Lecture 9, Impingement Flashcards
Subacromial Impingement
compression and mechanical abrasion of rotator cuff tendons, subacromial bursae, long head of the biceps tendon beneath the acromion/AC joint
Intrinsic impingement
compromise in the integrity of musculotendinous structures resulting from vascular changes in RC tendons. Collagen disorientation and degeneration are hallmarks.
caused by factors in tendon itself, tension overload
Extrinsic impingement
caused by factors outside of the tendon
Primary, Secondary, Posterior
Primary extrinsic impingement
from anatomical or biomechanical factors
Secondary Extrinsic impingement
from hypermobility or instability of GHJ
increased superior humeral head translation
Posterior impingement
occurs during elevation, H. abd, max ER
supraspinatus becomes trapped between humeral head and labrum
Possible structural contributions to extrinsic impingement
Shape of the acromion
Calcium deposits
Osteophytes
Over-use etiologies to extrinsic impingement
repetition or rapid force are mechanisms of injury
supraspinatus tendinitis = overhead
infraspinatus tendinitis = across the body
Bicipital tendinitis = eccentric lowering
Bursitis = overhead
Inferior angle scapular dysfunction
inferior medial border is prominent at rest
Kibler type 1
presentation results from anterior tipping of scapula
commonly seen with RC impingement
Medial border scapular dysfunction
kibler type 2
entire medial border is posteriorly displaced from thoracic wall
occurs from IR of scapula
may be seen in GHJ instability
Superior scapular dysfunction
kibler type 3
early and excessive superior scapular elevation during arm elevation
results from RC weakness and force couple imbalances
What will my patient complain of with impingement?
sleeping, laying on shoulder
push/pull
overhead reaching
lifting a load
dressing/undressing
sports involving overhead shoulder motion
grooming hair
What structural and functional impairments will a pt have with impingement?
impaired posture
decreased thoracic ROM
rotator cuff overuse and fatigue
hypomobile posterior GH joint capsule
muscle weakness secondary to neuropathy
Acute phase of impingement
protect from additional stress
control inflammation
promote healing
pt education
maintain integrity and mobility
develop scapular control
modify joint tracking and mobility
Interventions of Acute phase
postural awareness
ROM in pain free range
gentle isometrics
support arm
MWMs
