PTA135-Unit4-Shoulder

Question 1

Impingement Syndrome is also known as ___

Answer 1

Subacromial Rotator Cuff Impingement

Question 2

What is the etiology of impingement syndrome?

Answer 2

• RTC tendons become crowded/compressed under the coracoacromial arch
o Subacromial rotator cuff impingement
• Causes mechanical wear, stress and friction
• Age related degenerative changes occur that can decrease subacromial space between rotator cuff and coracoacromial arch
o Abnormal formation of bony osteophytes under acromion

Question 3

What is the primary type of impingement syndrome?

Answer 3

• Refers to mechanical compression of RTC
• Supraspinatus tendon is pinched as it passes under the corcoacromial arch by:
o Thickening of the coracoacromial ligament
o Curved or hooked acromion

Question 4

What is the secondary type of impingement syndrome?

Answer 4

•	Related to glenohumeral instability
•	Instability results from
      o	Impairment of muscle coordination
      o	Weakness of scapular stabilizers
      o	Laxity of shoulder ligaments

Question 5

How many stages of impingement are there?

Answer 5

3

Question 6

Impingement Syndrome, Stage I

Answer 6

• Usually occurs in 25 yo or younger
• Edema
• Hemorrhage
• Pain with shoulder aBduction greater than 90 deg
• Reversible injury
• Responds well to PT

Question 7

Impingement Syndrome, Stage II

Answer 7

• Ages 25-40
• Fibrosis and tendonitis (supraspinatus tendon, bicep tendon, subacromial bursa become fibrotic)
• Pain with ADL’s and at night is predominant feature
• Irreversible secondary to long term repeated stress

Question 8

Impingement Syndrome, Stage III

Answer 8

• Over age 40
• Characterized by tendon degeneration, rotator cuff tears, ruptures
• Associated with long history of shoulder pain and dysfunction
• Progressive weakness and atrophy

Question 9

Symptoms of Impingement Syndrome

Answer 9

• Sharp pain at superior aspect of the shoulder (per the Hawkins-Kennedy test) (90 deg flex, IR)
• Pain in lateral shoulder (neer’s) (slight abduct, full flex)
• Apprehension

Question 10

General Rehab for Impingement Syndrome

Answer 10

• Scapular stabilization exercises
– Scapula is the core of the upper extremity
– prevent improper winging/tipping of the scapula

• Strengthening of RTC
• Modification of painful activities - patient education
• Control pain and swelling
- NSAIDS, ice, US, injections
• Stretching and mobilizations as appropriate

Question 11

Rehab Phase I for Impingement Syndrome

Answer 11

• Modify daily, work, recreational activities!!!!
– Try to limit lifting of shoulder above 80-90 degrees abduction or flexion
– Manage pain and swelling
• Strengthening: easy scapular stabilization and RTC exercises in pain free ranges
• Stretching and capsular mobilization
– pain free motions
– < 80-90 degrees of shoulder flexion and abduction
– Emphasize shoulder horizontal adduction and internal rotation stretch
– Why?

Question 12

Rehab Phase II for Impingement Syndrome

Answer 12

• Advance scapular stabilization
  * Multiple positions
  * Serratus anterior
  * Rhomboids
  * Traps: Lower, middle
• More aggressive rotator cuff strengthening

Question 13

Rehab Phase III

Answer 13

• Return to normal function
– Pain free activity
– Strengthening in functional positions for ADL’s, work, and sports
• Surgery may be the option if patient is not able to progress to this level

Question 14

Surgery for Impingement Syndrome

Answer 14

• For failed conservative treatment
• Distal Clavicle Excision (DCE) - part of clavicle cut off
• Acromioplasty - fix acromion
• RTC debridement or repair, if needed, at time of surgery

Question 15

4 classifications of Rotator Cuff Tears

Answer 15

• Small – less than 1 cm
• Medium – between 1 and 3 cm
• Large – between 3 and 5 cm
• Massive – greater than 5 cm, not always reparable

Question 16

Medical Treatment for Rotator Cuff Tears

Answer 16

• Direct repair of rotator cuff defect

* Combination Arthroscopic/open or mini-open procedure