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South College MSK 4 > Week 1: Subacromial Impingement Syndrome > Flashcards

Week 1: Subacromial Impingement Syndrome Flashcards

1
Q

What is the most common condition of the shoulder that patients seek medical management?

A

Rotator cuff disease

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2
Q

At what age and activity level does rotator cuff disease occur?

A

Any age and activity level

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3
Q

According to the medical community, is rotator cuff disease from a single cause?

A

No, it is multifactorial

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4
Q

RCD classifications

A
  • Tendon degeneration
  • Tear to avascular region
  • Impingement
  • Trauma/instability
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5
Q

How does the process of tendon degeneration occur?

A
  • Fibroblasts undergo senescence and apoptosis
  • The fibers lose their parallel organization and fray
  • Tendon swells, making it susceptible to further damage
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6
Q

Senescence

A

The condition or process of deterioration with age

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7
Q

Apoptosis

A

The death of cells which occurs as a normal and controlled part of an organism’s growth or development

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8
Q

What is the critical zone of the tendon?

A

Region with low blood flow on the tendon

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9
Q

Where is the critical zone of the supraspinatus?

A

~10 mm from the distal attachment on the humerus

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10
Q

Impingement classifications

A
  • Primary
  • Secondary
  • Internal
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11
Q

What is primary impingement?

A
  • Impingement is the primary problem
  • Mechanical impingement b/t the GH joint and subacromial space
  • Associated AC joint problems
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12
Q

What role does strength imbalance play in primary impingement of the shoulder?

A

If the supraspinatus and deltoid are imbalanced, the humerus might flight superiorly

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13
Q

Structures involved in primary impingement?

A
  • RC tendons
  • Long head of biceps
  • GH joint capsule
  • Subacromial bursa
  • Subacromial arch
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14
Q

What causes primary impingement?

A
  • RC tendinopathy
  • Posterior capsule tightness
  • Morphology of the acromion
  • Postural dysfunction
  • Hooked acromion
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15
Q

Acromial types

A
  • Type 1
  • Type 2
  • Type 3
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16
Q

Type 1 acromion

A

Large area available for tendons and bursa

17
Q

Type 2 acromion

A

Small area available for tendons and bursa

18
Q

Type 3 acromion

A
  • Small area available for tendons and bursa

- Hooked acromion

19
Q

Neer classification for SIS

A
  • Stage 1
  • Stage 2
  • Stage 3
20
Q

Stage 1 SIS Neer Classification

A
  • Edema and hemorrhage
  • <25
  • Reversible
  • Conservative treatment
21
Q

Stage 2 SIS Neer Classification

A
  • Fibrosis and tendinopathy
  • 25-40
  • Recurrent pain
  • Consider subacromial decompression (SAD)
22
Q

Stage 3 SIS Neer Classification

A
  • Bone spurs and tendon rupture
  • > 40
  • Progressive disability
  • Surgical management
23
Q

Secondary impingment

A

Impingement is due to underlying instability

24
Q

Internal impingement

A
  • AKA undersurface impingement
  • Occurs at 90+ degrees ER and 90 degrees ABD
  • Inferior surface of supra/infraspinatus contacts glenoid rim
25
Q

Structures involved in internal impingement

A
  • Supra/infraspinatus
  • GH joint capsule
  • Subacromial bursa
26
Q

Causes of internal impingement

A
  • Capsular laxity
  • RC weakness
  • Scapular dyskinesia
  • Poor throwing mechanics
27
Q

Test item cluster for SIS (Park et al.)

A
  • Hawkins-Kennedy Test
  • Painful arc sign
  • Infraspinatus muscle test
28
Q

Patient presentation for SIS

A
  • Pain at night
  • Pain w/ OH activities
  • Complaints of stiffness
29
Q

Hawkins-Kennedy Test

A
  • Elbow flexed
  • IR
  • Horizontal ADD
30
Q

Painful arc sign

A
  • Patient actively elevates the arm in the scapular plane

- Sign of RC tendon pathology when patient hikes shoulder during ABD

31
Q

Infraspinatus muscle test

A

Pain on resisted ER

32
Q

Neer’s Test

A
  • Pt sitting
  • One hand depresses scapula
  • IR pt arm
  • Forced forward flexion
  • Positive test is pain
33
Q

Empty Can (Jobe)

A
  • Standing or sitting
  • Arms elevated to 90 degrees in scapular plane
  • Full IR
  • Downward force applied
  • Positive test is weakness or pain
34
Q

Patient presentation for secondary SIS

A
  • Young
  • History of instability
  • Pain w/ OH
  • Generalized laxity
  • OH reaching increases symptoms
35
Q

Objective findings for secondary SIS

A
  • Scapular dyskiinesis
  • Weakness or scapular stabilizers
  • Hypermobility of anterioir capsule
    • instability tests
36
Q

Patient presentation for internal SIS

A
  • Athlete
  • Pain OH reaching, throwing
  • Aching posterior shoulder
37
Q

Objective findings for internal SIS

A
  • +posterior impingement test
  • +instability tests
  • Scapular dyskinesis
  • Weakness of scapular stabilizers
  • Hypermobility anterior capsule
38
Q

Best exercises to manage scapular dyskinesis

A
  • Forward in side-lying
  • Horizontal ABD w/ ER
  • Side-lying ER
  • Prone extension
39
Q

Clinical prediction rule via logistic regression analysis

A
  • Pain-free shoulder flexion <127
  • Shoulder IR <53 at 90 degree ADB
  • Negative Neer test
  • Not taking meds for pain
  • Symptoms < 90 days

South College MSK 4 (14 decks)

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