Shoulder Complex- Impingement thru Tendon Healing Flashcards by Siva Pye

Impingement Syndrome is also known as what?

Subacromial Pain Syndrome (SAPS)

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Impingement syndrome is a _______ of associated S&S

cluster

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Impingement syndrome _________ indicate definitive signs or cause

DOES NOT

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What is the prevalence of all shoulder complaints being impingement?

44-65%

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What is the primary etiology for impingement?

limited motion (hypomobility)

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What can cause limited motion involving impingement?

muscle/capsule shortening

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Muscle/capsule shortening can lead to…

disuse/immobilization

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Persistent FHP leads to….
- shortened ______’s/_________ capsule tightness and limits ER

IR/ anterior

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Persistent FHP leads to shortened scapular….

protractors/elevators/upward rotators

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With limited motion in impingement ________ or ________ of the acromion can occur

spurring or hooking

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What is the secondary etiology for impingement?

excessive motion (hypermobility)

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What can cause excessive motion involving impingement syndrome?

Ligamentous laxity from trauma, activities with excessive motion, and overhead throwing sports (baseball)

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What are the 4 causes of muscle inhibition?

pain, swelling, joint laxity, disuse

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What is the third etiology of impingement syndrome?

combination of primary/secondary (ex. scapular hypomobility and GH hypermobility)

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Which is the MOST common tendon involved with impingement?

Supraspinatus

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With the supraspinatus tendon, ________ is involved and may tear __________

A. tendinitis; suddenly
B. tendinopathy; gradually
C. tendinosis; gradually

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There is limited _______ in the distal supraspinatus and affects healing

vascularity

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Which head of the biceps is associated with impingement and may tear gradually?

long

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__________ is associated with the biceps long head and impingement

A. Tendinopathy
B. Tendinosis
C. Tendinitis

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The labrum in impingement may tear ______

A. suddenly
B. gradually

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Impingement at the subacromial bursa can lead to ______

bursitis

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When the sub and coracoacromial space are compromised it results in __________ or ___________ of the tendons

impingement/compression

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Pathomechanics of impingement:

Increased ________ on the tendons when they are loaded and as they wrap around the bone, results in ______

tension; compression

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What does PSGI stand for?

Posterior-superior glenoid impingement

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PSGI is more common in who?

overhead athletes

With PSGI, which motions are excessive?

ER ROM and anterior GH slide

With impingement syndrome, P! is typically localized to the ....

tip of the shoulder and referred into the lateral shoulder and arm

With impingement syndrome, there will be P! or limitation with...

elevation lifting/pushing.pressing activities reaching behind the back

What are possible scapular compensations for GH restrictions?

increased elevation inconsistent upward rotation ( increased and decreased) scapular dyskinesia (symptomatic and asymptomatic)

Which scapular test will test for passive upward rotation?

Scapular Assistance Test (SAT)

Which scapular test will tests for passive upward ROT and post tilt?

Scapular Repositioning Test

Which scapular test will test for voluntary retraction?

Scapular Retraction Test

Functionally, what will a pt. with impingement syndrome have issues with?

limited and P!ful reaching overhead, behind back, and lifting

What actions will be limited and P!ful with impingement?

FLX, ABD, and ER (IR may be as well)

Post shd. P! with ER indicates what kind of impingement?

posterior impingement

With Resisted/MMT for impingement, there will be inhibited....

scapular and cuff muscles

Propioceptive impairment is greatest at __________ elevations

higher

What should you perform in your biomechanical exam for shoulder hypomobility?

accessory motion

Hypomobility typically involves ______ shd tightness and limited post. ______

posterior and glide

With GIRD, the ratio is _____/______ at 90° abd > 1

IR/ER

ER typically _________ as IR ________ in overhead athletes

increases; decreases

With the infraspinatus tests or ER test in 0° ABD, a positive would indicate...

P! or giving away

With the IR Resisted Strength Test, _____ would be weaker than ______ @ 90° ABD

IR/ER

Which special test provides minimal to no support for impingement?

