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DPT 730/1: MSK > E3- Shoulder Impingement-Tendinosis > Flashcards

E3- Shoulder Impingement-Tendinosis Flashcards

1
Q

what is the functional ROM of the shoulder for washing hair in the shower

A

120 flexion for hair
70 flexion for trunk

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2
Q

what is the functional ROM for donning a shirt in the shoulder

A

90 flexion

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3
Q

what is the functional ROM for reaching high shelf in the shoulder

A

150 flexion

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4
Q

what is the functional ROM for fasten a bra behind back in the shoulder

A

50 + extension
70 horizontal ADD
full IR

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5
Q

what bones and jts move with the shoulder complex motion

A

scapula
humerus
clavicle
upper thoracic
SC
AC
GH
scapulothoracic

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6
Q

movement of the humerus is accompanied by what other movements

A

scapula
AC,SC, upper thoracic

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7
Q

what is important about companion motions

A

assists with optimal motion
prevent impingement
keeps actin and myosin overlap efficient

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8
Q

what is active insufficiency

A

so much overlap of muscle they can not wok properly

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9
Q

why does companion motion prevent active insufficiency

A

more force due to cross bridging

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10
Q

what humeral motions do you observe during 150 degree overhead

A

FLX
ABD
ER

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11
Q

what scapular motion do you observe with 150 degree overhead

A

protraction
elevation
upward RT

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12
Q

what are the eccentric controls of humerus with overhead movement to 150

A

EXT/ADD- post deltoid, lat dorsi, teres major, LH triceps, pec major
IR- subscapularis, pec major, lat dorsi, teres major, ant deltoid

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13
Q

what are the concentric controls of humerus with overhead movements to 150

A

FLX- ant/mid deltoid, coracobrachialis, bicep brachii
ABD-supraspinatus
ER- infraspinatus, teres minor, post deltoid

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14
Q

what are the concentric controls of scapula with overhead movements to 150

A

elevators- levator scapulae, upper trap, rhomboids
protractors- serratus anterior and pec minor
upward rotators- SA and U/L trap

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15
Q

what are eccentric controls of scapula with overhead movement to 150

A

depressors- LT, Lat dorsi, pec minor, subclavius
retractors- MT, LT, rhomboids
downward rotators

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16
Q

what is the result of sh. complex motion to 150 degrees due to the scapula

A

max tension on brachial plexus as clavicle rotates post

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17
Q

what is the motion, concentric and eccentric controls of the humerus with overhead motion to 200 degrees

A

same as 150

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18
Q

what is the motion of the scapula when reaching overhead between 150-200 deg

A

depression
retraction
post tilt - SC jt

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19
Q

what is the concentric and eccentric controls of the scapula when reaching overhead between 150-200 deg

A

same plus lower trap

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20
Q

what motion is the upper thoracic producing with reaching overhead in 150-200 deg

A

ipsilateral SB, RT, and EXT

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21
Q

why is unilateral motion of the upper thoracic spine important

A

triggers concenteric control of LT along with subclavius for scapula and clavicle motion
prevents tension on brachial plexus

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22
Q

what can happen if the upper thoracic has a unilateral restriction

A

GH and AC become hypermobile
inhibit LT activity leading to impaired scap motion

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23
Q

what can happen to the brachial plexus with an upper thoracic unilateral restriction

A

allows excessive post clavicle RT and excessive tension on med cord cutting off the median and ulnar n with overhead motion

misdiagnosed as TOS

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24
Q

what is the motion of humerus with reaching behind your back

A

hyper extension
add
ir

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25
Q

what is the motion of the scapula when reaching behind your back

A

elevation
downward RT
retraction

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26
Q

what are the concentric controls of the humerus when reaching behind your back

A

EXT/ADD- post deltoid, lat dorsi, teres major, LH triceps, pec major
IR- subscapularis, pec major, lat dorsi, teres major, ant deltoid

