Second PT Trauma Lecture 16 October 2024 PDF

Prof.Dr. NASR AWAD Assistant professor, Sinai University sinaiuniversity.net  LECTURE_2 DIAGNOSIS+REHABILIATION OF SHOULDER IMPINGEMENT SYNDROME Prepared by PROF Dr. Nasr Awad, PhD,MBBCH,High Diploma Physical Medicine & Rehabilitation Assi...

Prof.Dr. NASR AWAD Assistant professor, Sinai University sinaiuniversity.net  LECTURE_2 DIAGNOSIS+REHABILIATION OF SHOULDER IMPINGEMENT SYNDROME Prepared by PROF Dr. Nasr Awad, PhD,MBBCH,High Diploma Physical Medicine & Rehabilitation Assistant Professor, Sinai University @Sinaiunieg [email protected] www.su.edu.eg DIAGNOSIS IMPINGMENT TESTS Neer test 2- Hawkins–Kennedy impingement test Yocum Impingement Test Posterior impingement test 100 abduction 10 extension  At 90- 110-120 abduction A positive response for posterosuperior glenoid impingement is pain (not apprehension) on the anteriorly directed force, which is relieved when the force is directed posteriorly. The modified subluxation/relocation test for posterosuperior glenoid Internal rotation resistance strength test 90 of abd 90 of elbow flexion 80 of external rotation  Positive test Comparative weakness of internal rotation represents a positive test and is suggestive of internal impingement. If internal rotation is stronger, primary impingement should be suspected. NONOPERATIVE REHABILITATION OF ROTATOR CUFF IMPINGEMENT  Goals in the initial phase of rehabilitation include the following: (1) Decrease in pain to allow for initiation of submaximal rotator cuff and scapular exercise. (2) Normalization of capsular relationships through the use of specific mobilization and stretching techniques. (3) Early submaximal rotator cuff and Initial rehabilitation begins with protection of the rotator cuff from stress but not function by modifying the following: Ergonomic Sport-specific activity Activities of daily living (ADLs) Postures and movement patterns  Physical therapy modalities Electrical stimulation US Iontophoresis >>>>>>Can be applied to improve blood supply and to decrease pain levels Early use of IR and ER isometrics or submaximal manual resistance in the scapular plane with low levels of elevation to prevent any subacromial contact early in the rehabilitation process, can increase local blood flow  Scapular stabilization Manual Techniques are recommended to directly interface the clinician with the patient’s scapula. Figure shows the specific technique used by one of the authors to manually resist scapular retraction. Scapular retraction has a role in reduction of the width of subacromial space. Activation of lower trapezius and serratus anterior is important to enable scapular upward rotation and stabilization during arm elevation. Activation of serratus anterior Activation of lower trapezius Elevation of shoulder in scapular plane Rhythmic stabilization applied to the proximal aspect of the extremity, progressing to distal with the GH joint in 80° to 90° of elevation in the scapular plane, can be initiated to provide muscular co-contraction in a functional position. Scapular protraction to strengthen serratus anterior as it was found that there is decreased activation of serratus anterior with patients with GH impingement.  In addition to the early scapular stabilization and submaximal rotator cuff exercise, ROM and mobilization may be indicated according to the underlying mobility status of the patient NB: Patients with secondary rotator cuff impingement and tensile overload injury due to underlying instability should not undergo accessory mobilization techniques to increase mobility, as this would only compound their existing capsular laxity.  Treatment of limitation of IR according to the cause A- Muscle tightness; stretching for IR (B) Restriction in joint capsule; stretching for posterior capsule and muscle tendon unit Other positions for stretches as sleeper stretch and cross arm adduction stretch can be used as a home exercises Active assisted forward elevation and active assisted external rotation (10 repetition- 2times/day-4 week) (A)The wall stretch.(B)Stretching the affected arm behind the head can also be used to achieve end-range forward elevation or forward flexion PHASE-II: Total arm strengthening/kinetic chain exercise application phase: The progression of exercises should be as follow (Jobe Isotonic Rotator Cuff Exercises) Shoulder flexion (protraction) and extension (retraction) using theraband Closed-chain exercise using the “plus” position, which is characterized by maximal scapular protraction. Rhythmic stabilization using a ball against a wall Shoulder Proprioception THANK YOU Prof. Dr. Nasr Awad Assistant professor, faculty of physical therapy, Sinai University