Impingement Syndrome & Tendons - Exam 3

Question 1

Subacromial Pain Syndrome aka (SAPS)
-a _______ of symptoms
-_____ % of all shoulder complaints

Answer 1

cluster
44-65%

Question 2

Pathomechanics #1:
The sub and coracoacromial space gets compromised resulting in

Answer 2

impingement or compression of tendons

Question 3

Pathomechanics #2:
Increases _______ on tendons when loaded and as they wrap the bone resulting in _______

Answer 3

tension; compression

Question 4

What is the most common structure involved in Impingement Syndrome?

Answer 4

supraspinatus tendon

Question 5

Impingement Syndrome:
Supraspinatus Tendon may ______ tear and limited vascularity in distal part affects _______
-tendinitis or tendinopathy?

Answer 5

gradually; healing
tendinopathy

Question 5

What is another tendon that is likely involved in impingement syndrome?
-tendinitis or tendinopathy?

Answer 5

biceps tendon - long head
tendinopathy

Question 6

Labrum may gradually tear in impingement syndrome and subacromial bursa will lead to bursitis? T or F

Answer 6

True

Question 7

1. With impingement syndrome, you are more likely to see what type of motion?

-Trauma with _________ changes
-_______________
–muscle/capusule shortening
–muscle inhibition

Answer 7

1. limited motion - hypomobility

-fibrotic capsular
-disuse/immobilization

Question 8

________ leads to shortened IRs/ant. capsule tightness and limits ER

Answer 8

persistent FHP

Question 9

Insufficient motion by shoulder mm. due to cervical dysfunction is known as:

Answer 9

regional interdependence

Question 10

With an impingement syndrome, you may get _____ or _____ of the acromion

Answer 10

spurring or hooking

Question 11

1. What are the SECONDARY etiologies/pathomechanics of impingement syndrome?

-trauma or ________ jt. hypomobility resulting in _____
-disuse/immobilization
–mm. _______
–limiting _______

Answer 11

1. excessive motion - hypermobility

adjacent joint ; laxity
–muscle inhibition
–limiting stabilization

Question 12

Regional Interdependence of SECONDARY etiologies/pathomechanics impingement syndrome?
-_______ shoulder stabilization
-________ impairment greatest at __________
-_________ > ___________ so emphasize _________

Answer 12

-insufficient
-proprioceptive ; higher elevation
-kinesthetic impairment > proprioceptive impairment; coordination

Question 13

What is an example of primary and secondary impingement syndrome etiologies and pathomechanics?

Answer 13

Scapular hypomobility and GH hypermobility

Question 14

______ impingement is MORE common in overhead athletes
-_____ ROM and _________ glide typically excessive
- location on labrum?

Answer 14

posterior superior glenoid impingement (PSGI)
-ER ROM; anterior GH glide
-superior glenoid on labrum

Question 15

P! is typically _______ to ______ and referred into ______ and _______ with impingement syndrome

Answer 15

localized; tip of shoulder; lateral shoulder and arm

Question 16

Pt. with impinging symptoms may include P! and/or limitation with:

Answer 16

elevation
lifting/pushing/pressing activities
reaching behind back

Question 17

Nociplastic P! may develop with impingement syndrome. T or F?

Answer 17

True

Question 18

Impingement Syndrome Signs Observation:
-possible ________ compensation for _________ restrictions
-_________ elevation
-inconsistent w/_________

Answer 18

Scapular compensation; GH
-increased
-upward rotation

Question 19

Symptom alteration tests are unreliable with scapula? T or F

Answer 19

false; reliable

Question 20

What are the 3 Scapular Alteration Test and others?
-details?

Answer 20

Scapular Assistance Test (SAT) - passive upward rot.
Scapular Repositioning Test- passive upward rot and pos. tilt
Scapular Retraction Test- voluntary retraction
Taping for LT assistance- reminder (short-term benefit)

Question 21

Impingement syndrome: Function
-limited and P!ful when:

Answer 21

limited and P!ful reaching overhead and behind the back, and with lifting

Question 22

Impingement syndrome: ROM
-most often limited and P!ful into:
-Post shd P! with ER indicates _________

Answer 22

flexion, abduction, external rotation, IR (maybe)
posterior impingement

Question 23

Resisted/MMT of impingement syndrome not ______ enough but will show

Answer 23

specific; inhibited scapular and RC muscles

Question 24

Proprioceptive impairment is greatest when?

Answer 24

at higher elevations

Question 25

The primary type of impingement regarding the joints is_________ -particularly______________ -________ is secondary type

Answer 25

limited motion/ hypomobile; -post shoulder tightness w/ limited post glide -hypermobility

Question 26

Limited ROM ALWAYS indicates limited accessory motion T or F

Answer 26

false

Question 27

What are the 3 specials tests for impingement syndrome?