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27
Q

what are the eccentric controls of the humerus when reaching behind your back

A

FLX- ant/mid deltoid, coracobrachialis, bicep brachii
ABD-supraspinatus
ER- infraspinatus, teres minor, post deltoid

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28
Q

what are the concentric controls of the scapula when reaching behind your back

A

elevators- levator scapulae, upper trap, rhomboids
retractors- MT, LT, rhomboids
downward rotators

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29
Q

what are the eccentric controls of the scapula when reaching behind your back

A

depressors- LT, Lat dorsi, pec minor, subclavius
protractors- serratus anterior and pec minor
upward rotators- SA and U/L trap

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30
Q

which muscles in the shoulder complex would be inhibited and the most important focus

A

SITS
lower trap
rhomboids

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31
Q

how can we activate the RTC

A

tighter grip with activities
preposition the humerus in ER

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32
Q

what muscles are activated when we ER the humerus

A

lower trap
mid trap
rhomboids major and minor
levator scapulae

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33
Q

when does SA have most activation

A

closed chain activities

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34
Q

what TE can we do for more SA activation

A

wall slides - push the wall as we slide up
weight shifts
push ups
off/on unstable surface

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35
Q

why do I, T, W, Y in prone

A

eliminate the upper trap and isolate the shoulder muscles

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36
Q

why do both arms during MET exercise

A

more motor coordination activation with the uninjured UE

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37
Q

what has to happen to local m before higher level or global m happen

A

activation
endurance
strength
coordination

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38
Q

what are the benefits of cervical manip for sh complex

A

diminished pain
improve sh and neck mobility

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39
Q

what are the benefits of C5-6 JM for sh complex

A

immediate increase in m strength of ER

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40
Q

what are the benefits of C/T JM for sh complex

A

improved symptoms and function

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41
Q

why can cervical issues cause sh issues

A

regional interdependence- cervical dysfunction (innervation) can alter sh m activity due to shared innervation

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42
Q

what are 4 (+) for a good prognosis in sh issues

A

lower baseline
lower symptoms at rest
higher pt expectation
higher self efficacy despite symptoms

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43
Q

what is SAPS

A

subacromial pain syndrome

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44
Q

what is a syndrome

A

cluster of symptoms
does not indicate definitive signs or causes

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45
Q

what are the two most common structures that are impinged

A

supraspinatus and long head of bicep

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46
Q

how can the tendon develop tendinopathy

A

sub and coracromial space is compromised resulting in impingement or compression of tendon

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47
Q

what can happen with increased tension in an impingement

A

increased activation on tendons when loaded as they wrap around the bone can result in compression

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48
Q

what is the most common structure involved in impingement

A

supraspinatus tendon

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49
Q

what other structures are involved with impingement

A

long head bicep tendon
labrum
subacromial bursa

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50
Q

how can the subacromial bursa be affected with impingement

A

result of everything else causing inflammation and coming into the bursa

51
Q

what is primary impingement syndrome

A

limited motion

52
Q

how can persistent FHP cause primary impingement

A

leads to shortened IR/ant capsule that limits ER

53
Q

how can regional interdependence cause primary impingement

A

insufficient motion of sh m due to cervical dysfunction

54
Q

what can cause the spurring and hooking of the acromoin

A

inflammatory repair phase producing more fibrotic tissue due to the bone taking on more compression

55
Q

what is secondary impingement

A

excessive motion

56
Q

what can cause primary impingement

A

fibrotic capsular change
disuse/immobilization
persistent FHP
regional interdependence
spurring/hooking of acromion

57
Q

what can cause secondary impingement

A

trauma resulting in adjacent jt hypomobility
disuse/immobilization
regional interdependence

58
Q

how can regional interdependence cause secondary impingement

A

insufficient sh stabilization
proprioceptive impairment at higher elevation
motion is worse than proprioceptive impairment= more coordination

59
Q

can there be a combo of primary and secondary impingement

if so, how

A

yes
scapular hypo and GH hyper

60
Q

what is PSGI

A

post-sup glenoid impingement
more overhead athletes
ER and ant GH glide = excessive
impingement of post labrum = breakdown

