E3- Shoulder Impingement-Tendinosis Flashcards
(124 cards)
1
Q
what is the functional ROM of the shoulder for washing hair in the shower
A
120 flexion for hair
70 flexion for trunk
2
Q
what is the functional ROM for donning a shirt in the shoulder
A
90 flexion
3
Q
what is the functional ROM for reaching high shelf in the shoulder
A
150 flexion
4
Q
what is the functional ROM for fasten a bra behind back in the shoulder
A
50 + extension
70 horizontal ADD
full IR
5
Q
what bones and jts move with the shoulder complex motion
A
scapula
humerus
clavicle
upper thoracic
SC
AC
GH
scapulothoracic
6
Q
movement of the humerus is accompanied by what other movements
A
scapula
AC,SC, upper thoracic
7
Q
what is important about companion motions
A
assists with optimal motion
prevent impingement
keeps actin and myosin overlap efficient
8
Q
what is active insufficiency
A
so much overlap of muscle they can not wok properly
9
Q
why does companion motion prevent active insufficiency
A
more force due to cross bridging
10
Q
what humeral motions do you observe during 150 degree overhead
A
FLX
ABD
ER
11
Q
what scapular motion do you observe with 150 degree overhead
A
protraction
elevation
upward RT
12
Q
what are the eccentric controls of humerus with overhead movement to 150
A
EXT/ADD- post deltoid, lat dorsi, teres major, LH triceps, pec major
IR- subscapularis, pec major, lat dorsi, teres major, ant deltoid
13
Q
what are the concentric controls of humerus with overhead movements to 150
A
FLX- ant/mid deltoid, coracobrachialis, bicep brachii
ABD-supraspinatus
ER- infraspinatus, teres minor, post deltoid
14
Q
what are the concentric controls of scapula with overhead movements to 150
A
elevators- levator scapulae, upper trap, rhomboids
protractors- serratus anterior and pec minor
upward rotators- SA and U/L trap
15
Q
what are eccentric controls of scapula with overhead movement to 150
A
depressors- LT, Lat dorsi, pec minor, subclavius
retractors- MT, LT, rhomboids
downward rotators
16
Q
what is the result of sh. complex motion to 150 degrees due to the scapula
A
max tension on brachial plexus as clavicle rotates post
17
Q
what is the motion, concentric and eccentric controls of the humerus with overhead motion to 200 degrees
A
same as 150
18
Q
what is the motion of the scapula when reaching overhead between 150-200 deg
A
depression
retraction
post tilt - SC jt
19
Q
what is the concentric and eccentric controls of the scapula when reaching overhead between 150-200 deg
A
same plus lower trap
20
Q
what motion is the upper thoracic producing with reaching overhead in 150-200 deg
A
ipsilateral SB, RT, and EXT
21
Q
why is unilateral motion of the upper thoracic spine important
A
triggers concenteric control of LT along with subclavius for scapula and clavicle motion
prevents tension on brachial plexus
22
Q
what can happen if the upper thoracic has a unilateral restriction
A
GH and AC become hypermobile
inhibit LT activity leading to impaired scap motion
23
Q
what can happen to the brachial plexus with an upper thoracic unilateral restriction
A
allows excessive post clavicle RT and excessive tension on med cord cutting off the median and ulnar n with overhead motion
misdiagnosed as TOS
24
Q
what is the motion of humerus with reaching behind your back
A
hyper extension
add
ir
25
what is the motion of the scapula when reaching behind your back
elevation
downward RT
retraction
26
what are the concentric controls of the humerus when reaching behind your back
EXT/ADD- post deltoid, lat dorsi, teres major, LH triceps, pec major
IR- subscapularis, pec major, lat dorsi, teres major, ant deltoid
27
what are the eccentric controls of the humerus when reaching behind your back
FLX- ant/mid deltoid, coracobrachialis, bicep brachii
ABD-supraspinatus
ER- infraspinatus, teres minor, post deltoid
28
what are the concentric controls of the scapula when reaching behind your back
elevators- levator scapulae, upper trap, rhomboids
retractors- MT, LT, rhomboids
downward rotators
29
what are the eccentric controls of the scapula when reaching behind your back
depressors- LT, Lat dorsi, pec minor, subclavius
protractors- serratus anterior and pec minor
upward rotators- SA and U/L trap
30
which muscles in the shoulder complex would be inhibited and the most important focus
SITS
lower trap
rhomboids
31
how can we activate the RTC
tighter grip with activities
preposition the humerus in ER
32
what muscles are activated when we ER the humerus
lower trap
mid trap
rhomboids major and minor
levator scapulae
33
when does SA have most activation
closed chain activities
34
what TE can we do for more SA activation
wall slides - push the wall as we slide up
weight shifts
push ups
off/on unstable surface
35
why do I, T, W, Y in prone
eliminate the upper trap and isolate the shoulder muscles
36
why do both arms during MET exercise
more motor coordination activation with the uninjured UE
37
what has to happen to local m before higher level or global m happen
activation
endurance
strength
coordination
38
what are the benefits of cervical manip for sh complex
