Chronic Shoulder

Question 1

subacromial impingement
1. faulty mechanics
2. associated sports
3. structures affected
4. clinical presentation

Answer 1

1. alt scapulohumeral kinematics (insufficient superior rot and post tilt), glenohumeral instability due to excessive anterior superior translation of humerus (due to dislocation or weak rotator cuffs)
2. faulty mechanics combined with repetitive and fast motion in overhead sports compromises subacromial space and pinches structures located there
3. subacromial bursa which protects supraspinatus inflamed (bursitis), supraspinatus tendinopathy, and long head bicep tendinopathy since all three run under acromion
4. intermittent to continuous pain aggravated in impingement post (mid ROM), location of pain depends on structure affected, painful during over head flex and abduct but also painful during ECC motion for tendinopathy (ext/add)

Question 2

shoulder mechanics and impingement when raising arm

Answer 2

1. raising arm >45 deg abduct/flex require highly coordinated motion between scapula and humerus with 2:1 ratio of GH:scapula ratio
2. scapula must sup rot (abduct), post tilt (flex), retract and humerus must ext rot and stay centred in glenoid fossa to elevate the shoulder girdle
3. altered kinetics can lead to pinching of structures (impingement)

Question 3

posterior internal impingement
1. faulty mechanics
2. structures affected
3. associated sport
4. clinical presentation

Answer 3

1. posterior superior rim of glenoid fossa and greater tuberosity of humerus pinching deep surface of tissues, due to excessive scapular protraction (used to keep GH when unstable in place when retracting) and extensive GH crossext, GH instability, and low internal rot GH (1.5 OR for PII if glenohumeral internal rotation deficiency > 10 deg) when shoulder is abducted and ext rot to extreme ranges
2. supraspinatus, infraspinatus, post and superior glenoid labrum (SLAP lesion)
3. throwing sports
4. intermittent to continuous pain, pain on posterior, clicking may mean labrum dmg, painful on deaccelaration of swing when ECC contract rotator cuff to prevent internal rot and

Question 4

OSTRC shoulder injury prevention 5 exercises (week 1-6)
1. exercise
2. body pos
3. purpose
4. type of impingement effected

Answer 4

1. trunk rot, elbow plank pos to side plank pos through trunk rot, strengthen and increase ROM of trunk rotators to improve capacity of bringing arm bck without excessive cross ext or ant humeral translation for PII
2. standing Y flys, standing with elastic tied at abdomen level, pull elastics overhead in Y pos with elbows fully ext, strengthen LFT to inrease superior rotation of scapula for SAI
3. trunk rotation, hands and knees to side plank pos through trunk rot, strengthen and increase ROM of trunk rotators to improve capacity of bringing arm bck without excessive cross ext or ant humeral translation for PII
4. sleeper stretch, side lying pos, arm slightly below 90 deg shoulder flex, push shoulder into internal rotation to reduce GIRD for PII
5. ext rot, standing with 90 deg abduction and elbow flex and weight in hand as resistance, ext rot to 90 deg, strengthen ext rot (SIT) and limit superior translation of humerus for PII