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Extremities Technique II > Rotator Cuff Tendinopathy & Impingement > Flashcards

Rotator Cuff Tendinopathy & Impingement Flashcards

1
Q

What are the major functions of the rotator cuff muscles?

A
  • Rotate the humerus
  • Stabilize the glenohumeral joint
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2
Q

What are the two methods by which the rotator cuff muscles rotate the humerus?

A
  • Contraction of individual RC muscles
  • Use of a force couple
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3
Q

rotating the humerus

Which individual rotator cuff muscle performs abduction?

A

Supraspinatus (SSp)

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4
Q

rotating the humerus

Which individual rotator cuff muscle performs internal rotation?

A

Subscapularis (SSc)

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5
Q

rotating the humerus

Which rotator cuff muscles perform external rotation?

A

Infraspinatus and teres minor

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6
Q

What is a force couple?

A

Two forces of equal magnitude acting in opposite directions to rotate a body around its axis of motion

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7
Q

use of a force couple

In addition to the medial pull of subscapularis, infraspinatus, and teres minor, these muscles also…

A

pull in an inferior direction

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8
Q

Which force couple of muscles will aid in flexion and adduction of the humerus?

A

Infraspinatus, teres minor, and subscapularis coupled with deltoids

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9
Q

Which muscles are most important in stabilizing the glenohumeral joint in the mid-ranges of motion?

A

Rotator cuff muscles

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10
Q

Rotator cuff muscles are most important in stabilizing the glenohumeral joint in the ___ ranges of motion

A

mid-ranges

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11
Q

What is the compression of the humeral head into the glenoid fossa called?

A

Concavity-compression stability mechanism

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12
Q

What is the most important method of glenohumeral joint stabilization by the rotator cuff muscles?

A

Concavity-compression stability mechanism

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13
Q

stability mechanism

The more shallow the concavity of the glenohumeral joint, the greater ___ is required for stabilization

A

more shallow concavity = greater compression required

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14
Q

What is the concavity-compression stability mechanism?

A

Compression of the humeral head into the glenoid fossa; the most important method of glenohumeral joint stabilization by the rotator cuff muscles

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15
Q

What is the most common cause of shoulder pain in patients over 35 years old?

A

Rotator cuff disorders

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16
Q

What is tendinopathy?

A

A broad term used to describe any pathology involving a tendon and is inclusive of several different tendon pathologies

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17
Q

What are some examples of tendinopathy?

A
  • Tendinitis
  • Tendinosis
  • Tenosynovitis
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18
Q

What is the inflammatory condition of a tendon termed?

A

Tendinitis

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19
Q

Tendinitis is often used incorrectly as…

A

a catch-all term since inflammatory infiltrates within a tendon are not usually seen

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20
Q

What are non-inflammatory degenerative changes in a tendon termed?

A

Tendinosis

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21
Q

What is the inflammation of the synovial sheath surrounding some tendons termed?

A

Tenosynovitis

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22
Q

What are some common causes of tendinosis?

A
  • Aging
  • Microtrauma
  • Vascular compromise
  • Failed healing
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23
Q

Is tendinosis symptomatic?

A

Not necessarily

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24
Q

What is tendinitis?

A

Inflammatory condition of a tendon

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25
Q

What is tendinosis?

A

Non-inflammatory degenerative changes in a tendon

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26
Q

What is tenosynovitis?

A

Inflammation of synovial sheath surrounding some tendons

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27
Q

Which tendon of the rotator cuff is most commonly affected by tendinopathies?

A

Supraspinatus

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28
Q

What age group is typically affected by rotator cuff tendinopathies?

A

Over 35 years old

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29
Q

Patients under 35 years old with rotator cuff tendinopathy are mostly ___

A

athletes

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30
Q

What are four major causes of rotator cuff tendinopathies?

A
  1. Major trauma
  2. Age-related degeneration
  3. Tension overload
  4. Subacromial impingement
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31
Q

What are some major traumas causing rotator cuff tendinopathies?

