Impingement Syndrome & Frozen Shoulder Flashcards
What are the 3 main tests for for Impingement that, when done together, have great Sensitivity and Specificity for impingement syndrome?
- Neers Impingement Test
- Hawkins Kennedy
- Painful Arc Test
How do you perform a Neers Impingement Test? What is a positive test?
- Pt. supine with arm at side
- Raise arm in full flexion in ER.
- Raise arm in full flexion in IR.
A positive test has pain that increases with IR.
How do you perform a Hawkins Kennedy Test. What is a positive test?
- Pt. supine or standing with arm flexed to 90° and elbow at 90°.
- Take wrist and internally rotate the shoulder while telling pt. to resist your motion.
A positive test is reproduction of the pt’s pain.
How do you perform a painful arc test?
What is a positive test for impingement?
What is a positive test for AC joint issues?
- Pt. standing
- Raises arm in abduction (scaption & flexion).
A positive test for impingement is reproduction of pain from 60 to 120°.
A positive test for AC join issues is increasing pain as arm as you reach closer to 180°.
Also, you can do empty can at same time by putting arm in IR then ER (pain greater in IR than ER is +)
How do you perform an Internal Rotation Resistance Stress Test (IRRST). What does it test?
- Pt. sitting
- Put arm at 90/90 position
- Isometrically resist ER and then IR.
Diff Dx. between subacromial and internal impingement.
If IR is weaker than ER, then that is a positive sign of internal impingement.
How do you perform an External Rotation Lag Sign (ERLS) test? Explain positive signs & stuff.
- Pt. sitting with arm at 20° of scaption with therapist stabilizing elbow.
- Therapist puts arm in ext. rotation to end range then lets go as pt. tries to hold position.
A lag forward into int. rotation 5° or less indicates a small supra/infraspinatous tear, greater than ° indicates a larger tear.
How do you do a drop arm test? What is it testing? What is a positive?
- Pt. seated or standing
- Pt. puts arm at 90° abd. then releases arm, telling pt. to lower arm slowly and deliberately.
It is testing for a supraspinatous tear.
A positive would be if pt. is unable to lower this on their own and arm drops OR if they compensate by shrugging or leaning or something.
How do you perform a Lift off test? What is it testing? How can you modify it (2 ways)?
- Pt. seated or standing
- Pt. puts hand behind low back and tries to lift off hand backwards with resistance.
Inability to lift hand off back indicates a full thickness subscapularis tear.
Modified by holding hand off back and telling pt. to to not allow it to fall toward the low back or by having them do a belly press (if they lack IR).
What are the 3 stages of Frozen Shoulder?
- Painful for Freezing Phase
- Stiffening or Frozen Phase
- Thawing Phase
Stage 1 of Frozen Shoulder:
- More common in men or women?
- More common in dominant or non-dominant arm?
- Pain level (scale of 1-10)?
- What dermatome most affected?
- Main goal of treatment in this stage?
- Contraindications during this stage?
- women
- non-dominant arm
- 8-10/10
- C5 (ant. shoulder/arm)
- Get rid of inflammation ASAP
- Higher grade mobs of shoulder
Stage 2-3 of Frozen Shoulder:
- More or less pain than Stage 1?
- Pain in shoulder to elbow or just shoulder?
- Tx: heat or ice?
- Tx: Can you use mobs?
- Should you do mobs forward or backward through capsular pattern?
- Less
- Just in the shoulder
- Heat
- low grade ones, yes.
- backward (flex then IR then abd. then ER)
Neer’s Stages of Impingement. What are they? What ages do they usually effect?
Stage I: Edema and Hemorrage - <25 years old
Stage II: Tendonitis/Tendonosis, bursitis, fibrosis - 25–40 years old
Stage III: Bone spurs and possible tendon disruption - Over 40 years old.
Stage I of Impingement:
- Resisted tests?
- Impingement tests + or -?
- ROM restrictions?
- Treatment (4 things)?
- strong and painful
- +
- none usually, just painful arc of movement
- Reduce and eliminate inflammation, pt education, rest from painful activity, restore proximal periscapular control.
Stage II of Impingement:
- ROM restrictions?
- More or less pain than stage I?
- Treatment?
- Capsular pattern of restriction
- More pain
- Same things from Stage I, plus reestablish GH capsular mobility, especially post. and inf. tightness to prevent ant. and sup. humeral head migration.
Stage III of Impingement:
- Weakness anywhere?
- What does treatment depend on?
- Yes, in abduction and ER
2. Depends on the size of the tear.
