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Musculoskeletal 1 > Subacromial Pain syndrome/Shoulder impingement > Flashcards

Subacromial Pain syndrome/Shoulder impingement Flashcards

1
Q

Subacromial pain syndrome/anterior shoulder pain frequency and prevalence in what areas?

A
  • most common shoulder disorder
  • prevalence is high in repetitive over head sports (swimming, volleyball, throwing)
  • prevalent in manual jobs requiring overhead work
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2
Q

what are the types of shoulder impingement

A
  • anterior impingement/subacromial space
  • posterior internal impingement
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3
Q

Anterior impingement/subacromial space

A
  • compression of structures between anterior humerus and corocoacromial arch
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4
Q

Posterior internal impingement

A
  • overhead athletes/thrower RC infraspinatus is compressed against posterior glenoid and labrum
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5
Q

Types of Anterior impingement/subacromial space

A
  • primary vs secondary
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6
Q

Primary Anterior impingement

A

Anatomical reasons:

  • osteophytes on acromion
  • abnormally shaped acromion
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7
Q

Secondary Anterior impingement

A
  • muscle imbalances: rotator cuff, scapular muscle weakness, decreased endurance, muscle tightness (pec minor)
  • hyper mobility/hypomobility GH, ST joints leads to abnormal kinematics
  • poor posture: anterior tilt of scapula with rounded shoulders –> muscle tightness/weakness
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8
Q

What structures are involved in shoulder impingement

A
  • SA bursa
  • supraspinatus tendon
  • superior capsule
  • LH of biceps tendon
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9
Q

For full abduction how much does each joint int he shoulder move for the motion to occur

A
  • GH: 120º
  • ST: 60º
  • AC: 30º upward rotation
  • SC: 30º elevation
  • 40º of clavicle with posterior rotation
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10
Q

What are the force couples at the shoulder

A
  • supraspinatus, deltoid = abductor couple
  • Subscap, infraspinatus, teres minor = downward pull of HH in glenoid
  • Upward rotation of scapula thoracic: upper trap, lower trap and Serratus anterior
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11
Q

How does posture/rounded shoulders cause impingement

A
  • scapular depression, anterior tilt due to tight pec minor
  • decreases subacromial space
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12
Q

True abduction and Scaption in regards to shoulder impingement

A
  • true abduction: gives less space due to hitting the back of the acromion
  • scapular plane: humeral head is more situation in the higher part of the acromial arch = less likely to impingement
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13
Q

How does an anterior impingement naturally progress

A
  • cumulative: many reps over head and overtime in a decreases subacromial space
    1. initial tendonitis/tendonosis
    2. enlargement of bursae
    3. osteophytes off acromion
    4. partial tears in RC
    5. full thickness RC tears
    *due to poor vascularity and degeneration of RC
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14
Q

Mulitfactoral - acromial shapes due to osteophytes

A
  • Smooth (stage 1)
  • Curved (stage 2)
  • hooked (stage 3)
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15
Q

How does hypomobility in GH joint cause impingement?

A
  • joint capsule tightness
  • esp. if it is limited inferiorly or posteriorly
  • HH cant glide inferior or posterior on glenoid
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16
Q

How does hypermobility and RC weakness cause impingement

A
  • weak infraspinatus, Teres minor, subscapularis casues an inefficient downward pull of the humeral head
  • combined with excessive movement can cause impingement and less stability
17
Q

How can posture cause impingement

A
  • forward head and rounded shoulders can decrease subacromial space
  • tightness in pec minor
  • weakness of serratus anterior, upper adn lower trap
18
Q

Describe how a posterior internal impingement occurs

A
  • in late cocking phase
  • throwers: excessive ER with posterior roll and anterior glide of humeral head
  • infraspinatus internal surface impinges against glenoid due to excessive ER
19
Q

Posterior internal impingement signs and symptoms

A
  • pain in posterior shoulder during late cocking phase
  • posterior internal impingement test: place shoulder in 90 of abduction with 15-20 extension and max ER
  • positive if pain occurs in the posterior shoulder
  • pain with palpation of infraspinatus to confirm as well as RI of ER
20
Q

