Shoulder Flashcards
What are intrinsic factors of RTC tendinopathy?
Tendon degeneration due to age
neovascularization
change in vascularity with age
thinning of tendon and increased thickness of the structure
fatty infiltration
what are extrinsic factors of RTC tendinopathy?
abnormal scapulohumeral rhythm
shortening of posterior/inferior structures and pec minor
thoracic kyphosis
abnormal muscle activation patterns of RTC and scapular stabilizers
osseous changes to the AC joint or coracoacromial ligament due to overuse
What are the 3 types of shoulder impingement syndrome (SIS)?
- subacromial impingement
- intrinsic impingement
- internal impingement
what is subacromial impingement?
RTC tendons on the bursal side become comprssed in the subacromial space
what is intrinsic impingement?
tendon degeneration associated with age, shoulder muscle dysfunction, and overuse of the shoulder
what is internal impingement?
compression of the articular side of the infraspinatus tendon between between the superior-posterior glenoid rim and the head of the humerus when positioned in 90deg external rotation and 90deg abduction. It is associated with extrinsic factors and commonsly seen in overhead athletes. Sx is pain in the RTC
What is Glenohumeral Internal Rotation Deficit (GIRD)?
A type of internal impingement. PROM will reveal excessive ER and limited IR with an asymmetry of 25deg or more btwn involved and uninvolved sides
During functional testing, what symptoms are associated with supraspinatus impingement?
pain and weakness with abduction and external rotation during resisted isometric testing
What is the Hawkins-Kennedy test?
test of subacromial impingement
client in 90deg scaption or forward flexion, with elbow flexed, arm is passively move into IR
What is Neers Impingement Test?
test of subacromial impingement
place client in end-range flexion with slight IR and provide overpressure
what is Yergason’s test?
a test of involvement of the long head of the biceps in subacromial impingement
resisted elbow flexion with supination
What is the test for posterior internal impingement?
internal impingement between supra and infraspinatus and the posterior superior portion of the glenoid labrum
client is supine in a 90/90 throwing position and overpressure is applied toward more ER and extension
positive test is pain in posterior shoulder
What are the 3 progressive phases/goals of non-operative rehab for SIS?
Progressions are based on gradual tendon loading and include:
1. decreasing pain and increasing ROM through pain relief modalities and manual techniques, taping, activity modification, postural education, & isometric ther ex for scapular stabilizers and RTC in pain-free tolerance
2. increase ROM and soft tissue extensibility while continuing to decrease pain through pec minor and posterior capsule stretching, job mob to GH and scapulothoracic joints, and isotonic exercise for RTC and scapular stabilizers
3. Progressive strengthening and proprioceptive retraining once strength is 4/5 manual testing or equal to uninvolved side and there is normal GH rhythm
What are the 3 phases of rehab afer acromioplasty or subacromial decompression (SAD)?
Phase I: 0-2 weeks, decrease pain and increase PROM, pendulum exercises, wear sling between exercise
Phase 2: 2-6 weeks, manage pain, increase PROM, progress A/AAROM, sling as needed
Phase 3: 6-12 weeks, increase to full AROM, strengthen stabilizers for retrurn to function, full end-range AROM and PROM, open and closed chain kinetic training, plyometrics and proprioception drills
3 symptoms associated with RTC tear
- weakness with abduction and external rotation
- nocturnal shoulder pain
- greater than 60 years of age
3 tests for supraspinatus tear
- CHampagne Toast
- Drop Arm Test
- Jobe’s or Empty Can
2 tests for infraspinatus and teres minor tears
- External rotation Lag Sign
- Horn Blowers
3 tests for subscapularis tears
- LIft Off test
- Bear Hug Test
- Belly Press
Describe the Champagne Toast test
test of supraspinatus tear
Position GH joint at 30deg abduction and flexion with slight ER, as if moving to perform a champagne toast. Apply resistance in this position
describe the Drop Arm Test (aka Codman’s test)
test of supraspinatus tear
Passively elevate pt’s shoulder to 90deg abduction and ak them to hold this position x10s. Postive test when client is unable to hold
Jobe’s/Empty Can Test
Test of supraspinatus tear
Pt holds arm out into 90deg of scaption and thumb pointed down into internal rotation. Apply resistance
Describe the External Rotation Lag Sign
special test for infraspinatus and teres minor tears
pt’s elbow flexion to 90deg and humerus held at 20deg elecation in scapular plane at maximal ER less 5deg to allow for elastic recoil
pt asked to hold this position. positive if pt cannot hold position actively. record magnitude of lag to nearest 5deg
Describe Horn Blower’s Test
test for infraspinatus an teres minor tears
flex pt’s elbow to 90 and shoulder in 90deg and place pt into 5deg less than full ER. Positive if they cannot hold this position
Describe the Lift Off Test
special test for subscapularis tear
place arm on dosum of the back and ask pt to internally rotate arm to lift hand off back. Pos test if pt unable to lift hand away from their back
Describe Bear Hug Test
special test for subscap tear
Place involved hand on opposite shoulder. Hold this position while therapist attempts to pull hand from shoulder using an ER force. Positive if pt cannot hold the position
describe the Belly Press test
special test for subscap tear
ask pt to push into their belly while keeping wrist straight. Positive test is wrist flexion and elbow dropping to side
supraspinatus action
abducts shoulder
infraspinatus and teres minor action
externally rotate shoulder
subscapularis action
internally rotates shoulder