Podcast
Questions and Answers
What is one consequence of rounded shoulders?
What is one consequence of rounded shoulders?
Which muscle is typically not tight in the muscle imbalance associated with rounded shoulders?
Which muscle is typically not tight in the muscle imbalance associated with rounded shoulders?
What happens if the scapula does not upwardly rotate during shoulder movement?
What happens if the scapula does not upwardly rotate during shoulder movement?
What mechanical impact results from the anterior position of the head of the humerus?
What mechanical impact results from the anterior position of the head of the humerus?
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Which muscle is typically weak in a person with rounded shoulders?
Which muscle is typically weak in a person with rounded shoulders?
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What consequence does rounded shoulders have on thoracic mobility?
What consequence does rounded shoulders have on thoracic mobility?
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Which of these is NOT a part of the muscle imbalance associated with rounded shoulders?
Which of these is NOT a part of the muscle imbalance associated with rounded shoulders?
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Which issue is likely to arise from the anterior positioning of the humeral head?
Which issue is likely to arise from the anterior positioning of the humeral head?
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Which one is a possible result of scapular upward rotation not occurring during shoulder flexion?
Which one is a possible result of scapular upward rotation not occurring during shoulder flexion?
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What aspect is directly impacted by rounded shoulders?
What aspect is directly impacted by rounded shoulders?
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Which muscle is commonly tight in the muscle imbalance related to rounded shoulders?
Which muscle is commonly tight in the muscle imbalance related to rounded shoulders?
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What condition can result from decreased thoracic mobility due to rounded shoulders?
What condition can result from decreased thoracic mobility due to rounded shoulders?
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What is a consequence of the scapula not upwardly rotating?
What is a consequence of the scapula not upwardly rotating?
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What effect can an anterior humeral head position have on the shoulder capsule fibers?
What effect can an anterior humeral head position have on the shoulder capsule fibers?
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Which muscle is typically weak in a person with rounded shoulders?
Which muscle is typically weak in a person with rounded shoulders?
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Rounded shoulders cause which of the following in terms of scapular position?
Rounded shoulders cause which of the following in terms of scapular position?
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If the scapula does not upwardly rotate, which range of motion is affected most?
If the scapula does not upwardly rotate, which range of motion is affected most?
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Which issue is likely to arise from the anterior positioning of the humeral head?
Which issue is likely to arise from the anterior positioning of the humeral head?
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Which of the following is directly decreased by rounded shoulders?
Which of the following is directly decreased by rounded shoulders?
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Which muscle is NOT commonly tight in the muscle imbalance associated with rounded shoulders?
Which muscle is NOT commonly tight in the muscle imbalance associated with rounded shoulders?
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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
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Description
Identify the clinical features and stages of rotator cuff impingement, including Neer's classification, based on age, symptoms, and treatment response.
