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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
Q

What does the scapular assistance test (SAT) help with?

A

passive upward rotation

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23
Q

What does the scapular repositioning test help with?

A

Passive upward rotation and posterior tilt

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24
Q

What is the name of the test for voluntary retraction?

A

Scapular retraction test

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25
Q

What can taping help with in terms of impingement syndrome?

A

LT assistance

  • helps muscle do its job, if helps tells us we need to activate it better
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26
Q

Are symptom alteration tests reliable with the scapula??

A

Yes

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27
Q

What are some signs with function that can indicate impingement syndrome?

A

Limited and painful reaching overhead / behind back / with lifting

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28
Q

What will we see with ROM along with impingement syndrome?

A
  • Most often limited and painful into flexion, abduction, and external rotation, but internal rotation may be as well
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29
Q

What does posterior shoulder pain with external rotation indicate?

A

A posterior impingement

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30
Q

What would we find with resisted tests and MMT for impingement syndrome?

A

Inhibited scapular and cuff muscles
- ERs - ER/IR ratio < .66
- most scapular muscle groups except elevators

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31
Q

Why is it important that proprioceptive impairments are greatest at higher elevations?

A

closest to the body is the safest feedback from shoulder to brain

32
Q

Where is proprioceptive impairment greatest?

A

higher elevation

33
Q

What would we be testing accessory motion for throughout the shoulder complex joints with impingement syndrome?

A

hypomobility

34
Q

What is the primary type of glide restriction with impingement syndrome?

A

posterior shoulder tightness with limited posterior glide

35
Q

What are some special tests for impingement?

A

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
Q

What is the glenohumeral IR deficit (GIRD) ratio?

A

change in internal rotation / the change in external rotation at 90 degrees of abduction

37
Q

What will happen with the IR/ER of overhead athletes?

A

ER typically increases as IR decreases

38
Q

What does the GIRD ratio influence?

A

Humeral head position on glenoid

39
Q

What are we testing for with the infraspinatus or ER test in 0 degrees of abduction?

A

Painful or giving away
high spec

40
Q

What are we looking for with the IR resisted strength test?

A

IR weaker than ER at 90 degrees of abduction

LR + 22; LR- .12

41
Q

What test has minimal to no support for impingement?

A

Speeds and Hawkins/Kennedy

42
Q

What test is moderate spec for RC?

43
Q

What is included with stability tests for hypermobility?

A

Labral and rotator cuff
ligamentous tests

44
Q

What age group are RC pathologies most common in ?

A

Oldest age group - 78%

45
Q

Is RC pathology associated with impingement symptoms?

46
Q

What percentage of asymptomatic professional pitchers between the ages of 18-22 years of age had rotator cuff and labral changes?

A

80%

BUT THEY WERE ASYMPTOMATIC - can have changes without effecting function

47
Q

Out of 51 asymptomatic men ages 40-70, what percentage had a pathology? What kind?

A

96%

  • DJD, tendinosis, partial thickness tear, labral and bursal abnormalities
48
Q

What type of tissue are tendons made up of?

A

Dense regular connective tissue
- type I collagen
- Low elastin
- fibrocytes
- parallel fibers for more unidirectional loads

49
Q

What do tendons do?

A

RESIST tension and release energy with muscle actions

50
Q

What does more stiffness lead to with tendons?

A

Better force transmission or storing of potential energy

51
Q

What are characteristics of the mid portion of the tendon?

A

Hypovascular
hyponeural

52
Q

What are characteristics of the insertion of the tendon?

A

Hypervascular
hyperneural

53
Q

What is the prevalence of tendinopathy?

A

30% of general MSK injuries
30-50% of sports injuries

54
Q

Is tendinitis common?

A

NO - uncommon

55
Q

What is tendinitis?

A

Inflammation of tendon without structural changes due to overuse

56
Q

What are S&S of tendinitis?

A
  • TTP
  • Pain and limitation with lengthening
  • Pain with resisted testing / MMT, - particularly in a lengthened position - may be weak
57
Q

What is the most common tendinopathy?

A

Tendinosis

58
Q

What is tendinosis?

A

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
Q

What are some symptoms & signs of tendinosis?

A
  • If acute - tendinitis S&S
  • Persistant (>4-6 weeks) often with previously failed PT
  • decreasing tendon tolerances
60
Q

What is tendinosis often mislabeled as?

A

Tendinitis

61
Q

What are observation signs of tendinosis?

A

Enlarged tendon may be visable

62
Q

What will we find with ROM/MMT with tendinosis?

63
Q

Is there an association with strength deficits and tendinopathy?

64
Q

Have to settle down __________ to treat __________

A

tendinitis, tendinosis

65
Q

What will we find with palpation with tendinosis? Why?

A

TTP, decreased pain thresholds
Increased in-growth of vessels and nerves
Elevated pain neurotransmitters

66
Q

What special tests will be positive with tendinosis? (not specific)

A

Tests specific to tendon, etiologies, and pathomechanics

67
Q

Will we have inflammation with tendinosis?

A

Little to none

68
Q

What fiber changes will we see on imaging with tendinosis?

A
  • Degeneration, disorganization that also may have been present prior to symptoms
  • increased non-collagen matrix
  • fatty infiltration
  • weakness
69
Q

What does corticospinal movement influence?

A
  • increased inhibition
  • increased excitability - aberrant / excessive firing
  • Bilateral influence
70
Q

What can weakness lead to?

A

A greater likelihood of overload

71
Q

What is the likelihood of an acute tendon tear?

72
Q

What happens to cause an acute tendon tear?

A
  • Higher and oblique forces during fast eccentric loading
  • prior degeneration or tendinosis
73
Q

What makes an acute tendon tear more likely?

A

Age and disuse

74
Q

What happens with age and disuse that can lead to a tendon tear?

A
  • Elastin and vascularity decrease
  • Atrophy and drying
  • Shorter smaller tendon is less pliable and durable
75
Q

When does the primary resolution of inflammation happen with tendinitis?

A

4-6 weeks in most cases

76
Q

What can happen with tendinosis and smaller tears that leads to healing?

A
  • proliferating tendon
  • tensile strength
  • PT
  • Sx
77
Q

When does the tensile strength initially improve with tendinosis?

A

~3-5 weeks

78
Q

When does even greater tensile strength fill in? why?

A

~8-12 weeks
dense fibrous tissue fills in

79
Q

What would traumatic and full tears likely require?

80
Q

How long after tendinitis surgery does normal strength return?

A

10-12 months

MSK 1 - Shoulder (5 decks)

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