61
Q

what can the pt tell you if they have impingement

A

pain at the tip and lateral shoulder
pain with reaching, lifting, pushing, pressing activities, and reaching behind back

62
Q

how would you know if nociplastic pain is occuring with impingement

A

how long the pain is occuring and sensation the pt is feeling

63
Q

what ob signs are with impingement

A

FHP
increased elevation due to UT compensating
inconsistent upward RT
scapular dyskinesia

64
Q

what are the scapula alteration test

A

help move scapual bc muscles are doing it
testing to see if function or symptoms change with help

65
Q

what is the scapular assistance test

A

passive upward RT

66
Q

what is scapular repositioning test

A

passive upward RT and post tilt

67
Q

what is the scapular retraction test

A

voluntary retraction

68
Q

what function/ROM signs are present with impingement

A

limited and painful reaching overhead and behind back and with lifting
painful into FLX, ABD, ER and possibly IR

69
Q

what does post sh pain indicate

A

posterior impingement

70
Q

what are RST/MMT signs with impingement

A

inhibited scapular and cuff muscles- ER is weaker
proprioceptive impairments

71
Q

what can happen with accessory motion in impingement

A

hypo=primary, post sh tightness with limited post glide
hyper= secondary

72
Q

what is glenohumeral IR deficit special test for impingement

A

IR/ER at 90 deg ABD > 1
ER increases and IR decreases in overhead athletes
influences humeral head position in glenoid

73
Q

what is infraspinatus or ER special test for impingement

A

in 0 ABD
painful or giving way
high spec

74
Q

what is IR restisted strength special test for impingement

A

IR weaker than ER at 90 deg ABD

75
Q

what does research say about imaging with impingement

A

pathology not associated with impingement symptoms

76
Q

what is tendon made of

A

type 1 collagen
low elastin
fibrocytes
parallel fibers for more unidirectional loads

77
Q

what does a tendon resist

A

tension and releases energy with muscle action

78
Q

why is stiffness better for a tendon

A

better force transmission or storing of potential energy

79
Q

describe mid portion of tendon

A

hypovascular
hyponeural

80
Q

describe insertion of tendon

A

hypervascular
hyperneural

81
Q

what is tendinitis

A

uncommon
inflammation of tendon without structural changes due to overuse

82
Q

what are the S&S of tendinitis

A

typically acute
TTP
pain with limitation with lengthening
pain with resisted testing/MMT, particularly in lengthened position- may be weak

83
Q

what is tendinosis

A

most common
degenerative changes with some inflammation

84
Q

what can cause tendinosis

A

repetitive stress and tendinitis
impingement patho
neural/vascular insufficiency
exercise induced hyperthermia
older age
hormonal fluctuations

85
Q

what are symptoms of tendinosis

A

persistent >4-6 wks often with failed PT
decreased tendon tolerance

86
Q

what can be found in a scan for tendinosis that is persistent

A

ob- enlarged tendon due to fat
ROM- WNL
RST/MMT- WNL
palpation - TTP

87
Q

why is tendinosis TTP

A

decreased pain thresholds
increased in growth of vessels and nerves
elevated pain neurotransmitters

88
Q

what is pathologically going on with tendinosis

A

little to no inflammation
fiber changes seen on imaging
corticospinal (voluntary movement)

89
Q

describe an acute tendon tear

A

rare
during fast eccentric loading
prior degeneration or tendinosis

90
Q

what can cause a persistent tendon tear

A

elastin and vascularity decrease
atrophy and drying
shorter/smaller tendon= less pliable and durable

