Impingement Tests and Nonoperative Rehab

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
• 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
• 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
• Scapular Protraction:
  • Strengthens serratus anterior
  • Addresses decreased serratus anterior activation in patients with GH impingement
• 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
• Treatment for Limited Internal Rotation:
  • Muscle tightness: stretching for internal rotation
  • Joint capsule restriction: stretching for posterior capsule and muscle tendon unit
• 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
• Wall Stretch and Stretching Behind the Head:
  • Used to achieve end-range forward elevation or forward flexion
• 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
• Shoulder Proprioception Exercises:
  • Exercises that improve awareness and control of shoulder movements

Thank you:

• Prof.Dr.Nasr Awad, Assistant professor, Sinai University

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.