Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

MSK 1 > 9/27 - Rotator Cuff NonOp > Flashcards

9/27 - Rotator Cuff NonOp Flashcards

1
Q

what are 3 different terms that all describe subacromial shoulder pain

A

subacromial impingement syndrome
rotator cuff tendinopathy
rotator cuff related shoulder pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

scapulohumeral rhythm ratio for 180deg of shoulder elevation

A

2deg of GH motion for every 1deg of ST motion

180deg shoulder elevation
- 120deg humeral elevation
- 60deg scap rotation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

the coordinated effort in scapulohumeral rhythm is important for what function

A

overhead function
- shoulder elevation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

what is the primary function of the rotator cuff

A

offset force of deltoid
- the ER and IR that it also does is less important

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

what does the RC provide at the GH joint

A

dynamic stabilization by compressing humeral head into glenoid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

what is the relationship of the RC muscles to the GH joint capsule

A

RC muscles blend w capsule & create dynamic ligament tension
- since fibers blend, when cuff contracts provides tension in the capsule

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

what are the force couples at work in the shoulder joint

A

deltoid - RC
anterior-posterior RC
upper trap - serratus anterior

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

what happens when there is an unopposed deltoid

A

superior migration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

what ms are included in the anterior and posterior force couple

A

anterior - subscap
posterior - infra and teres minor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

why would an isolated supraspinatus injury have a good prognosis

A

not part of a force couple

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what osteokinematics is the upper trap - serratus anterior force couple responsible for

A

shoulder elevation
upward rotation of the scap

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

what are 4 functions of the upper trap - serratus anterior force couple

A
  1. optimal position of glenoid
  2. deltoid length - tension
  3. prevents impingement
  4. stable base to recruit scap musculature
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

how does the upper trap - serratus anterior force couple prevent impingement

A

creates posterior tipping which inc the subacromial space

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

what are extrinsic mechanisms behind subacromial impingement

A

subacromial compression
- acromial arch shape
- posture (more forward, less space)
- ms performance (dec, less upward rotation)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

what are intrinsic mechanisms for subacromial impingement

A

age
- dec vascularity >40yo (healing potential declines)
- tendon degeneration

hypercholesterolemia
DM
smoking

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

what do all intrinsic mechanisms play a role in? where else does this apply other than non-op cases?

A

tissue’s ability to heal

relates to post op
- quality of tissue relates to how well do after surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

what is in the subacromial space? what role do these play in subacromial impingement?

A

tendons of RC
LHB tendon
subacromial bursa
superior capsule

all can create sx if compressed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

how does sub acromial space change w shoulder motion

A

in a normal shoulder - space gets smaller as you get up and above head

space is 1/2 the size it was w shoulder down when shoulder raised at 90deg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

what is a hypothesis for subacromial impingement

A

dec ST upward rotation inc risk for RC compression d/t dec clearance in subacromial space

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

what combined motion w shoulder elevation can inc sub acromial clearance if reduced scap upward rotation

A

max IR
- RC insertions may have passed under lateral acromion at 90deg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

what motions inc the acromiohumeral distance at 45deg of elevation

A

inc ST upward rotation
posterior tilt

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

what can change the impact of dec ST upward elevation on subacromial space

A

depends on angle of elevation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