Examination for impingement: Review of systems and history

A
  • anterior impinge = frequent elevation activites; pain with elevation or adduction/IR
  • Internal impingement: throwers; pain posterior, excessive ER and anterior glide, many reps, overuse, inadequate rest
21
Q

Examination for impingment: diagnostic test/PMH

A

DX:

  • X-Rays: acromion shape (hooked) osteophytes
  • MRI: rotator cuff tear

PMH:

  • episodes of bursitis, tendinitis/tendinosis
  • cortisone injections (2-3 over weeks or months)
  • previous physical therapy bouts
22
Q

Examination for impingement: observations

A
  • posture: fwd head, rounded shoulders, anterior scapular tilt, scapula elevation/winging
  • functional screen: dysfunctional movement
  • Atrophy RC
23
Q

Examination for impingement: examination/signs of impingement

A
  • GH A/PROM = limited or excessive
  • Painful arc = 60-120 (anterior impingement)
  • posterior impingement (throwers) = pain in late cocking phase, increase ER than IR
24
Q

Examination for impingement: GH, AC, SC, ST mobility testing

A
  • hypomobile, abnormal capsular end feel (stiff), posterior/inferior capsule
    hypermobilty/instability:
  • abnormal capsular end feel = laxity
  • poor dynamic stabilization of RC
25
Q

Examination for impingement: musculature

A
  • resisted isometrics = weakness/painful (rotator cuff and biceps)
  • ST muscles weak, poor endurance of serratus anterior upper and lower trap
  • length testing: pec minor and major
26
Q

impingement special tests

A
  • Neer
  • hawkins-kennedy
  • coracoid impingement sign
  • supine impingement test
  • painful arc test
  • scapular relocation tests/empty can
27
Q

Predictors for anterior impingement syndrome:

Clinical Findings

A
  • (+) hawkins-kennedy
  • (+) painful arc test
  • supraspinatus, infraspinatus pain and weakness
28
Q

Examination for impingement: palpation

A
  • pain with palpation on
  • suprapsinatus tendon: put arm in Ext+IR and palpate near greater tubercle
  • infraspinatus tendon
  • long head of biceps tendon
29
Q

Impingement due to …?

A
  • posture:
  • decreased RC strenght/endurance
  • decrease scapula strength and endurance
  • scapula dyskinesia
  • shoulder hypomobility
  • shoulder hypermobility
  • hooked acromion
  • combination
30
Q

Neer Subacromial impingement classification: stage 1

A
  • young age <25
  • inflammation of RC, edema, hemorrhage
  • RI = strong and painful
  • mild
31
Q

Neer Subacromial impingement classification: stage 2

A
  • age 25-40 (history of episodes)
  • hx: tendinitis/bursitis; fibrosis of RC tendon
  • RI = strong and painful
  • capsular pattern developing
  • could have injections
32
Q

Neer Subacromial impingement classification: stage 3

A
  • age >40
  • bone spurs, osteophytes, hooked acromion
  • tendon disruption
  • RI weak and painful (could have a tear now)
  • capsular pattern present
  • may require surgery
33
Q

Neer Subacromial impingement classification: stage 4

A
  • age>60
  • chronic RC tear progressed to full tear
  • surgery – depends on quality of tissue
  • decompression/acromioplasty (create more space) :
    - RC repair
    - removal of the acromion
    - resect the distal calvicle
    - release the coracoacromial ligament
34
Q

Acute stage impingement treatment

A
  • modalities: pulsed US (LIPUS), iontophoresis, cryotherapy
  • rocking rhythmic exercise (pendulums)
  • grade 1-2 mobs
  • educate the patient: posture, impinge zone, activity modification
35
Q

MD interventions for shoulder impingement

A
  • medications (NSAIDs, pain meds, steriods)
  • steriod injections
  • surgery decompression acromioplasty
  • RC repair if needed
36
Q

standardized treament program

A
  • 3 phase = 12 weeks
  • manual therapy: shoulder stretches, mobilization/manipulations
  • strengthening RC/scapular muscules
  • patient HEP, educaiton, activity modificaiton
  • 8/10 patients increase DASH by 50%
37
Q
A

Musculoskeletal 1 (42 decks)

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