Impingement Syndrome Overview

Podcast

Play an AI-generated podcast conversation about this lesson

Questions and Answers

What is the primary cause of secondary impingement?

Narrowing of the glenohumeral joint

Excessive humeral rotation

Inflammation of the rotator cuff

Excessive GH joint mobility or scapular dyskinesis (correct)

Which symptom is commonly associated with secondary rotator cuff impingement?

Loss of strength in the forearm

Pain and weakness during overhead motions (correct)

Numbness in the fingers

Decreased range of motion in the elbow

How does muscular fatigue affect the rotator cuff during repetitive overhead movements?

It prevents compression of the rotator cuff on the coracoacromial arch

It enhances the stabilizing function of the rotator cuff

It decreases stabilizing function, allowing superior migration of the humeral head (correct)

It has no effect on shoulder stability

What can contribute to impingement in patients with scapular dyskinesis?

Improper positioning of the scapula in relation to the humerus Signup and view all the answers

What physical examination aspect is NOT typically assessed for patients with secondary impingement?

Strength testing of wrist flexors Signup and view all the answers

What is the most common cause of pain around the shoulder?

Rotator cuff syndrome Signup and view all the answers

Which condition is NOT part of the rotator cuff syndrome?

Shoulder dislocation Signup and view all the answers

What symptom is commonly associated with shoulder impingement syndrome?

Referred pain into the deltoid region Signup and view all the answers

What occurs if rotator cuff impingement is not recognized and addressed early?

Degradation of tissue and possible tears Signup and view all the answers

During which stage of Neer's impingement does edema and inflammation occur?

Stage 1 Signup and view all the answers

What type of shoulder movement may produce a painful arc of abduction in Stage 1 of impingement?

Between 60 and 120 degrees Signup and view all the answers

Which statement is true regarding muscular function during rotator cuff impingement?

It diminishes dynamic control of the GH joint Signup and view all the answers

What is recommended during the assessment of a patient with impingement syndrome?

Consider proximal segments like trunk and hips Signup and view all the answers

What is a primary cause of shoulder impingement?

Abnormal mechanical relationship between the rotator cuff and the coracoacromial arch Signup and view all the answers

Which symptom is associated with primary shoulder impingement?

Inability to sleep on the affected side Signup and view all the answers

What structural factor can increase the risk of subacromial impingement?

Congenital anomaly Signup and view all the answers

Which test is used for diagnosing shoulder impingement?

Hawkin’s sign Signup and view all the answers

Which of the following describes pain experienced in primary shoulder impingement?

Localized to the anterolateral shoulder and upper lateral arm Signup and view all the answers

What is a common sign of shoulder weakness in primary impingement?

Weakness specifically in shoulder abduction and external rotation Signup and view all the answers

How is rotator cuff strength typically affected in primary impingement?

Strength is usually normal at rest, but symptoms worsen with elevation Signup and view all the answers

Which statement about primary shoulder impingement is accurate?

It can result from degenerative spur formation and unresolved anomalies. Signup and view all the answers

What is the primary focus of the late phase of rehabilitation?

Restoration of shoulder girdle strength Signup and view all the answers

Which exercise is recommended during the intermediate phase of rehabilitation?

Scapular retraction with horizontal abduction Signup and view all the answers

What degree range is allowed for isotonics to begin after effective cuff isometrics?

0 to 90 degrees of shoulder elevation Signup and view all the answers

Which of the following movements should be avoided during rehabilitation?

Bench presses Signup and view all the answers

How often should strength training be performed during rehabilitation?

On alternating days, 3 to 4 days per week Signup and view all the answers

What type of exercises should begin at the late phase of rehabilitation?

Full range strength training with weights Signup and view all the answers

What should be the patient’s status before progressing to the late phase?

Demonstrating normal mechanics in full range Signup and view all the answers

Which of the following techniques is part of the initial phase of rehabilitation?

Limited range isotonics Signup and view all the answers

What condition often results from posterior capsular tightness?

Obligate anterosuperior translation of the humeral head Signup and view all the answers

What is the primary complaint of patients under 35 experiencing internal impingement during repetitive overhead activities?

Posterior shoulder pain Signup and view all the answers

Which of the following is commonly performed to address internal shoulder impingement?

Jobe’s relocation test Signup and view all the answers

What physical examination finding is associated with internal shoulder impingement?

