilization is key. PROM with restrictions. Codman’s pendulum exercises and gentle AAROM may begin 3 months post op. Submax isometrics and scapular stabilization may be added cautiously 2-4 months after surgery. Full function and recovery may take 10 months.

Answer 10

Massive RTC Tears

Question 11

For anterior dislocation avoid

Answer 11

Abduction, External Rotation

Question 12

Stage 1 Freezing Stage

Answer 12

Slow onset of pain and decreased ROM.

Question 13

Stage 2 Frozen Stage

Answer 13

Slow improvement in pain, but the stiffness remains.