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Questions and Answers
What is the goal of the initial phase of rehabilitation for shoulder impingement syndrome?
What is the goal of the initial phase of rehabilitation for shoulder impingement syndrome?
Which test is indicative of internal impingement when weaker internal rotation is noted?
Which test is indicative of internal impingement when weaker internal rotation is noted?
What is the primary role of the lower trapezius and serratus anterior during arm elevation?
What is the primary role of the lower trapezius and serratus anterior during arm elevation?
What therapeutic modality can be applied to improve blood supply and decrease pain levels?
What therapeutic modality can be applied to improve blood supply and decrease pain levels?
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What should be avoided in patients with secondary rotator cuff impingement and instability?
What should be avoided in patients with secondary rotator cuff impingement and instability?
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During rehabilitation, what is the first step to protect the rotator cuff?
During rehabilitation, what is the first step to protect the rotator cuff?
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Which exercise position is characterized by maximal scapular protraction?
Which exercise position is characterized by maximal scapular protraction?
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Which impingement test is characterized by pain due to anteriorly directed force relieved by posterior force?
Which impingement test is characterized by pain due to anteriorly directed force relieved by posterior force?
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What should be included in the management of limited internal rotation due to muscle tightness?
What should be included in the management of limited internal rotation due to muscle tightness?
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What is a recommended manual technique for scapular stabilization?
What is a recommended manual technique for scapular stabilization?
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What is a common home exercise to achieve end-range forward elevation?
What is a common home exercise to achieve end-range forward elevation?
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What is the importance of maintaining early isometric exercises in the scapular plane during rehabilitation?
What is the importance of maintaining early isometric exercises in the scapular plane during rehabilitation?
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What type of exercise should be initiated in a functional position with the GH joint in 80° to 90° elevation?
What type of exercise should be initiated in a functional position with the GH joint in 80° to 90° elevation?
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What does a positive response in a modified subluxation/relocation test indicate?
What does a positive response in a modified subluxation/relocation test indicate?
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What is the focus of phase II in shoulder rehabilitation protocol?
What is the focus of phase II in shoulder rehabilitation protocol?
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Which of the following stretches can be performed at home to help with shoulder mobility?
Which of the following stretches can be performed at home to help with shoulder mobility?
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Study Notes
Impingement Tests
-
Neer Test
- Evaluates potential subacromial impingement
-
Hawkins-Kennedy Impingement Test
- Evaluates potential subacromial impingement by internally rotating the shoulder joint
-
Yocum Impingement Test
- Evaluates potential subacromial impingement by externally rotating the shoulder joint
-
Posterior Impingement Test
- Evaluates potential posterosuperior glenoid impingement by applying anterior and posterior force at 90-120 degrees of abduction
-
Internal Rotation Resistance Strength Test
- Evaluates potential internal impingement by resisting internal rotation at 90 degrees of abduction, 90 degrees of elbow flexion, and 80 degrees of external rotation
- Weakness in internal rotation suggests internal impingement
- Increased strength in internal rotation suggests primary impingement
Nonoperative Rehabilitation of Rotator Cuff Impingement
-
Initial Phase Goals:
- Reducing pain to initiate rotator cuff and scapular exercises
- Normalizing capsular relationships with mobilization and stretching
- Early submaximal rotator cuff and scapular exercises
-
Initial Rehabilitation:
- Protection of the rotator cuff from stress, but not function
- Modifications of ergonomic activities, sports-specific activities, activities of daily living, postures and movement patterns
- Physical therapy modalities: electrical stimulation, ultrasound, iontophoresis to improve blood supply and reduce pain
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Early Use of Isometrics:
- Isometric exercises or submaximal manual resistance for internal and external rotation in the scapular plane with low levels of elevation
- Prevent subacromial contact and increase local blood flow
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Scapular Stabilization:
- Manual techniques to directly interface the clinician with the patient's scapula
- Scapular retraction reduces the width of the subacromial space
- Activation of lower trapezius and serratus anterior enables scapular upward rotation and stabilization during arm elevation
-
Elevation of Shoulder in Scapular Plane:
- Rhythmic stabilization applied to the proximal aspect of the extremity, progressing distally
- GH joint in 80-90 degrees of elevation in the scapular plane
- Provides muscular co-contraction in a functional position
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Scapular Protraction:
- Strengthens serratus anterior
- Addresses decreased serratus anterior activation in patients with GH impingement
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Range of Motion and Mobilization:
- May be indicated depending on the underlying mobility status of the patient
- Avoid accessory mobilization techniques in patients with secondary rotator cuff impingement and tensile overload injury due to underlying instability
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Treatment for Limited Internal Rotation:
- Muscle tightness: stretching for internal rotation
- Joint capsule restriction: stretching for posterior capsule and muscle tendon unit
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Home Exercises:
- Sleeper stretch and cross-arm adduction stretch
-
Active Assisted Forward Elevation and External Rotation:
- 10 repetitions, 2 times per day, for 4 weeks
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Wall Stretch and Stretching Behind the Head:
- Used to achieve end-range forward elevation or forward flexion
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Phase II - Total Arm Strengthening and Kinetic Chain Exercise Application:
- Progression of exercises, including:
- Jobe Isotonic Rotator Cuff Exercises
- Shoulder flexion and extension using theraband
- Closed-chain exercise using the "plus" position with maximal scapular protraction
- Rhythmic stabilization using a ball against a wall
- Progression of exercises, including:
-
Shoulder Proprioception Exercises:
- Exercises that improve awareness and control of shoulder movements
Thank you:
- Prof.Dr.Nasr Awad, Assistant professor, Sinai University
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Description
This quiz covers various impingement tests used to evaluate shoulder conditions, including the Neer Test and Hawkins-Kennedy Impingement Test. Additionally, it explores the initial goals of nonoperative rehabilitation for rotator cuff impingement. Test your knowledge about these essential assessments and rehabilitation techniques.