diminished pain
improve sh and neck mobility
39
what are the benefits of C5-6 JM for sh complex
immediate increase in m strength of ER
40
what are the benefits of C/T JM for sh complex
improved symptoms and function
41
why can cervical issues cause sh issues
regional interdependence- cervical dysfunction (innervation) can alter sh m activity due to shared innervation
42
what are 4 (+) for a good prognosis in sh issues
lower baseline
lower symptoms at rest
higher pt expectation
higher self efficacy despite symptoms
43
what is SAPS
subacromial pain syndrome
44
what is a syndrome
cluster of symptoms
does not indicate definitive signs or causes
45
what are the two most common structures that are impinged
supraspinatus and long head of bicep
46
how can the tendon develop tendinopathy
sub and coracromial space is compromised resulting in impingement or compression of tendon
47
what can happen with increased tension in an impingement
increased activation on tendons when loaded as they wrap around the bone can result in compression
48
what is the most common structure involved in impingement
supraspinatus tendon
49
what other structures are involved with impingement
long head bicep tendon
labrum
subacromial bursa
50
how can the subacromial bursa be affected with impingement
result of everything else causing inflammation and coming into the bursa
51
what is primary impingement syndrome
limited motion
52
how can persistent FHP cause primary impingement
leads to shortened IR/ant capsule that limits ER
53
how can regional interdependence cause primary impingement
insufficient motion of sh m due to cervical dysfunction
54
what can cause the spurring and hooking of the acromoin
inflammatory repair phase producing more fibrotic tissue due to the bone taking on more compression
55
what is secondary impingement
excessive motion
56
what can cause primary impingement
fibrotic capsular change
disuse/immobilization
persistent FHP
regional interdependence
spurring/hooking of acromion
57
what can cause secondary impingement
trauma resulting in adjacent jt hypomobility
disuse/immobilization
regional interdependence
58
how can regional interdependence cause secondary impingement
insufficient sh stabilization
proprioceptive impairment at higher elevation
motion is worse than proprioceptive impairment= more coordination
59
can there be a combo of primary and secondary impingement
if so, how
yes
scapular hypo and GH hyper
60
what is PSGI
post-sup glenoid impingement
more overhead athletes
ER and ant GH glide = excessive
impingement of post labrum = breakdown
61
what can the pt tell you if they have impingement
pain at the tip and lateral shoulder
pain with reaching, lifting, pushing, pressing activities, and reaching behind back
62
how would you know if nociplastic pain is occuring with impingement
how long the pain is occuring and sensation the pt is feeling
63
what ob signs are with impingement
FHP
increased elevation due to UT compensating
inconsistent upward RT
scapular dyskinesia
64
what are the scapula alteration test
help move scapual bc muscles are doing it
testing to see if function or symptoms change with help
65
what is the scapular assistance test
passive upward RT
66
what is scapular repositioning test
passive upward RT and post tilt
67
what is the scapular retraction test
voluntary retraction
68
what function/ROM signs are present with impingement
limited and painful reaching overhead and behind back and with lifting
painful into FLX, ABD, ER and possibly IR
69
what does post sh pain indicate
posterior impingement
70
what are RST/MMT signs with impingement
inhibited scapular and cuff muscles- ER is weaker
proprioceptive impairments
71
what can happen with accessory motion in impingement
hypo=primary, post sh tightness with limited post glide
hyper= secondary
72
what is glenohumeral IR deficit special test for impingement
IR/ER at 90 deg ABD > 1
ER increases and IR decreases in overhead athletes
influences humeral head position in glenoid
73
what is infraspinatus or ER special test for impingement
in 0 ABD
painful or giving way
high spec
74
what is IR restisted strength special test for impingement
IR weaker than ER at 90 deg ABD
75
what does research say about imaging with impingement
pathology not associated with impingement symptoms
76
what is tendon made of
type 1 collagen
low elastin
fibrocytes
parallel fibers for more unidirectional loads
77
what does a tendon resist
tension and releases energy with muscle action
78
why is stiffness better for a tendon
better force transmission or storing of potential energy
79
describe mid portion of tendon
hypovascular
hyponeural
80
describe insertion of tendon
hypervascular
hyperneural
81
what is tendinitis
uncommon
inflammation of tendon without structural changes due to overuse
82
what are the S&S of tendinitis
typically acute
TTP
pain with limitation with lengthening
pain with resisted testing/MMT, particularly in lengthened position- may be weak
83
what is tendinosis
most common
degenerative changes with some inflammation
84
what can cause tendinosis
repetitive stress and tendinitis
impingement patho
neural/vascular insufficiency
exercise induced hyperthermia
older age
hormonal fluctuations
85
what are symptoms of tendinosis
persistent >4-6 wks often with failed PT
decreased tendon tolerance
86
what can be found in a scan for tendinosis that is persistent
ob- enlarged tendon due to fat
ROM- WNL
RST/MMT- WNL
palpation - TTP
87
why is tendinosis TTP
decreased pain thresholds
increased in growth of vessels and nerves
elevated pain neurotransmitters
88
what is pathologically going on with tendinosis
little to no inflammation
fiber changes seen on imaging
corticospinal (voluntary movement)
89
describe an acute tendon tear
rare
during fast eccentric loading
prior degeneration or tendinosis
90
what can cause a persistent tendon tear
elastin and vascularity decrease
atrophy and drying
shorter/smaller tendon= less pliable and durable
91
how can tendinitis be healed
POLICED
at most 4-6 wks
92
what is the main goal of treating tendinosis
proliferating tendon
93
when can we see initial tensile strength of tendinosis
3-5 wks
94
when does dense connective tissue fill in with tendinosis/tear
8-12 wks
95
how long does it take to see full strength with post op tendon tear
10-12 months
96
how do we treat tendinopathy
Pt edu- load management
POLICED
modalities
97
what can delay healing with tendinopathy
NSAIDS - if injury is at insertion
98
how can NSAIDS help tendinopathy
short term pain relief if acute
99
Why are NSAIDS have poor response to persistent tendinopathy
the problem is degeneration of the tendon not inflammation
100
what does bracing/taping do for tendinopathy
decrease resistance arm
101
how are modalities with tendinopathy
lack sufficient evidence
102
how do we treat tendinosis
Pt edu
manual therapy
MET
103
Pt asks if they should take anti-inflammatory since they are sore due to their tendinopathy, what is your response
soreness rule
if the mild pain increases during your exercise or up to 24 hours after activity and no change in movement quality
104
what is the primary purpose of MET with tendinosis
tendon proliferation
105
what are parameters for MET with tendinosis after acuity settles
heavy load
slower eccenteric
possible 3 sec muscle actions
106
what are our sets and reps for the m that has tendinosis
2-3 sets of 10-15 reps to fatigue
2-3 exercises
8-12 wks
every other day
mild to mod pain - soreness rule!
107
what are the precautions with heavy loads for tendinosis
deconditioned population
peri-pubescent population until growth plate fuses
108
what are complication of healing with tendinosis
predisposition of failed healing response
obesity
diabetes
low grade inflammation
109
why is obesity a complication of healing for tendinosis
excessive fat absorbs inflammatory cells away from tendon
110
why is diabetes a complication of healing for tendinosis
excessive glucose impairs collagen production and remodeling
111
why is a low grade inflammation a complication of healing for tendinosis
systemic disease and a poor diet
limits proliferation and remodeling
112
what are MD Rx for tendons
cortisone injection - short term benefits
glycerin trinitrate patch
sclerosing injections - stiffen tendon for pain relief
surgical debridement
113
what are the benefits for scapular taping in impingement syndome
improved short term pain
may provide window for MET and limit ADL provocation
no difference at 6 wks
114
what are the research for JM for impingement syndrome
strong
115
how does JM for thoracic spine benefit the sh
reduces pain
with added exercise it more more effective than exercise alone
116
what is the MET parameters for the inhibited m that could have caused the overworked m to get tendinosis
3x30
want to recreate activation, coordination, endurance, and strength
117
what is the most common region in the neck that gives sh pain
C5-6
118
what can dysfunction with reaching overhead due to C5-6 cause
excessive recruitment of IR
inhibited and protective ER
imbalance of position and m activity limits optimal motion
119
what can happen due to excessive IR recruitment because of C5-6 dysfunction
humeral head pulled ant of coracoid process
excess tension/compression on LHB could lead to tendinopathy
brings greater tubercle under the acromion
120
what can happen due to inhibited ER because of C5-6 dysfunction
greater tubercle wont fully move out from under the acromion
impinged SS and LHB lead to tendinopathy
121
what can dysfunction with reaching overhead due to C2-3 cause
excessive scapular elevators
inhibited and protective depressors
GH and AC jt compensation
imbalance of position and m activity limits optimal motion
122
what can happen due to inhibited depressors in C2-3 dysfunction
scapula wont depress
impingement after 150
impinged SS and LHB
123
why can impingement occur due to inhibited depressors from a C 2-3 dysfunction
depressors pull the scapula down and out of the way in the last bit of ROM
124
what can happen due to excessive sh elevation from C2-3 dysfunction
scapula elevated or elevation
excess tension/compression on SS