A
  • FOOSH
  • Traumatic dislocation
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32
Q

What are some age-related degeneration related causes of rotator cuff tendinopathies?

A

Etiology unknown
Most likely due to poor vascular supply of the supraspinatus tendon in the critical zone (area of the tendon where degeneration and tears most often occur)

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33
Q

When about does age-related degeneration begin causing rotator cuff tendinopathy?

A

Can begin after age 40

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34
Q

What is the prevalence of age-related degeneration causing rotator cuff tendinopathy?

A

Prevalence is unknown because it is often asymptomatic

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35
Q

tension overload

Repetitive eccentric contraction of the rotator cuff is needed to:

A
  • Decelerate the arm during the follow through of the throwing motion
  • Stabilize an unstable glenohumeral joint
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36
Q

Tension overload causing rotator cuff tendinopathy is seen in ___ athletes

A

overhead athletes

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37
Q

What is subacromial impingement?

A

Compression of tissue in subacromial space (between humeral head and undersurface of coracoacromial arch)

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38
Q

What is the most common cause of symptomatic rotator cuff tendinopathy?

A

Subacromial impingement

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39
Q

What is the subacromial space?

A

Space between coracoacromial arch and head of the humerus

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40
Q

What is made up of the following?

  • Anterior third of acromion
  • AC joint
  • Coracoacromial ligament
  • Coracoid process
A

Coracoacromial arch

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41
Q

What tissues can be found in the subacromial space?

A
  • Subacromial bursa
  • Supraspinatus tendon
  • Long head of biceps tendon
42
Q

In which position of the shoulder will tissues in the subacromial space normally compress?

A

Beginning at 60 degrees shoulder abduction

43
Q

How are compressive forces normally distributed in the subacromial space?

A

Evenly distributed over a large area and are not excessive (if the shoulder is working correctly)

44
Q

Compressive forces on the subacromial space can become concentrated on certain tissues and excessive if there is:

A
  • Faulty mechanics (functional narrowing)
  • Structural narrowing
  • Swelling within the subacromial space
45
Q

Which tissues are impinged in the subacromial space in order of prevalence?

A
  1. Subacromial bursa (subacromial bursitis)
  2. Supraspinatus tendon (supraspinatus tendinopathy)
  3. Long head biceps tendon (LHBT tendinopathy)
46
Q

What are some major causes of subacromial impingement?

A
  • Functional narrowing of subacromial space
  • Structural narrowing of subacromial space
  • Swelling in the subacromial space
47
Q

What are some causes of functional narrowing of the subacromial space?

A
  • RC/deltoid strength imbalance
  • Tight posterior GHJ capsule (loss of A-P glide)
  • Tight inferior GHJ capsule (loss of S-I glide)
  • Decreased upward rotation of the scapula
48
Q

What are some causes of structural narrowing of the subacromial space?

A
  • AC joint spurs
  • Abnormal shape of the acromion
49
Q

What are some causes of swelling in the subacromial space?

A
  • Secondary to tension overload
  • Secondary to trauma
50
Q

What is the most common cause of subacromial impingement?

A

Functional narrowing of subacromial joint space

51
Q

If the humerus is pulled superior during flexion or abduction of the shoulder, what is the likely cause of the impingement in the SAS tissue?

A

Strength imbalance between the rotator cuff and deltoid

52
Q

What happens if the strength of the deltoid overwhelms the concavity-compression stability mechanism of the rotator cuff muscles?

A

Strength imbalance between the rotator cuff and deltoid leads to impingement of the subacromial space

53
Q

What are some causes of strength imbalance causing impingement of the subacromial space?

A
  • Rotator cuff deconditioning
  • Rotator cuff tendinopathy of another cause
  • Rotator cuff tear
54
Q

Does rotator cuff deconditioning (leading to impingement) affect the RC muscles or the deltoid more?

