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MSK 1 - Shoulder > Shoulder Complex- Impingement thru Tendon Healing > Flashcards

Shoulder Complex- Impingement thru Tendon Healing Flashcards

1
Q

What is another name for impingement syndrome?

A

subacromial pain syndrome (SAPS)

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2
Q

What is a syndrome?

A

A cluster of associated S&S, does not indicate definitive signs or cause

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3
Q

What percentage of shoulder complaints are impingement syndrome?

A

44-65%

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4
Q

What is the primary etiology of impingement syndrome?

A

limited motion

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4
Q

What can the limited motion with impingement syndrome be due to?

A
  • Muscle / capsule shortening
    - disuse / immobilization
    - persistent FHP
  • Spurring or hooking of acromion
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4
Q

What does persistent FHP lead to?

A
  • shortened IRs/Anterior capsule tightness and limits ER
  • shortened scapular protractors, elevators, and upward rotators
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5
Q

What is the secondary etiology of impingement syndrome?

A

Excessive motion

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6
Q

What can excessive motion be from?

A
  • Ligamentous laxity from trauma and / or activities with excessive motion (i.e. baseball)
  • muscle inhibition
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7
Q

What are the 4 causes of muscle inhibition?

A

swelling
disuse
laxity
pain

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8
Q

Can a neck problem create a shoulder impingement?

A

Yes - neck problem CAN cause shoulder impingement

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9
Q

What is an example of a (impingement syndrome) combination of primary and secondary etiologies? How would we treat this?

A

scapular hypomobility and GH hypermobility

  • mobilize one (the hypo) stabilize the other (the hyper)
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10
Q

What structures are involved with impingement syndrome?

A

Supraspinatus tendon
biceps tendon - long head
labrum
subacromial bursa

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11
Q

What is the most common structure involved with impingement syndrome?

A

Supraspinatus tendon

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12
Q

What happens with the supraspinatus tendon with impingement syndrome? Why may it be difficult to heal?

A

Tendinopathy
- may tear gradually
- limited vascularity in distal supraspinatus affects healing

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13
Q

What happens with the long head of the biceps with impingement syndrome?

A

tendinopathy
may tear gradually

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14
Q

What may the labrum do with impingement syndrome?

A

Tear gradually

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15
Q

What can happen with the subacromial bursa with impingement syndrome?

A

bursitis

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16
Q

What happens to compress tendons with impingement syndrome?

A

sub and coracoacromial space is compromised resulting in impingement or compression of tendons

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17
Q

What happens to increase tension on the tendons with impingement syndrome?

A

when the tendons are loaded and as they wrap around the bone the tension is increased which results in compression

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17
Q

What is a posterior-superior glenoid impingement? (PSGI)

A

impingement at posterior - superior glenoid on the labrum

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18
Q

What kind of athlete are posterior-superior glenoid impingements more common in?

A

Overhead athletes

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19
Q

What happens with the ROM along with a posterior - superior glenoid impingement?

A

ER ROM and Anterior GH glide are typically excessive

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20
Q

What are symptoms of impingement syndrome?

A
  • Pain, typically localized to tip of shoulder and referred into lateral shoulder and arm
  • Pain and/or limitation with
    - elevation
    - lifting/pushing/pressing activities
    -reaching behind the back
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21
Q

What are signs in the observation that can lead us to impingement syndrome?

