Painful Shoulder/ Tendinopathy Management Flashcards
Pain in combination with Weakness/ Decreased Motor Control:
Cuff, Scapula, Shoulder
Scapulohumeral Motion Deficits
Pain in combination with Tightness:
Pec Minor, Joint Capsule
Pain in combination with Posture:
Thoracic & Shoulder
Intrinsic Factors of Tendon Degeneration:
Aging
Vascularity
Morphology
Mechanical
Extrinsic Factors of Tendon Degeneration:
Strength/Motor Control
Shoulder Tightness
GH Joint Laxity
Posture
Bony Abnormality
Kinematics
Irritability:
Pain Intensity
Night/ Resting Pain
Pain with ROM
End Feel
Disability/Functional Loss Levels
High irritability =
high pain >7/10
consistent night or rest pain
pain before end of ROM
AROM < PROM
minimize physical stress:
activity modification
monitor impairments
Moderate irritability =
moderate pain 4-6/10
intermittent night or rest pain
pain at end of ROM
AROM ~ PROM
mild-moderate physical stress:
address impairments
basic-level functional activity restoration
Low irritability =
low pain <3/10
absent night or rest pain
minimal pain with overpressure
AROM = PROM
moderate-high physical stress:
address impairments
high-demand functional activity restoration
General Treatment Principles:
Relative Rest = Limit the exacerbating factor = All tissue needs to see forces to be healthy: “Goldilocks zone”
(No load can be just as bad as overload)
Local Tissue Pain vs Central Sensitization
Normalize Associated Kinematics/ Find the Root
Pt Education = Minimal amounts of pain are acceptable
Closed Chain Shoulder Programs
Theory: Higher loading of shoulder musculature with less pain in closed chain positions
Jury: Still out if it leads to better outcomes than typical management
Eccentric Shoulder Programs
Theory: Similar to Achilles tendinopathy- need to load the healthy part of the tendon
Jury: Still out, but promise given evidence in other areas (likely not the eccentric itself but the increased loading)
Special Population
Throwers:
Assess Total Motion
If total motion is not similar (15+):
> Usually too much ER not enough IR
> Stretch Posterior cuff/ capsule
> Microtrauma instability
> Anterior Cuff: Dynamic stabilizer
> Posterior Cuff: Decelerator
The root is commonly in the Hips, Core, Thoracic Spine but manifests at the shoulder/elbow in throwers
> The arm is the whip
Throwers - pitching phases:
wind-up = knee up
stride to arm cocking = foot contact
arm cocking to arm acceleration = max ER
arm acceleration to arm deceleration = release
arm deceleration to follow-through = max IR
Thoracic Outlet Syndrome:
Diagnosis of exclusion
Common sites of NV compression:
> First rib/ Cervical rib
> Clavicle (hx of fx)
> Scalenes
