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Clinical Medicine > Shoulder Impingment > Flashcards

Shoulder Impingment Flashcards

1
Q

What is impingement?

A
  1. A progressive condition of shoulder pain and loss of motion function
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2
Q

What can cause impingement?

A
  1. A genetic structure of the shoulder
  2. Injury
  3. Repetition
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3
Q

What are the main joints of the shoulder?

A
  1. Glenohumeral joint: multiaxial, ball-and-socket synovial joint
  2. Acromioclavicular joint: plane synovial joint
  3. Sternoclavicular joint: saddle-shaped synovial joint
  4. Scapulothroacic joint: not a true joint
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4
Q

What are the 4 muscles of the rotator cuff?

A
  1. Subscapularis
  2. Supraspinatus
  3. Infraspinatus
  4. Teres minor
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5
Q

What is the origin, insertion and innervation of the subscapularis?

A

O: scapula
I: lesser tuberosity of the humerus
Nerve: Subscapular

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6
Q

What is the origin, insertion, and nerve supply of the Supraspinatus and infraspinatus?

A

O: Scapula
I: greater tuberosity
Nerve: Suprascapular nerve

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7
Q

What is the origin, innervation, and insertion of the teres minor?

A

O: scapula
I: greater tuberosity
Nerve: axillary

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8
Q

What is the subacromial space?

A
  1. The area beneath the acromion, the coracoid process, the Acromioclavicular joint, and the coracoacrmial ligament
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9
Q

What are the dynamic stabilizers of the glenohumeral joint?

A
  1. Rotator cuff
  2. Biceps tendon
  3. Other shoulder girdle muscles
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10
Q

What are the static stabilizers of the glenohumeral joint?

A
  1. Capsule
  2. Labrum
  3. Glenohumeral ligaments
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11
Q

What do the rotator cuff muscles do to the humeral head?

A
  1. Generate torque
  2. Depress the humeral head
    *90% ER strength
    *45% abduction strength
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12
Q

What are some possible causes or contributing factors to shoulder impingement?

A
  1. Outlet syndrome
  2. Subacromial spurs
  3. AC joint osteophytes
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13
Q

What are the 3 different variations of an acromion?

A

Type I: normal or flat
Type II: increased curve and dips downward
Type III: further increased curve (hooks) and dips downward, obstructs the Supraspinatus outlet

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14
Q

Where is there increased risk of rotator cuff tears?

A

Type II and Type III

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15
Q

If the coracoacromial ligament is calcified what can that lead to?

A
  1. Impingement
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16
Q

Why is impingement classified as a vicious cycle?

A
  1. Bc pain from injury can lead to disuse of the shoulder
  2. The disuse can lead to weakness/atrophy of the rotator cuff and upward migration of the humeral head
  3. The superior migration then increases the impingement
17
Q

What is stage one of impingement?

A
  1. Edema and or hemorrhage
  2. Occurs most in patients less than 25 years old
  3. Due to overuse
  4. Typically reversible
18
Q

What is stage 2 of impingement?

A
  1. More advanced of stage I
  2. Tends to occur in patients aged 25-40 years
  3. Irreversible tendon changes/fibrosis typically present
19
Q

What is stage III of impingement?

A
  1. Occurs in patients over 50
  2. Involves tendon tearing/rupture
  3. Typically associated with joint degeneration overuse, fibrosis, and tendinosis
20
Q

What are the common symptoms of shoulder impingement?

A
  1. Pain
  2. Weakness
  3. Loss of motion
  4. Sleep disrupted
    *sleeps in a recliner can’t lie down flat bc of painful shoulder
21
Q

What is the age group of shoulder impingement?

A
  1. Usually older patients
    *but can be see in overhead athletes at a younger age
22
Q

What will be shown on the PE if a patient has shoulder impingement?

A
  1. AROM is painful
  2. A/C joint tenderness
  3. Supraspinatus/greater tuberosity tenderness
  4. Biceps tendon tenderness
  5. Atrophy
23
Q

What are the specials test to complete is you’re suspecting a patient has shoulder impingement?

A
  1. Neer’s sign
    *Passively raise the arm and put it into flexion (+ if grimace)
  2. Hawkins sign
    *Abducted and externally rotate arm
  3. Speed testing
    *Want to isolate biceps tendon, the arm will be in supination and push down on the arm
  4. Supraspinatus isolation
    *Arms out, thumbs down, push down (+will not be able to resist your movement)
24
Q

If a patient has a RCT or impingement how will corticosteroids help it?

A

Impingement: condition will improve
RCT: pain improves, but may still have strength and motion deficits

25
Q

What degrees will the arm be able to move if there is shoulder impingement syndrome?

A

0 to 70 degrees
120 to 180
*will be painful around 70-120 degrees

26
Q

What diagnostic testing is recommended for shoulder impingement?

A
  1. Plain radiograph
    *AP view with arm at 30 degrees external rotation
    *Outlet Y view
    *Axillary view
    *wont show the tendon but will show a calcified tendon
27
Q

What is the best test for evaluating a rotator cuff?

A
  1. MRI
    *can evaluate RCT, tendinitis, bursitis, tumors/masses
    *the fluid will look black or white (black is where the tear is)
28
Q

What is the treatment for Type I shoulder impingement?

A

1: rest and stop aggravating activities
2: prolonged PT/ strengthening for the rotator cuff
*IR, ER, abduction
3: NSAIDS (naproxen 600-800mg)
4: ice
*NEVER USE A SLING

29
Q

What is the treatment for a type II shoulder impingement

A

1: Involves more formal PT
2: modalities (E-stim and ultrasound)
*can use corticosteroids

30
Q

What is the treatment for Type III impingement?

A

1: Most likely will need surgery due to associated tearing of the rotator cuff as well as the bicep

31
Q

What type of injections are used for shoulder impingement?

A
  1. Lidocaine + Corticosteroid
    *can be therapeutic and diagnostic
32
Q

What are the indications to use lidocaine + corticosteroid if a patient has shoulder impingement?

A
  1. Non responsive to therapy NSAIDS
  2. Poor surgical candidates with surgical conditions
33
Q

What is the injection technique?

A
  1. Posterior subacromial approach
  2. Feel for the acromion and inject inferior to the acromion, but angle up to the underside of the acromion
34
Q

What are the adverse affects if a patient has a RCT but does not want surgery?

A
  1. Will not heal
  2. Retraction
    *the rotator cuff is pulling away from the tendon. The muscle of the rotator cuff starts pulling on the tendon
  3. Atrophy
    *The patient will lose the muscle, the tendon will atrophy. There will be fatty atrophy the tendon and the muscle turns to fat
35
Q

What are the different types of surgical options for shoulder impingement?

A
  1. Open procedure
  2. Arthroscopic procedure
  3. Rotator cuff repair
  4. Subacromial decompression

Clinical Medicine (164 decks)

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