91
Q

how can tendinitis be healed

A

POLICED
at most 4-6 wks

92
Q

what is the main goal of treating tendinosis

A

proliferating tendon

93
Q

when can we see initial tensile strength of tendinosis

A

3-5 wks

94
Q

when does dense connective tissue fill in with tendinosis/tear

A

8-12 wks

95
Q

how long does it take to see full strength with post op tendon tear

A

10-12 months

96
Q

how do we treat tendinopathy

A

Pt edu- load management
POLICED
modalities

97
Q

what can delay healing with tendinopathy

A

NSAIDS - if injury is at insertion

98
Q

how can NSAIDS help tendinopathy

A

short term pain relief if acute

99
Q

Why are NSAIDS have poor response to persistent tendinopathy

A

the problem is degeneration of the tendon not inflammation

100
Q

what does bracing/taping do for tendinopathy

A

decrease resistance arm

101
Q

how are modalities with tendinopathy

A

lack sufficient evidence

102
Q

how do we treat tendinosis

A

Pt edu
manual therapy
MET

103
Q

Pt asks if they should take anti-inflammatory since they are sore due to their tendinopathy, what is your response

A

soreness rule
if the mild pain increases during your exercise or up to 24 hours after activity and no change in movement quality

104
Q

what is the primary purpose of MET with tendinosis

A

tendon proliferation

105
Q

what are parameters for MET with tendinosis after acuity settles

A

heavy load
slower eccenteric
possible 3 sec muscle actions

106
Q

what are our sets and reps for the m that has tendinosis

A

2-3 sets of 10-15 reps to fatigue
2-3 exercises
8-12 wks
every other day
mild to mod pain - soreness rule!

107
Q

what are the precautions with heavy loads for tendinosis

A

deconditioned population
peri-pubescent population until growth plate fuses

108
Q

what are complication of healing with tendinosis

A

predisposition of failed healing response
obesity
diabetes
low grade inflammation

109
Q

why is obesity a complication of healing for tendinosis

A

excessive fat absorbs inflammatory cells away from tendon

110
Q

why is diabetes a complication of healing for tendinosis

A

excessive glucose impairs collagen production and remodeling

111
Q

why is a low grade inflammation a complication of healing for tendinosis

A

systemic disease and a poor diet
limits proliferation and remodeling

112
Q

what are MD Rx for tendons

A

cortisone injection - short term benefits
glycerin trinitrate patch
sclerosing injections - stiffen tendon for pain relief
surgical debridement

113
Q

what are the benefits for scapular taping in impingement syndome

A

improved short term pain
may provide window for MET and limit ADL provocation
no difference at 6 wks

114
Q

what are the research for JM for impingement syndrome

A

strong

115
Q

how does JM for thoracic spine benefit the sh

A

reduces pain
with added exercise it more more effective than exercise alone

116
Q

what is the MET parameters for the inhibited m that could have caused the overworked m to get tendinosis

A

3x30
want to recreate activation, coordination, endurance, and strength

117
Q

what is the most common region in the neck that gives sh pain

A

C5-6

118
Q

what can dysfunction with reaching overhead due to C5-6 cause

A

excessive recruitment of IR
inhibited and protective ER
imbalance of position and m activity limits optimal motion

119
Q

what can happen due to excessive IR recruitment because of C5-6 dysfunction

A

humeral head pulled ant of coracoid process
excess tension/compression on LHB could lead to tendinopathy
brings greater tubercle under the acromion

120
Q

what can happen due to inhibited ER because of C5-6 dysfunction

A

greater tubercle wont fully move out from under the acromion
impinged SS and LHB lead to tendinopathy

121
Q

what can dysfunction with reaching overhead due to C2-3 cause

A

excessive scapular elevators
inhibited and protective depressors
GH and AC jt compensation
imbalance of position and m activity limits optimal motion

122
Q

what can happen due to inhibited depressors in C2-3 dysfunction

A

scapula wont depress
impingement after 150
impinged SS and LHB

123
Q

why can impingement occur due to inhibited depressors from a C 2-3 dysfunction

A

depressors pull the scapula down and out of the way in the last bit of ROM

124
Q

what can happen due to excessive sh elevation from C2-3 dysfunction

A

scapula elevated or elevation
excess tension/compression on SS

DPT 730/1: MSK (11 decks)

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