20 Questions
What is one consequence of rounded shoulders?
A tipped scapula
Which muscle is typically not tight in the muscle imbalance associated with rounded shoulders?
Deep neck flexors
What happens if the scapula does not upwardly rotate during shoulder movement?
Decreased subacromial space
What mechanical impact results from the anterior position of the head of the humerus?
Posterior capsule fibers become taut
Which muscle is typically weak in a person with rounded shoulders?
Deep neck flexors
What consequence does rounded shoulders have on thoracic mobility?
Decreases thoracic mobility
Which of these is NOT a part of the muscle imbalance associated with rounded shoulders?
Strong posterior capsule fibers
Which issue is likely to arise from the anterior positioning of the humeral head?
Overstretched anterior capsule fibers
Which one is a possible result of scapular upward rotation not occurring during shoulder flexion?
Decreased range of shoulder flexion
What aspect is directly impacted by rounded shoulders?
Thoracic mobility and scapula position
Which muscle is commonly tight in the muscle imbalance related to rounded shoulders?
Levator scapulae
What condition can result from decreased thoracic mobility due to rounded shoulders?
Decreased subacromial space
What is a consequence of the scapula not upwardly rotating?
Decreased subacromial space
What effect can an anterior humeral head position have on the shoulder capsule fibers?
Stretches posterior and tightens anterior fibers
Which muscle is typically weak in a person with rounded shoulders?
Deep neck flexors
Rounded shoulders cause which of the following in terms of scapular position?
Tipped scapula
If the scapula does not upwardly rotate, which range of motion is affected most?
Flexion
Which issue is likely to arise from the anterior positioning of the humeral head?
Overstretching of anterior capsule fibers
Which of the following is directly decreased by rounded shoulders?
Thoracic mobility
Which muscle is NOT commonly tight in the muscle imbalance associated with rounded shoulders?
Deep neck flexors
Study Notes
Neer's Classification/Stages of Rotator Cuff Impingement
- Stage 1: Occurs in younger patients (< 25 years old), characterized by edema and hemorrhage, with pain worsened by shoulder abduction > 90 degrees, responds to conservative treatment.
- Stage 2: Typically occurs between 25-40 years old, with pain as the primary feature, limiting daily activities, worse at night, and fibrosis seen in the supraspinatus and biceps tendons and subacromial bursa.
- Stage 3: Typically occurs in patients > 40 years old, with a long history of shoulder pain, repeated overuse, significant muscle weakness and atrophy, and characterized by tendon degeneration and rotator cuff micro tears.
- Stage 4: Typically occurs in patients > 50 years old, with a complete rotator cuff tear.
PT Special Tests
- Painful Arc: 60-120 degrees of abduction
- Hawkins-Kennedy Impingement Test: 90 degrees abduction and internal rotation, causing pain
- Neer Impingement Test: unknown
- Drop Arm Test: demonstrates rotator cuff pathology
- Empty/Full Can Tests: demonstrates weakness, difficulty, or lack of mobility in the shoulder joint
Impairments
- Pain when reaching above shoulder level
- Painful arc of motion 60-120 degrees of flexion or abduction
- Pain with palpation to the musculotendinous junction
- Pain with resisted abduction
Impaired Posture
- Thoracic kyphosis
- Forward head
- Rounded shoulders
- Muscle imbalances
- Weakness or incoordination of the scapular stabilizers and rotators
Hypomobility or Hypermobility of the Capsule
- PT will work to improve the inferior glide/stretch the inferior capsule
- Forward shoulders can lead to a tight posterior capsule and looser anterior capsule due to the anterior position of the humeral head in the glenoid fossa
Neer's Classification/Stages of Rotator Cuff Impingement
- Stage 1: Occurs in younger patients (< 25 years old), characterized by edema and hemorrhage, with pain worsened by shoulder abduction > 90 degrees, responds to conservative treatment.
- Stage 2: Typically occurs between 25-40 years old, with pain as the primary feature, limiting daily activities, worse at night, and fibrosis seen in the supraspinatus and biceps tendons and subacromial bursa.
- Stage 3: Typically occurs in patients > 40 years old, with a long history of shoulder pain, repeated overuse, significant muscle weakness and atrophy, and characterized by tendon degeneration and rotator cuff micro tears.
- Stage 4: Typically occurs in patients > 50 years old, with a complete rotator cuff tear.
PT Special Tests
- Painful Arc: 60-120 degrees of abduction
- Hawkins-Kennedy Impingement Test: 90 degrees abduction and internal rotation, causing pain
- Neer Impingement Test: unknown
- Drop Arm Test: demonstrates rotator cuff pathology
- Empty/Full Can Tests: demonstrates weakness, difficulty, or lack of mobility in the shoulder joint
Impairments
- Pain when reaching above shoulder level
- Painful arc of motion 60-120 degrees of flexion or abduction
- Pain with palpation to the musculotendinous junction
- Pain with resisted abduction
Impaired Posture
- Thoracic kyphosis
- Forward head
- Rounded shoulders
- Muscle imbalances
- Weakness or incoordination of the scapular stabilizers and rotators
Hypomobility or Hypermobility of the Capsule
- PT will work to improve the inferior glide/stretch the inferior capsule
- Forward shoulders can lead to a tight posterior capsule and looser anterior capsule due to the anterior position of the humeral head in the glenoid fossa
Identify the clinical features and stages of rotator cuff impingement, including Neer's classification, based on age, symptoms, and treatment response.
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