Speeds and Hawkins/Kennedy

The ______ _________ test provides moderate speculation for impingement

Empty Can

RC pathology related to age Youngest: _____% Middle: _____% Oldest: ______%

32 48 78

Is RC pathology associated with impingement symptoms? A. yes B. no

Dense regular connective tissue is Type __ collagen ____ elastin ______cytes _______ fibers for more indirectional loads

I Low Fibro Parallel

A tendon ______ tension and releases _______ with muscle actions

resists; energy

More _______ = better force transmission or storing of potential energy A. collagen B. elastin C. stiffness

The mid portion of the tendon is...

hypovascular and hyponeural

The insertion of the tendon is...

hypervascular hyperneural

Tendinopathy is _______% of general MSK injuries

Tendinopathy is involved with ____-____% of sports injuries

30-50

Which tendon condition is UNCOMMON? A. Tendinitis B. Tendinosis

________ is the inflammation of the tendon without structural changes due to overuse A. Tendinosis B. Tendinitis

With _______ it is typically has an acute and classic presentation A. Tendinitis B. Tendinosis

Which tendon condition will have the pt. TTP P! and limitation with lengthening P! with resisted testing/MMT (lengthened position)- amy be weak

Tendinitis

Which tendon condition is MOST common? A. Tendinosis B. Tendinitis

_________ occurs with degenerative changes and some inflammation

Tendinosis

Tendinosis involves degenerative changes with some inflammation due to... ________ stress and tendinitis (irregular or repetitive) _________ pathomechanics (influence or impingement) ________/vascular insufficiency (neural or tactile) ________ induced hyperthermia (non-exercise or exercise) ________ age (younger or older) _________ fluctuations (degenerative or hormonal)

repetitive impingement neural exercise older hormonal

With tendinosis, if it is acutely irritated what condition can the S&S present as...

tendinitis

With tendinosis, it is persistent for > ____- ____ weeks often with previously failed PT

4-6

Tendinosis is often mislabeled as ________ and has _______ tendon tolerances

tendinitis/decreasing

An _______ tendon may be visible with tendinosis

enlarged

With tendinosis, ROM and resistance testing/MMT are likely _________

WNL

With tendinosis, special tests are specific to tendon _________ and _________

etiologies/pathomechanics

With tendinosis, palpation will be __________ with decreased P! thresholds (tender or pain-free) ________ in-growth of vessels and nerves (decreased or increased) _________ P! neurotransmitters (increased or decreased)

tender increased increased

__________ has little to no inflammation A. Tendinitis B. Tendinosis

Degeneration and disorganization is involved with A. Tendinosis B. Tendinitis

Is it tendinitis or tendinosis associated with weakened and greater likelihood of overload?

tendinosis

Increased non-collagen matrix and fatty infiltration are associated with what tendon condition?

tendinosis

With tendinosis, corticospinal (voluntary movement) influences.... increased _________ increased __________- aberrant/excessive firing ________ influence as well

inhibition excitability bilateral

An __________ tendon tear is RARE A. acute B. chronic

acute

With acute tendon tears, it has _________ and oblique forces during fast ________ loading

higher; eccentric

An acute tendon tear is most likely with ______ and _______ A. youth; overuse B. age; repetitive stress C. age; overuse

With acute tendon tears, _________ and vascularity decrease A. collagen B. elastin

Atrophy and drying occurs with what kind of tear?

acute

With an acute tendon tear, a ________ smaller tendon is less pliable and durable

shorter

With tendinitis, you want to focus primarily to resolve what?

inflammation in 4-6 weeks

With tendinosis, you want to focus primarily to resolve what?

proliferating the tendon

With tendinosis, tensile strength initially improves @ ____-____ weeks

3-5

With tendinosis, greater tensile strength initially improves ____-_____ weeks

8-12

What kind of tendon tears can improve with PT?

gradual and partial

Traumatic and full tears of the tendon require what?

surgery

How many months post. op does it take to return to normal strength after a traumatic and full tear of the tendon?

10-12