Impingement Syndrome & Tendons - Exam 3 Flashcards
Subacromial Pain Syndrome aka (SAPS)
-a _______ of symptoms
-_____ % of all shoulder complaints
cluster
44-65%
Pathomechanics #1:
The sub and coracoacromial space gets compromised resulting in
impingement or compression of tendons
Pathomechanics #2:
Increases _______ on tendons when loaded and as they wrap the bone resulting in _______
tension; compression
What is the most common structure involved in Impingement Syndrome?
supraspinatus tendon
Impingement Syndrome:
Supraspinatus Tendon may ______ tear and limited vascularity in distal part affects _______
-tendinitis or tendinopathy?
gradually; healing
tendinopathy
What is another tendon that is likely involved in impingement syndrome?
-tendinitis or tendinopathy?
biceps tendon - long head
tendinopathy
Labrum may gradually tear in impingement syndrome and subacromial bursa will lead to bursitis? T or F
True
- With impingement syndrome, you are more likely to see what type of motion?
-Trauma with _________ changes
-_______________
–muscle/capusule shortening
–muscle inhibition
- limited motion - hypomobility
-fibrotic capsular
-disuse/immobilization
________ leads to shortened IRs/ant. capsule tightness and limits ER
persistent FHP
Insufficient motion by shoulder mm. due to cervical dysfunction is known as:
regional interdependence
With an impingement syndrome, you may get _____ or _____ of the acromion
spurring or hooking
- What are the SECONDARY etiologies/pathomechanics of impingement syndrome?
-trauma or ________ jt. hypomobility resulting in _____
-disuse/immobilization
–mm. _______
–limiting _______
- excessive motion - hypermobility
adjacent joint ; laxity
–muscle inhibition
–limiting stabilization
Regional Interdependence of SECONDARY etiologies/pathomechanics impingement syndrome?
-_______ shoulder stabilization
-________ impairment greatest at __________
-_________ > ___________ so emphasize _________
-insufficient
-proprioceptive ; higher elevation
-kinesthetic impairment > proprioceptive impairment; coordination
What is an example of primary and secondary impingement syndrome etiologies and pathomechanics?
Scapular hypomobility and GH hypermobility
______ impingement is MORE common in overhead athletes
-_____ ROM and _________ glide typically excessive
- location on labrum?
posterior superior glenoid impingement (PSGI)
-ER ROM; anterior GH glide
-superior glenoid on labrum
P! is typically _______ to ______ and referred into ______ and _______ with impingement syndrome
localized; tip of shoulder; lateral shoulder and arm
Pt. with impinging symptoms may include P! and/or limitation with:
elevation
lifting/pushing/pressing activities
reaching behind back
Nociplastic P! may develop with impingement syndrome. T or F?
True
Impingement Syndrome Signs Observation:
-possible ________ compensation for _________ restrictions
-_________ elevation
-inconsistent w/_________
Scapular compensation; GH
-increased
-upward rotation
Symptom alteration tests are unreliable with scapula? T or F
false; reliable
What are the 3 Scapular Alteration Test and others?
-details?
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)
Impingement syndrome: Function
-limited and P!ful when:
limited and P!ful reaching overhead and behind the back, and with lifting
Impingement syndrome: ROM
-most often limited and P!ful into:
-Post shd P! with ER indicates _________
flexion, abduction, external rotation, IR (maybe)
posterior impingement
Resisted/MMT of impingement syndrome not ______ enough but will show
specific; inhibited scapular and RC muscles
Proprioceptive impairment is greatest when?
at higher elevations
The primary type of impingement regarding the joints is_________
-particularly______________
-________ is secondary type
limited motion/ hypomobile;
-post shoulder tightness w/ limited post glide
-hypermobility
Limited ROM ALWAYS indicates limited accessory motion T or F
false
What are the 3 specials tests for impingement syndrome?
GH IR deficit (GIRD) ratio
Infraspinatus or ER test in 0º abduction
IR resisted Strength Test
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
Glenohumeral IR deficit ratio (GIRD)
Which of the following impingement special test is being described:
-ER in 0º abd —> P!ful or giving away
-high specificity
Infraspinatus or ER test in 0º
Which of the following impingement special test is being described:
-IR weaker than ER @90º abd
IR resisted Strength Test
Rotator Cuff pathology related to age- MOST affected and LEAST affected?
oldest age group 78% ; youngest age 32%
RC pathology IS associated with impingement symptoms? T or F?
False
You should not be misled by imaging (MRI):
14 _______ professional pitchers
______ years of age
____% had RC and labral changes
asymptomatic
18-22
80%
- you can have changes without symptoms
What are the characteristics of a tendon? (4)
type I collagen
low elastin
fibrocytes
parallel fibers for more unidirectional loads
Tendons resist _____ and releases energy with _____
tension; muscle actions
Tendon:
More _______ = better ________
stiffness = better force transmission or storying of potential energy
The mid-portion of the tendon is
hypovascular and hyponeural
The insertion portion of the tendon is
hypervascular and hyper neural
Tendinopathy prevalence:
______% of general MSK injuries
______% of sports injuries
30%
30-50%
Tendinitis is common. T or F
False
Inflammation of a tendon without structural change due to overuse is better known as_________
tendinitis
What are S&S of tendinitis:
-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
Tendinosis is the MOST common tendinopathy. T or F
True
Degenerative changes with some inflammation due to:
-repetitive stress and tendinitis
-impingement pathomechanics
-neural/vascular insufficiency
-exercise-induced hyperthermia
-older age
-hormonal fluctuations
tendinosis
If tendinosis is acute ________ S&S are present
tendinitis
What are the symptoms of tendinosis: (2)
-often mislabeled as ________
persistent (> 4-6 weeks) often with previously fail PT
decreasing tendon tolerances
-often mislabeled as tendinitis and treated as such
Signs of tendinosis:
observation:
ROM:
enlarged tendon if superficial
possibly P! and limitation with lengthening if aggravated but may be WNL
Signs of Tendinosis:
Resisted testing/MMT
possible P! and weakness, lengthened position if aggravated, but may be strong and P!-less
Tendinosis special test will be:
Palpation and Pathogenesis:
-localized TTP with _________ P! thresholds
-________in growth of vessels and nerves
-________ P! neurotransmitters
(+) specific to region/tendon
-decreased
-Increased
-Elevated
Tendonosis has little to no ___________ and fibers changes can be seen on ________
inflammation; imagning
Tendinosis Pathogenesis:
________ and _________may be present prior to tendinosis symptoms
_____ and _____ likelihood of overload
_______ non-collagen matrix
______infiltration
degeneration and disorganization
weakened; greater
increased
fatty
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 ________
False; rare
higher; oblique
Age and disuse
decrease
pliable and durable
Tendinitis primarily resolution of _________; at most in _________
inflammation; 4-6 weeks
Tendinosis and Tears:
-primarily __________
-tensile strength initially improves at ________
-even greater tensile strength when ___________ in at_________
proliferating tendon
3-5 wks.
dense fibrous tissue; 8-12 wks.
Partial tears and full tears of tendons can be improved with PT? T or F.
False: full tear requires Sx