A
  • possible scapular compensations for GH restrictions
  • increased elevation
  • inconsistent with upward rotation
    – increased
    – decreased
  • observational scapular dyskinesia but may not be symptomatic
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22
What does the scapular assistance test (SAT) help with?
passive upward rotation
23
What does the scapular repositioning test help with?
Passive upward rotation and posterior tilt
24
What is the name of the test for voluntary retraction?
Scapular retraction test
25
What can taping help with in terms of impingement syndrome?
LT assistance - helps muscle do its job, if helps tells us we need to activate it better
26
Are symptom alteration tests reliable with the scapula??
Yes
27
What are some signs with function that can indicate impingement syndrome?
Limited and painful reaching overhead / behind back / with lifting
28
What will we see with ROM along with impingement syndrome?
- Most often limited and painful into flexion, abduction, and external rotation, but internal rotation may be as well
29
What does posterior shoulder pain with external rotation indicate?
A posterior impingement
30
What would we find with resisted tests and MMT for impingement syndrome?
Inhibited scapular and cuff muscles - ERs - ER/IR ratio < .66 - most scapular muscle groups except elevators
31
Why is it important that proprioceptive impairments are greatest at higher elevations?
closest to the body is the safest feedback from shoulder to brain
32
Where is proprioceptive impairment greatest?
higher elevation
33
What would we be testing accessory motion for throughout the shoulder complex joints with impingement syndrome?
hypomobility
34
What is the primary type of glide restriction with impingement syndrome?
posterior shoulder tightness with limited posterior glide
35
What are some special tests for impingement?
Glenohumeral IR deficit (GIRD) ratio Infraspinatus or ER test in 0 degrees abd IR resisted strength test Speed and Hawkins/Kennedy Empty Can scapular muscle lengths stability tests
36
What is the glenohumeral IR deficit (GIRD) ratio?
change in internal rotation / the change in external rotation at 90 degrees of abduction
37
What will happen with the IR/ER of overhead athletes?
ER typically increases as IR decreases
38
What does the GIRD ratio influence?
Humeral head position on glenoid
39
What are we testing for with the infraspinatus or ER test in 0 degrees of abduction?
Painful or giving away high spec
40
What are we looking for with the IR resisted strength test?
IR weaker than ER at 90 degrees of abduction LR + 22; LR- .12
41
What test has minimal to no support for impingement?
Speeds and Hawkins/Kennedy
42
What test is moderate spec for RC?
Empty can
43
What is included with stability tests for hypermobility?
Labral and rotator cuff ligamentous tests
44
What age group are RC pathologies most common in ?
Oldest age group - 78%
45
Is RC pathology associated with impingement symptoms?
NO
46
What percentage of asymptomatic professional pitchers between the ages of 18-22 years of age had rotator cuff and labral changes?
80% BUT THEY WERE ASYMPTOMATIC - can have changes without effecting function
47
Out of 51 asymptomatic men ages 40-70, what percentage had a pathology? What kind?
96% - DJD, tendinosis, partial thickness tear, labral and bursal abnormalities
48
What type of tissue are tendons made up of?
Dense regular connective tissue - type I collagen - Low elastin - fibrocytes - parallel fibers for more unidirectional loads
49
What do tendons do?
RESIST tension and release energy with muscle actions
50
What does more stiffness lead to with tendons?
Better force transmission or storing of potential energy
51
What are characteristics of the mid portion of the tendon?
Hypovascular hyponeural
52
What are characteristics of the insertion of the tendon?
Hypervascular hyperneural
53
What is the prevalence of tendinopathy?
30% of general MSK injuries 30-50% of sports injuries
54
Is tendinitis common?
NO - uncommon
55
What is tendinitis?
Inflammation of tendon without structural changes due to overuse
56
What are S&S of tendinitis?
* TTP * Pain and limitation with lengthening * Pain with resisted testing / MMT, - particularly in a lengthened position - may be weak
57
What is the most common tendinopathy?
Tendinosis
58
What is tendinosis?
Degenerative changes with some inflammation due to - repetitive stress and tendinitis - impingement pathomechanics - neural / vascular insufficiency - exercise induced hyperthermia (tendon cant regulate so it develops excess heat) - older age - hormonal fluctuation
59
What are some symptoms & signs of tendinosis?
- If acute - tendinitis S&S - Persistant (>4-6 weeks) often with previously failed PT - decreasing tendon tolerances
60
What is tendinosis often mislabeled as?
Tendinitis
61
What are observation signs of tendinosis?
Enlarged tendon may be visable
62
What will we find with ROM/MMT with tendinosis?
WNL
63
Is there an association with strength deficits and tendinopathy?
No
64
Have to settle down __________ to treat __________
tendinitis, tendinosis
65
What will we find with palpation with tendinosis? Why?
TTP, decreased pain thresholds Increased in-growth of vessels and nerves Elevated pain neurotransmitters
66
What special tests will be positive with tendinosis? (not specific)
Tests specific to tendon, etiologies, and pathomechanics
67
Will we have inflammation with tendinosis?
Little to none
68
What fiber changes will we see on imaging with tendinosis?
- Degeneration, disorganization that also may have been present prior to symptoms - increased non-collagen matrix - fatty infiltration - weakness
69
What does corticospinal movement influence?
- increased inhibition - increased excitability - aberrant / excessive firing - Bilateral influence
70
What can weakness lead to?
A greater likelihood of overload
71
What is the likelihood of an acute tendon tear?
Rare
72
What happens to cause an acute tendon tear?
- Higher and oblique forces during fast eccentric loading - prior degeneration or tendinosis
73
What makes an acute tendon tear more likely?
Age and disuse
74
What happens with age and disuse that can lead to a tendon tear?
- Elastin and vascularity decrease - Atrophy and drying - Shorter smaller tendon is less pliable and durable
75
When does the primary resolution of inflammation happen with tendinitis?
4-6 weeks in most cases
76
What can happen with tendinosis and smaller tears that leads to healing?
- proliferating tendon - tensile strength - PT - Sx
77
When does the tensile strength initially improve with tendinosis?
~3-5 weeks
78
When does even greater tensile strength fill in? why?
~8-12 weeks dense fibrous tissue fills in
79
What would traumatic and full tears likely require?
Surgery
80
How long after tendinitis surgery does normal strength return?
10-12 months

MSK 1 - Shoulder (5 decks)

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