Shoulder Pathology Flashcards
(41 cards)
Jobe’s Classification: Group 1
Pure impingement
Usually in an older recreational athlete with partial under surface rotator cuff tear and subacromial bursitis
Jobe’s Classification: Group 2
Impingement associated with labral and/or capsular injury, instability, and secondary impingement
Jobe’s Classification: Group 3
Hyper elastic soft tissue resulting in an anterior or multidirectional instability and impingement
Usually attenuated but intact labrum, undersurface rotator cuff tear
Jobe’s Classification: Group 4
Anterior instability without associated impingement
Result of trauma
Results in partial or complete dislocation
What type of posture might you expect with rotator cuff disease and tendinopathies
Thoracic kyphosis, forward head, and forward (anterior) tipped scapula with decreased thoracic mobility
When shoulder rotator cuff/tendinopathy is acute, where might pain be referred?
C5 and C6 reference zones
Rotator cuff mechanism of injury: end stage impingement
May cause tendon degeneration and progression to a complete tear
Due to compromise of subacromial space, decrease vascular and spur formation
Other conditions that may accompany rotator cuff tear
- biceps tendons hypertrophy
- increased EMG of biceps
- biceps tendon rupture
Signs and symptoms of rotator cuff tear
Pain/loss of function \+ AROM \+/- PROM findings \+ weakness or pain \+ special tests
Types of rotator cuff repairs
- arthroscopic approach
- mini open (arthroscopically assisted) approach
- traditional open approach
What is the definition of impingement syndrome?
- tendons of the rotator cuff and biceps and the sub-acromial bursa are subject to inflammation as a result of direct blows, excessive tensile forces and/or repetitive microtrauma
What do repetitive or sustained overhead activities frequently predispose?
Rotator cuff tendons to injury
Mechanical (primary) impingement of subacromial structures against the anterior acromion and coracoacromial ligament
Occurs when arm is lifted overhead, especially in abduction and flexion with arm internally rotated
What does secondary impingement frequently involve?
glenohumeral or functional scapular instability
Often on dominant side
Population of primary impingement
> 40 yo
Partly due to overall wear/tear
Could be related to aging process??
Population of secondary impingement
<35 years old
Typically athletic or overhead repetitive overhead activities
Associated pathologies of impingement syndrome
Bursitis, tendonitis, rotator cuff tears, and degenerative changes (osteophyte formation)
Signs and symptoms of impingement syndrome
Anterior pain \+ difficulty with sleep position \+ AROM \+/- PROM \+ weakness or pain \+ tenderness Primary impingement usually grade 3 \+ provocation with special tests
Procedures associated with impingement syndrome
Subacromial decompression
Also knows as anterior acromioplasty or decompression acromioplasty
Definition/MOI of instability
Excessive displacement anteriorly or posteriorly of the humeral head in relationship to the glenoid
Created by lack of active or passive stabilizers leading to increased likelihood of GH subluxation
Population of instability
Younger male, athletic population
Frequently <35 yo
Repetitive overhead sport or occupation
Types of GH instability
Anterior (common)
Posterior
Inferior
Multi-directional (anterior/inferior most common)
Common progression of instability
Vague sense of shoulder dysfunction
Over time experiences repetitive microtraumas
Actually starting to sublux
Frank dislocation
Signs and symptoms of instability
Anterior pain C/o clunk, click, pop \+/- AROM \+/- PROM - weakness or pain \+ accessory motion tests - tenderness
