20 Questions
What is the goal of supporting the arm to decrease pain in a patient?
To maximize blood flow and decrease tension
Which activity modification should be recommended to avoid shoulder impingement?
Adapting activity to avoid painful ranges
At what degree of flexion and/or abduction do shoulder impingement symptoms typically occur?
Above 90 degrees
Why is it important to educate patients about the role of overhead reaching in shoulder impingement?
To modify activities and avoid painful ranges
What is the main goal of activity modification in shoulder impingement treatment?
Modifying activities to avoid painful ranges
Which of these examples correctly describes an activity modification for a patient with shoulder impingement?
Performing backhand in tennis but avoiding overhead serving
What should be the primary consideration when modifying a patient's ADLs and work tasks for shoulder impingement?
Avoiding painful ranges
How should educational guidance for a patient with shoulder impingement be structured?
Highlight the importance of posture and modifying painful activities
Why is it important to not completely eliminate activities for someone with shoulder impingement?
Total elimination can lead to increased tension and reduced blood flow
What aspect should be emphasized while educating a patient about ADL modification in shoulder impingement pathology?
Identifying and modifying activities that cause pain
Which modification in tennis could be recommended to a patient with shoulder impingement?
Eliminate overhead serving but allow backhand shots
What key aspect should be focused on when educating a patient about modifying work tasks to avoid shoulder pain?
Understanding the role of overhead reaching
What is the primary goal of supporting the arm for a patient with shoulder impingement?
Maximizing blood flow and decreasing tension
At what degree of shoulder movement do painful ranges generally start for patients with shoulder impingement?
90 degrees
How should ADLs be modified for a patient with shoulder impingement to avoid painful ranges?
Modify ADLs to avoid activities above 90 degrees of flexion or abduction
Which of these is a correct sleep posture recommendation for a patient with shoulder impingement?
Using a pillow to support the arm
What role does posture play in the management of shoulder impingement?
It can contribute to or alleviate impingement
Why is it advised to modify and not eliminate activities for patients with shoulder impingement?
To prevent muscle atrophy and maintain functionality
When educating a patient about the role of overhead reaching in shoulder impingement, what should be emphasized?
The specific role of overhead reaching in causing pain
Which strategy should be employed when modifying the ADLs of a patient with shoulder impingement?
Identify activities involving overhead reaching and modify them
Study Notes
Conservative Management: Phase I
Overall Goals
- Reduce pain and inflammation
- Maintain range of motion
- Patient education on activities and postures
- Scapular stabilization
- Postural education
Pain and Inflammation
- Use of ice, ultrasound, iontophoresis, phonophoresis, and infrared laser
- In addition to MD prescribed anti-inflammatories
Range of Motion
- Pain-free, slow, and controlled movements
- Start with shoulder flexion
- Usually begin with passive range of motion (PROM) and progress to active assisted range of motion (AAROM)
- Use of cane and pulley exercises
- Start with ROM below shoulder level and work upward
- Work on joints above and below as appropriate
Stretching
- Focus on stretching the capsule to improve arthrokinematics
- Exercises include cross-body stretch, internal rotation stretch, and sleeper stretch
- Manual therapy techniques include trigger point release and joint mobilization
Strengthening
- Light rotator cuff strengthening and scapular stabilization
- Isometric exercises for internal rotation, external rotation, and abduction
- Start with elbow at 90-degree angle
- Progress to scapular stabilization exercises, including pain-free retraction and rhythmic stabilization
Strengthening (cont'd)
- Scapular stabilization exercises include proprioceptive neuromuscular facilitation (PNF) techniques
- Closed chain exercises, such as wall push-ups and wall plank, are useful at this stage
- Progress to open kinetic chain exercises when patient improves in motion and reports decreased pain with ADLs
Patient Education
- Modify activities and work tasks to avoid painful ranges
- Educate patient on the role of overhead reaching in the pathology
- Modify, don't eliminate, activities if possible
- Support the arm to decrease pain
- Educate on correct sleeping posture to decrease pain
- Educate on the role of posture in shoulder impingement
Painful Ranges
- Painful ranges usually occur above 90 degrees of flexion and/or abduction
Conservative Management: Phase I
Overall Goals
- Reduce pain and inflammation
- Maintain range of motion
- Patient education on activities and postures
- Scapular stabilization
- Postural education
Pain and Inflammation
- Use of ice, ultrasound, iontophoresis, phonophoresis, and infrared laser
- In addition to MD prescribed anti-inflammatories
Range of Motion
- Pain-free, slow, and controlled movements
- Start with shoulder flexion
- Usually begin with passive range of motion (PROM) and progress to active assisted range of motion (AAROM)
- Use of cane and pulley exercises
- Start with ROM below shoulder level and work upward
- Work on joints above and below as appropriate
Stretching
- Focus on stretching the capsule to improve arthrokinematics
- Exercises include cross-body stretch, internal rotation stretch, and sleeper stretch
- Manual therapy techniques include trigger point release and joint mobilization
Strengthening
- Light rotator cuff strengthening and scapular stabilization
- Isometric exercises for internal rotation, external rotation, and abduction
- Start with elbow at 90-degree angle
- Progress to scapular stabilization exercises, including pain-free retraction and rhythmic stabilization
Strengthening (cont'd)
- Scapular stabilization exercises include proprioceptive neuromuscular facilitation (PNF) techniques
- Closed chain exercises, such as wall push-ups and wall plank, are useful at this stage
- Progress to open kinetic chain exercises when patient improves in motion and reports decreased pain with ADLs
Patient Education
- Modify activities and work tasks to avoid painful ranges
- Educate patient on the role of overhead reaching in the pathology
- Modify, don't eliminate, activities if possible
- Support the arm to decrease pain
- Educate on correct sleeping posture to decrease pain
- Educate on the role of posture in shoulder impingement
Painful Ranges
- Painful ranges usually occur above 90 degrees of flexion and/or abduction
This quiz covers the goals and treatment options for conservative management of injuries or conditions in Phase I, including pain and inflammation reduction, maintaining range of motion, and patient education.
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