Localized symptom reproduction with special tests Signup and view all the answers

What approach is emphasized during physical therapy rehabilitation for shoulder impingement?

Focus on functional improvement and pain reduction Signup and view all the answers

Which stretching technique is recommended once full range of motion is achieved for shoulder impingement?

End-range stretching Signup and view all the answers

What is a common characteristic of the tears associated with internal impingement?

Undersurface tears of the posterior supraspinatus tendon Signup and view all the answers

Which action may help facilitate gains in range of motion before exercise?

Heat application Signup and view all the answers

Study Notes

Impingement Syndrome, Supraspinatus Tendinitis, and Cuff Disruption

Pain and/or weakness during certain movements of the shoulder.
Referred pain or paresthesias into the region of the deltoid insertion and upper lateral arm.
A thorough examination of the upper extremity and axial spine is necessary to rule out other pathology.
Rotator cuff impingement alters muscular function of the cuff and results in diminished dynamic control of the glenohumeral (GH) joint.

Stages of Impingement Syndrome

Stage 1: Edema and inflammation.
Stage 2: Fibrosis and Tendinitis.
Stage 3: Tears and Tendon Degeneration

Primary Impingement

Primary subacromial impingement is the result of an abnormal mechanical relationship between the rotator cuff and the coracoacromial arch (acromion, coracoacromial ligament, and/or coracoid process).
Primary impingement can also be caused by congenital anomalies, degenerative spur formation, unfused acromion (Os acromiale), degenerative spurs on the undersurface of the acromion, malunion/nonunion of fracture, abnormal shape after surgery or trauma, thickening of tendon from calcific deposits, tendon thickening after surgery or trauma, increased prominence of the greater tuberosity from anomalies or malunions.
Symptoms include anterolateral shoulder and upper lateral arm pain, inability to sleep on the affected side, shoulder weakness, and difficulty performing activities at or above the level of the shoulder.

Special Tests for Diagnosis

Hawkin’s sign
Neer impingement sign
Empty can sign (Jobe’s test)
Painful arc
External and internal rotation resistance
Strength tests
O’Brien’s test

Secondary Impingement

Secondary impingement is a clinical phenomenon that results from a “relative narrowing” of the subacromial space.
Contributing factors include excessive GH joint mobility or scapular dyskinesis.
Symptoms are caused by excessive demands placed on the rotator cuff to dynamically stabilize the shoulder.

Internal Impingement

Posterior shoulder pain produced by contact of the greater tuberosity with the posterosuperior aspect of the glenoid when the shoulder is abducted to approximately 90 degrees and fully externally rotated, produces impingement of the posterior rotator cuff, capsule, and labrum.
Internal impingement is often present in normal physiologic motion but can become pathologic with repetitive overhead activities.
Pathology consists of undersurface tears of the posterior supraspinatus and/or anterior aspect of the infraspinatus tendon and often includes superior labrum anterior to posterior (SLAP) tears.
Patients are typically under 35 years of age, involved in repetitive overhead abduction and external rotation demand activities.

Physical Therapy Rehabilitation

A comprehensive rehabilitation program for shoulder impingement should follow a progression of phases based on functional improvement and pain reduction.
Modalities such as heat applied before exercise may facilitate gains in ROM. Ice application following resistance exercises.
Active and active-assisted ROM in the scapular plane, posterior capsule stretching, and manual therapy techniques should be used to address specific GH joint capsular, scapulothoracic joint, or spinal mobility limitations.
Strength training should progress through initial, intermediate, and late phases.
Initial phase focuses on scapular neuromuscular control, closed chain exercises, rotator cuff isometrics, and limited range isotonics.
Intermediate phase progresses strengthening and attains full range of motion.
Late phase focuses on restoration of shoulder girdle strength, neuromuscular control, and maintenance of normal mobility.
Gradually return to traditional weightlifting exercises; Caution is recommended when returning to barbell pressing movements (bench, incline, and military presses) and dips because these movements can result in a return of symptoms. Behind the neck pull-downs and military press should be avoided.

Jobe’s Relocation Test

A test that helps diagnose posterior impingement.

Studying That Suits You

Use AI to generate personalized quizzes and flashcards to suit your learning preferences.

Description

This quiz covers the key aspects of impingement syndrome, supraspinatus tendinitis, and rotator cuff disruption. It explores the stages of impingement and the mechanisms involved, as well as symptoms and examination techniques. Test your understanding of this common shoulder condition and its implications for movement and functionality.