Term
| define impingement syndrome |
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Definition
| mechanical compression of the supraspinatus tendon, subacromial bursa, and/or long head of the biceps tendon under the coracoacromial arch |
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Term
| what is the greatest area of stress in impingement syndrome etiology |
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Definition
| supraspinatus tendon and anterior acromion |
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Term
| what is a type 3 acromion |
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Definition
| acromion hooks down into the subacromial space |
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Term
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Definition
| hardening of tissues. Can occur from bone suprring or from hardening of tissues that are rubbing against acromion |
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Term
| besides bad typing, what are things can happen on acromion to cause impingement |
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Definition
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Term
| where is the avascular zone of the head of the humerus |
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Definition
| on the greater tubercle where the supraspinatus comes in |
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Term
| what is another name for avascular zone |
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Definition
|
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Term
| who has the avascular zone |
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Definition
| everyone. People with or without injury |
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Term
| when does the avascular zone increase |
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Definition
|
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Term
| when does blood flow to the rotator cuff diminish |
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Definition
|
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Term
| besides age, what else decreases blood flow? |
|
Definition
| compression/impingement, positioning |
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Term
| what positions cause decreased blood flow |
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Definition
|
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Term
| when does impingement decrease blood flow |
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Definition
| when there is no inferior rotation in abduction, it causes compression |
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Term
| why does avascular zone increase with adduction |
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Definition
| tension mashes blood out. |
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Term
| does abduction or adduction cause greater avascular zone |
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Definition
|
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Term
| why does abduction allow for slightly more blood flow than adduction |
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Definition
| abduction causes a little less tension and more loose packed position. With just a little abduction, there is not yet compression. |
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Term
|
Definition
| inflammation of the tendon |
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|
Term
|
Definition
| condition of the tendon which doesn't necessarily involve inflammation; chronic degradation of muscle tendon without inflamation |
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Term
| tendinitis or tendinosis in what things cause impingement |
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Definition
| supraspinatus, biceps, infraspinatus |
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Term
| what other etiologies besides tendinitis/osis lead to impingement |
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Definition
| calcific deposits on the bottom of acromion, subacromial bursitis, rotator cuff tear |
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Term
| what age usually gets impingement in Neer Clinical Stage I |
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Definition
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Term
| what usually causes impingement syndrome Neer Clinical Stage I |
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Definition
| repetitive overhead activity |
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Term
| what is the cc for impingement syndrome Neer Clinical Stage I |
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Definition
| dull ache after activity. Hard to localize at this early point |
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Term
| what will you find in physical exam for Impingement Syndrome Neer Clinical Stage I |
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Definition
| poor scapulohumeral rhythm, point tenderness at GT supraspinatus insertion, tender anterior acromial edge, painful arc at 60-120 deg abd, + impingement sign, normal x-ray |
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|
Term
| what is the outcome for impingement syndrome Neer Clinical Stage I? |
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Definition
| reversible if you modify activity |
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|
Term
| what age usually gets impingement in Neer Clinical Stage II |
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Definition
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Term
| what is the cc for impingement syndrome Neer Clinical Stage II |
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Definition
| dull ache during and after activity. Hard to localize. Night pain |
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Term
| in what positions would a patient with impingement have night pain |
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Definition
| on bad side and supine (stretches anteriorly) |
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Term
| advice for treatment for impingement causing night pain |
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Definition
| sleep with pillow under armpit angled down towards belly button |
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Term
| what problems are happening in Clinical Stage II |
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Definition
|
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Term
| what will you find in physical exam for Impingement Syndrome Neer Clinical Stage II |
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Definition
| poor scapulohumeral rhythm, + impingement signs, strength loss associated with pain, catching sensation at 100 deg, A/PROM |
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|
Term
| what will you see on imaging in Stage II |
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Definition
| sclerosis, osteophytes, AC changes to compensate for lack of elevation at GH joint |
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Term
| is impingement reversible in stage II? |
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Definition
| no. Too late to prevent pain by rest/stopping activity. |
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Term
| what will happen if you don't treat stage 2 |
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Definition
| pathology to rotator cuff will occur or pt will stop using their arm, leading to frozen shoulder |
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Term
| if someone has had pain for 2 weeks, what stage are they |
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Definition
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Term
| what is the typical age of patients with Neers III |
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Definition
| >40 yo (70% of tears are in pts >40) |
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Term
| what is the history of Neers III |
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Definition
| chronic history of problems associated with Neers I, II |
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Term
| how is night pain in Neers III |
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Definition
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|
Term
| what can accelerate the process of getting to Neers III |
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Definition
|
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Term
|
Definition
| osteophytes, tendon rupture, always tears supraspinatus, can advance to tearing infraspinatus, may involve joint capsule |
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|
Term
| how do we know that the tendon has ruptured |
|
Definition
| weak and painless after initial pain. Severe weakness with no pain is really bad |
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Term
| what will you find in physical exam for Impingement Syndrome Neer Clinical Stage III |
|
Definition
| scapulohumeral rhythm changed, prolonged pain sometimes without provocation, weak and painless, AROM more limted than PROM, AC joint involvement, sometimes adhesive capsulitis, sclerosis and osteophytes on xray, supraspinatus tears more common than bicep tendon rupture |
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Term
| in Neer III, what is the ratio of supraspinatus tears to biceps tendon tears |
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Definition
|
|
Term
| what is Neer III, basically? |
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Definition
|
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Term
| what are the 2 main causes of rotator cuff tears |
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Definition
| extension of impingement or sudden force without history of severe degeneration |
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|
Term
| how to diagnose rotator cuff injury |
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Definition
| arthrogram, positive drop test, positive supraspinatus tests, resisted flexion weak, posterior tender points, loss of AROM with intact PROM |
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Term
| should treatment for Neer I be conservative or surgical |
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Definition
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Term
| what are some treatments for Neer I |
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Definition
| postural correction; exercises for scapulohumeral rhythm: serratus, lower trap, rhomboids, upper trap, levator; rotator cuff strengthening exercises; modify affecting activity |
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Term
| anti-inflammatory treatments for Neer I |
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Definition
| US/estim, ice following compromising activity, rest, NSAID |
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Term
| how long will therapy last for Neer 2 |
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Definition
|
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Term
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Definition
| same exercises as Neer 1. postural correction. Evaluate for surgery |
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Term
| modalities to use in Neer 2 |
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Definition
| US, estim, ice, phonophoresis, iontophoresis, heat, friction massage to break up scar tissue fibers that don't line up with the tendon |
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Term
| which patients are candidates for surgery |
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Definition
| Neer 3, active, involved in overhead activity |
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Term
| what modalities/exercises to use for Neer 3 |
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Definition
|
|
Term
| what kinds of surgery for Neer 3 |
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Definition
| arthroscopic: decompression/acromioplasty; partial to total acromionectomy; primary repair of tear |
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|
Term
| how to treat rotator cuff tear post surgery |
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Definition
| progress with exercises per protocol |
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Term
| goal for impingement syndrome exercises |
|
Definition
| normal scapulohumeral rhythm and proper seating of humeral head |
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|
Term
| impingement syndrome exercises for ROM |
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Definition
| pendulum, wand, wall walking, shoulder wheel |
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|
Term
| who can do progressive resistance exercises |
|
Definition
| someone who has NOT just had surgery and is Neer's I |
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|
Term
| should we push through shoulder pain |
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Definition
|
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Term
| why should progressive resistance exercises be performed below 90 deg |
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Definition
| to prevent impingement/hypovascularization |
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|
Term
| at what position should PRE be done |
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Definition
| resting position or 30-45 deg abduction |
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|
Term
| when can you increase elevation of PRE |
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Definition
|
|
Term
| what PRE to concentrate on |
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Definition
|
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Term
|
Definition
| submax isometrics; submax concentrics; full concentrics; submax eccentrics; eccentrics |
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