how does dec ST upward rotation change the risk of compression

A

shifts risks to lower angles

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

the subacromial space is the smallest between what angles

A

50-70deg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
how does the position of the RC change during shoulder elevation? what is the relevance of this when it comes to sx of compression
RC already medial to acromion in most at 90deg elevation - RC compression at lower angles may become sx in midrange due to inc force production
26
what would sx >90deg of elevation be related to
internal impingement (RC vs glenoid) or biceps
27
what was the old school of thought behind the mechanism of impingement? why is this not thought anymore?
a mechanical problem - run out of space and pinch stuff in between - true mechanical = compression of tissues hasn't been shown in all pts pts can have nonmechanical impingement - from tension in musculature
28
how does mechanical vs nonmechanical impingements differ in treatment plans
they don't - overall treatment is the same - interventions for hypomobility and dec strength
29
what are 5 etiology behind shoulder impingement
1. humeral head depressor weakness / fatigue 2. GH instability 3. posterior capsule tightness 4. scap dyskinesia / ms weakness 5. subacromial crowding (ie bone spurs, other anatomical changes)
30
is acute or chronic etiology more commonly seen w shoulder impingement
acute is rare chronic more common - usually overuse
31
what are 3 chronic etiologies of shoulder impingement
repetitive microtrauma throwing sports vocational demands
32
how do the presenting sx differ in the late cocking phase on location of path
anterior instability = anterior pain posterior impingement = posterior pain
33
what does it mean to have painful arc? when is this typically seen?
hurts starting at 50-70deg and then as get more flexion, starts to feel better - seen in subacromial pain syndrome
34
what are sx of subacromial pain syndrome
ant lat shoulder pain pain >/= 90deg painful arc pain worse at night
35
what sx are seen w a RC tear
ant lat shoulder pain dec strength**** night pain pain wakes from sleep*****
36
what sx are seen w posterior internal impingement
post shoulder pain in ABD-ER overhead athletes have dec performance
37
what sx are seen w long head of biceps tendinopathy
ant shoulder pain w shoulder flex and arm sup
38
what role does the biceps play in the function of an overhead athletes
deceleration phase of throwing
39
what frequently leads to LHB tendinopathy bc of one of its functions
can provide stability, esp if ligamentous structures slacking - has to work harder, esp if RC path
40
r/i findings for subacromial pain syndrome
(+) impingement signs painful arc pain w resisted ER (+) LHB tests
41
r/i findings for substantial RC tear
age >60yo (+) lag signs weakness atrophy
42
what type of problem should you think if lacking AROM and PROM
joint problem (ie adhesive capsulitis)
43
what type of problem should you think if poor AROM but good PROM
muscular problem
44
what is the biggest differential between subacromial pain syndrome and RC path
whether dec strength or not
45
what are 6 general areas of predisposing factors that can lead to impingement if impairments occur at those areas
1. AC joint 2. bursa 3. capsule/ligaments 4. scapula 5. acromion 6. RC
46
what impairment at AC joint could lead to impingement
degenerative bone spurs - where acromion and clavicle meet is a common place for bone changes
47
what impairment of the bursa can lead to impingement
chronic thickening - the more irritation, will get thicker - won't have same properties
48
what impairment of the capsule/ligaments can lead to impingement
hypermobility hypomobility
49
what impairment at the scapula can lead to impingement
abnormal position/rhythm - winging - anterior tipping anterior tipping may be d/t pec minor tight - brings acromion forward and dec space
50
what impairment at the acromion can lead to impingement
shape - if curved or hooked
51
what impairment at the rotator cuff can lead to impingement
impaired force couples unopposed delt
52
what does a shrug sign indicate
delt overpowers the RC - RC should hold joint in place while delt does that
53
etiology of a primary impingement
disruption of normal mechanics
54
what is a characteristic of primary impingement
hypomobile
55
what are important things to look at in subacromial pain syndrome bc can often have similar sx as impingements
strength and ROM
56
what are ways to normalize motion when treating primary impingement
capsular tightness - inferior and posterior mobs soft tissue adaptive changes - pec minor - if ms length issues
57
whaat muscles should be rehabed to improve dynamic stability when treating a primary impingement
posterior cuff scap ms
58
what are 5 treatment interventions for primary impingement
1. dec pain/inflammation 2. normalize motion 3. improve dynamic stability/endurance 4. postural correction 5. pt ed / activity modifications
59
what should you be educating your patients on when treating primary impingement
avoid repetitive microtrauma
60
sx of secondary impingement
hypermobility of static stabilizers
61
MOI of secondary impingement
overuse leads to loss of dynamic stability provided by rotator cuff
62
common pt population of secondary impingement
younger - 15-40yo
63
etiology of secondary impingement (8)
1. static stabilizers stretched 2. inc GH translation 3. RC fatigues (RC working harder to keep joint stable) 4. overuse tendinitis 5. tendon fibers fail 6. RC unable to control HOH during elevation (and offset force of delt) 7. superior migration occurs 8. RC dysfunction & pain
64
what is the goal of treatment for secondary impingement
help provide dynamic stability by inc strength of RC and scap stabilizers
65
secondary impingement treatment interventions
cuff strengthening - focus posterior scap stabilization - retraction - protraction - depression NM influences avoid repetitive microtrauma
66
how does a normal shoulder translate
posterior
67
MOI for posterior internal impingement (4)
1. ABD & ER (late cocking phase) 2. overhead athletes have excessive anterior translation & GH ER 3. compressive force b/w greater tub and posterior/superior labrum 4. undersurface of supraspinatus and infraspinatus implicated
68
pathophys of primary and secondary impingements
outlet impingement - abutting superior surface of HOH on acromion
69
presentation of posterior internal impingement
pain w excessive ER at 90deg ABD sx w overhead activities hx of recurrent sx loss of control and velocity
70
test to r/i posterior internal impingement
(+) jobe subluxation/relocation
71
interventions for posterior internal impingement are similar to interventions of what?
secondary impingement - difference is where sx are which is d/t where and how the tissues are being impacted
72
physical exam for posterior internal impingement
posterior pain on palpation - infraspinatus tendon anterior capsule laxity posterior shoulder tightness normal ROM - inc ER and dec IR - GIRD weak external rotators weak scap ms
73
why do you see anterior capsule laxity in overhead athletes
so much ER allowed
74
describe how IR/ER arc of motion changes in overhead athletes
shoulder IR/ER arc = 180deg - arc shifts w inc ER so less IR
75
where do you want to especially promote dynamic stability via perturbations for posterior internal impingement
challenging positions - aka late cocking phase
76
PT interventions for posterior internal impingement
dec pain/inflammation - avoid irritating motions/activities dynamic stability of RC - rhythmic stabilization - closed chain drills scap ms training - emphasize retraction & depression NM training - perturbaiton proper throwing mechanics
77
what structures are involved w posterior internal impingement that sx may be coming from (6)
subacromial bursa RC ms/tendons acromion coracoacromial ligament capsule intra-articular structures
78
what are factors that should be addressed when treating posterior internal impingement (4)
1. altered shoulder kinematics (2deg capsular tightness 2. RC/scap ms dysfunction 3. overuse 4. poor posture
79
what are interventions for posterior internal impingement dependent on
pts and reactivity weak = stronger stiff = move
80
what types of treatments have strong recs for posterior internal impingement
exercise - home and/or clinic - pain <5/10 - (+) resistance - 12wks exercise & manual therapy - joint mobs, MWM, STM, manips
81
who is appropriate for a corticosteroid injection as an intervention for posterior internal impingement
if reactivity is high - pain w ADLs not performance of sport can't work on deficits until reactivity calms down
82
what modality should you not use on posterior internal impingement
laser
83
what modalities have no evidence of effectiveness in treating posterior internal impingement
US extracorporeal shockwave therapy
84
why is extracorporeal shockwave therapy making a comeback to treat posterior internal impingement
option if can't do corticosteroid bc of DM
85
what are the best interventions for posterior internal impingement
therex mobs
86
op vs nonop w a RC tear
do well w/o surgery if go to PT try PT before surgery

MSK 1 (31 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions