overuse injury, Impingement Syndrome of the Shoulder

Question 1

The ______ Joint provides multiple and extreme degrees of functional motion that greatly depend on the rotator cuff muscles to properly seat the humeral head into the glenoid fossa to provide stability

Answer 1

glenohumeral joint

Question 2

__________ refers to a combination of shoulder symptoms, examination findings, and radiologic signs attributable to the compression of structures around the glenohumeral joint that occur with shoulder elevation

Answer 2

Shoulder impingement syndrome (SIS)

Question 3

Common structures impinged in the subacromion space:

(1) Subacromial bursa
(2) Tendon of the _______
(3) Tendon of the _______
(4) Long head of the _______ tendon

Answer 3

2) supraspinatus
3) infraspinatus
4) biceps

Question 4

Dx and Tx
Symptoms
-(1) Gradual onset of anterior and lateral shoulder pain exacerbated by overhead activity
-(2) Night pain and difficulty sleeping on affected side
Physical Exam
-(1) Palpation
—(a) Tenderness over greater or lesser tuberosity
—(b) Tenderness over bicipital groove
—(c) Systematically palpate shoulder structures and note tenderness
-(2) ROM
—(a) Typically full AROM but possibly limited due to pain
—(b) Pain worse between 90 degree and 120 degree of abduction and when lowering arm
-(3) Muscle Test
—(a) Flexion and abduction limited by pain
-(4) Neurovascular
—(a) Typically unremarkable
-(5) Special tests: Neers and Hawkins

Answer 4

• Shoulder impingement syndrome (SIS)
• Treatment
  (1) NSAIDS
  (2) Ice
  (3) Light duty to avoid offending activities
  (4) Home Exercise Program: Shoulder stretches and strengthening
  (5) Physical therapy consult if failed local management

Question 5

Referral decision:

(1) Orthopedic consult if failed conservative management after __-__ months or other pathology is suspected.

Answer 5

2-3