A

Affects RC muscles more

55
Q

A tight inferior capsule causes ___ translation of the humeral head during ___

A

superior translation of the humeral head during shoulder abduction

56
Q

Decreased upward rotation of the scapula occurs during which motions?

A

Flexion and abduction

57
Q

During 180 degrees of shoulder abduction and flexion, the humerus moves ___ degrees and the scapula rotates upward ___ degrees

A

humerus moves 120 degrees
scapula rotates upward 60 degrees

58
Q

As the scapula rotates upward, how does the acromion move?

A

Acromion moves out of the way of the humerus

59
Q

With decreased upward rotation of the scapula, how does the acromion move?

A

Acromion will not move out of the way of the humerus and will cause impingement

60
Q

The four most common causes of functional narrowing of the subacromial space can all be effectively treated with ___

A

conservative care

61
Q

What are some general causes of swelling of the subacromial joint space?

A
  • Tension overload (athlete)
  • Acute trauma
62
Q

swelling of the SAS

Repetitive, high intensity use can cause microtears and swelling of the ___ tendon

A

supraspinatus tendon

63
Q

swelling of the SAS

FOOSH or GHJ dislocation causes swelling of which structures?

A
  • Subacromial bursa (SAB)
  • Supraspinatus tendon (SSp)
  • Long head biceps tendon (LHBT)
64
Q

FOOSH injury can push the humerus ___, pinching the contents of the SAS causing injury and swelling

A

superior

65
Q

Any cause of rotator cuff tendinopathy can result in ___ which in turn can cause a secondary functional impingement

A

rotator cuff impingement

66
Q

What are the common chief complaints presented with subacromial impingment?

A
  • Anterolateral and/or anterior shoulder pain
  • Deltoid insertion (frequent referred pain)
67
Q

What are the less common complaints presented with subacromial impingement that may be present?

A
  • LH biceps tendon pain
  • Lateral arm referred pain (mimics C5 radiculopathy)
  • Lateral forearm referred pain (mimics C6 radiculopathy)
68
Q

A patient with subacromial impingement is typically greater than ___ years old
If younger, the patient is usually ___

A

greater than 35 years old
if younger, usually an athlete

69
Q

___% of subacromial impingement has no cause or activity the patient can relate to symptom onset

A

30%

70
Q

Most subacromial impingement is due to ___ combined with ___

A

functional and/or structural impingement combined with cumulative effects of repetitive impingement

71
Q

What are some causes of repetitive impingement causing subacromial impingement?

A
  • Overhead sports
  • Overhead occupation
72
Q

If causes of SAS impingement are present, and they are combined with high intensity overhead athletic activity, symptoms will…

A

develop in a short period of time

73
Q

If causes of SAS impingement are present, and they are combined with prolonged low intensity overhead activity, symptoms will…

A

take time to develop

74
Q

If causes of SAS impingement are present, and they are combined with no history of overhead activity, symptoms will…

A

take a very long time to develop

75
Q

___ of patients have no single precipitating event to impingement, while ___ patients do

A

Majority do not have a single event
Minority have a single event/injury

76
Q

Most patients with SAS impingement present ___ after onset of symptoms when they have not resolved on their own

A

weeks or months after onset

77
Q

Symptoms of SAS impingement are aggravated by…

A

overhead activities

78
Q

Upon palpation of SAS impingement, what are the probable areas of tenderness?

A
  • AC joint
  • Anterior and lateral edge of acromion
  • Insertion of supraspinatus on greater tuberosity
  • LHBT
79
Q

What is suspected if the following are tender upon palpation?

  • AC joint
  • Anterior and lateral edge of acromion
  • Insertion of supraspinatus on greater tuberosity
  • LHBT
A

Subacromial impingement

80
Q

What might be found upon passive range of motion of subacromial impingement?

A

Subacromial crepitus

81
Q

What strength test is used for supraspinatus?

A

Thumb up (full can)
Doctor pushes flexed arm inferiorly against resistance

82
Q

What strength test is used for infraspinatus/teres minor?