Answer 27

GH IR deficit (GIRD) ratio Infraspinatus or ER test in 0º abduction IR resisted Strength Test

Question 28

Which of the following impingement special test is being described: -IR/ER at 90º abd >1 -ER typically increases as IR decreases in overhead athletes -Infucleneces humeral head position on glenoid

Answer 28

Glenohumeral IR deficit ratio (GIRD)

Question 29

Which of the following impingement special test is being described: -ER in 0º abd ---> P!ful or giving away -high specificity

Answer 29

Infraspinatus or ER test in 0º

Question 30

Which of the following impingement special test is being described: -IR weaker than ER @90º abd

Answer 30

IR resisted Strength Test

Question 31

Rotator Cuff pathology related to age- MOST affected and LEAST affected?

Answer 31

oldest age group 78% ; youngest age 32%

Question 32

RC pathology IS associated with impingement symptoms? T or F?

Answer 32

False

Question 33

You should not be misled by imaging (MRI): 14 _______ professional pitchers ______ years of age ____% had RC and labral changes

Answer 33

asymptomatic 18-22 80% * you can have changes without symptoms

Question 34

What are the characteristics of a tendon? (4)

Answer 34

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

Question 35

Tendons resist _____ and releases energy with _____

Answer 35

tension; muscle actions

Question 36

Tendon: More _______ = better ________

Answer 36

stiffness = better force transmission or storying of potential energy

Question 37

The mid-portion of the tendon is

Answer 37

hypovascular and hyponeural

Question 38

The insertion portion of the tendon is

Answer 38

hypervascular and hyper neural

Question 39

Tendinopathy prevalence: ______% of general MSK injuries ______% of sports injuries

Answer 39

30% 30-50%

Question 40

Tendinitis is common. T or F

Answer 40

False

Question 41

Inflammation of a tendon without structural change due to overuse is better known as_________

Answer 41

tendinitis

Question 42

What are S&S of tendinitis:

Answer 42

-a typically acute and classic presentation -TTP -P! and limiting with lengthening -P! with resisted testing/MMT, particularly in lengthened position- may be weak * tendon doesn’t like to be lengthened or used/resisted

Question 43

Tendinosis is the MOST common tendinopathy. T or F

Answer 43

True

Question 44

Degenerative changes with some inflammation due to: -repetitive stress and tendinitis -impingement pathomechanics -neural/vascular insufficiency -exercise-induced hyperthermia -older age -hormonal fluctuations

Answer 44

tendinosis

Question 45

If tendinosis is acute ________ S&S are present

Answer 45

tendinitis

Question 46

What are the symptoms of tendinosis: (2) -often mislabeled as ________

Answer 46

persistent (> 4-6 weeks) often with previously fail PT decreasing tendon tolerances -often mislabeled as tendinitis and treated as such

Question 47

Signs of tendinosis: observation: ROM:

Answer 47

enlarged tendon if superficial possibly P! and limitation with lengthening if aggravated but may be WNL

Question 48

Signs of Tendinosis: Resisted testing/MMT

Answer 48

possible P! and weakness, lengthened position if aggravated, but may be strong and P!-less

Question 49

Tendinosis special test will be: Palpation and Pathogenesis: -localized TTP with _________ P! thresholds -________in growth of vessels and nerves -________ P! neurotransmitters

Answer 49

(+) specific to region/tendon -decreased -Increased -Elevated

Question 50

Tendonosis has little to no ___________ and fibers changes can be seen on ________

Answer 50

inflammation; imagning

Question 51

Tendinosis Pathogenesis: ________ and _________may be present prior to tendinosis symptoms _____ and _____ likelihood of overload _______ non-collagen matrix ______infiltration

Answer 51

degeneration and disorganization weakened; greater increased fatty

Question 52

Acute tendon tear is common. T or F _______and ______ forces during fast eccentric loading Acute tendon tear more likely with ________ & ________ Elastin and vascularity _______ Shorter smaller tendon less _______ and ________

Answer 52

False; rare higher; oblique Age and disuse decrease pliable and durable

Question 53

Tendinitis primarily resolution of _________; at most in _________

Answer 53

inflammation; 4-6 weeks

Question 54

Tendinosis and Tears: -primarily __________ -tensile strength initially improves at ________ -even greater tensile strength when ___________ in at_________

Answer 54

proliferating tendon 3-5 wks. dense fibrous tissue; 8-12 wks.

Question 55

Partial tears and full tears of tendons can be improved with PT? T or F.

Answer 55

False: full tear requires Sx