Shoulder Impingement

Question 1

Primary Impingement Cause

Answer 1

• Congenital or age related changes of subacromial space that causes impingement

Question 2

Primary Impingement Overview

Answer 2

• Age 60+
• Gender 1:1
• MOI is degenerative

Question 3

Primary Impingement Signs & Symptoms

Answer 3

• Active and passive ROM limited
• Resisted testing = strong and painless if below the painful arc
• Decreased joint mobility

Question 4

Secondary Impingement Cause

Answer 4

• Lack of stability / coordination of shoulder girdle leading to faulty movement
• Hypermobility, unstable in joint due to RTC weakness or scapular dyskinesia

Question 5

Secondary Impingement Overview

Answer 5

• Age - adolescents / young adults
• Gender 1:1
• Lack of stability / coordination of shoulder girdle leading to faulty movement due to weakness or dyskinesia

Question 6

Secondary Impingement Signs and Symptoms

Answer 6

• Excessive active and passive ROM
• Weakness in rotator and scap muscles
• Hypermobility
• Sharp pain in painful arc
• Shoulder pain that is dependent on activity OH

Question 7

Painful Arc

Answer 7

• Caused by subacromial bursitis, calcium deposits, tendonosis, unstable scap, or impingement
• Pt can abduct from 45-60 with little difficulty, pain with abducting from 60-120, and pain diminished after 120 degrees
• Pain in the last 10-20 degrees of elevation = caused by pathology in acromioclavicular joint or positive impingement test

Question 8

Scapulohumeral Rhythm

Answer 8

• During 180 degrees of abduction, there is a 2:1 ratio
• With 180 degrees of abduction, there is 120 degrees of movement occurring at the GH joint and 60 degrees occurring at the scapulothoracic joint (2:1)

Question 9

Shoulder Impingement Special Tests

Answer 9

• Neers
• Posterior internal impingement test
• Reverse impingement sign (impingement relief test)