A

External rotation
Doctor pushes flexed arm with bent elbow medially (internal rotation) against resistance

83
Q

What strength test is used for subscapularis?

A

Internal rotation: doctor pulls flexed arm with bent elbow laterally (external rotation) against resistance
Lift-off test: Patient puts arm behind back and tries to lift their hand off their back

84
Q

orthopedic tests

What are the most common impingement tests?

A

Neer test and Hawkins test
(impingement sign)

85
Q

orthopedic tests

How is the Neer test performed?
What is a positive result?

A

Humeral flexion is tested by slowly lifting the patient’s relaxed arm
Positive finding is induced pain

86
Q

orthopedic tests

How is Hawkins test performed?
What is a positive result?

A

Humeral internal rotation is tested when holding the patient’s relaxed arm with 90 degrees shoulder flexion (on scapular plane) and 90 degrees elbow flexion
Positive finding is induced pain

87
Q

orthopedic tests

What is a positive impingement sign?

A

Pain in top outer edge of shoulder upon orthopedic testing

88
Q

orthopedic tests

What is the supraspinatus press test?

A

Thumb down (empty can)
Doctor presses inferiorly on patient’s flexed and internally rotated arms against resistance

89
Q

orthopedic tests

Between the supraspinatus “thumb up” strength test and the supraspinatus press orthopedic test, which is more likely to cause pain if impingement is present?

A

Supraspinatus press test
Internal rotation of the humerus causes anterior tipping of the scapula which narrows the SAS

90
Q

What types of imaging are used to diagnose subacromial space impingement and in what circumstances?

A

Plain radiographs: for structural causes of impingement or bony pathology
MRI: if a rotator cuff tear is suspected

91
Q

manual treatment

What are some areas of treatment by a chiropractor when manipulating or mobilizing for subacromial impingement?

A
  • Glenohumeral joint
  • Acromioclavicular joint
  • Sternoclavicular joint
  • STA
  • Thoracic and cervical spine
92
Q

manual treatment

Which glenohumeral joint techniques can be beneficial for subacromial impingement?

A
  • S-I glide
  • A-P glide
  • All techniques with arm above 30 degrees abduction in the scapular plane which slackens the tendon to minimize stress
93
Q

What are some therapeutic modalities for treating subacromial impingement symptoms?

A
  • Ice/heat
  • Electrical stimulation
  • Ultrasound
  • Laser
94
Q

When should a chiropractor refer a patient with subacromial impingement to another professional?

A
  • Severe pain (>7/10)
  • Difficulty sleeping due to pain
  • Worsening pain, weakness, and/or dysfunction
  • No subjective or objective improvement after 4-6 weeks of treatment
95
Q

What are some medical treatments for subacromial impingement?

A
  • Medication: NSAIDs
  • Subacromial corticosteroid injection
  • Physical therapy
96
Q

Surgical treatment may be effective for ___ in the subacromial space, but is not effective for ___ causes of impingement

A

may be effective for structural causes or swelling in the SAS
not effective for functional causes of impingement

97
Q

subacromial decompression

What is the removal of an inflamed and thickened bursa, which allows a normal bursa to reform?

A

Busectomy

98
Q

subacromial decompression

What is the excision of dead or useless tissue such as tissue that is torn and cannot be repaired?

A

Debridement

99
Q

subacromial decompression

What is the smoothing of rough bony edges on the coracoacromial arch and or the humeral head?

A

Smoothing (surgical treatment)

100
Q

subacromial decompression

What is the bony resection of the anterior portion and undersurface of the acromion with release and resection of the anterior portion of the coracoacromial ligament?

A

Acromioplasty

101
Q

Subacromial decompression (surgical) can include combinations of:

A
  • Bursectomy
  • Debridement
  • Smoothing
  • Acromioplasty
  • Resection of AC joint inferior osteophytes

Extremities Technique II (8 decks)

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