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RC impingement and tear
Musculo Exam 2 RC impingement and tear
65
Anatomy
Graduate
03/20/2012

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Term
define impingement syndrome
Definition
mechanical compression of the supraspinatus tendon, subacromial bursa, and/or long head of the biceps tendon under the coracoacromial arch
Term
what is the greatest area of stress in impingement syndrome etiology
Definition
supraspinatus tendon and anterior acromion
Term
what is a type 3 acromion
Definition
acromion hooks down into the subacromial space
Term
what is sclerosis
Definition
hardening of tissues. Can occur from bone suprring or from hardening of tissues that are rubbing against acromion
Term
besides bad typing, what are things can happen on acromion to cause impingement
Definition
sclerosis, osteophytes
Term
where is the avascular zone of the head of the humerus
Definition
on the greater tubercle where the supraspinatus comes in
Term
what is another name for avascular zone
Definition
critical zone
Term
who has the avascular zone
Definition
everyone. People with or without injury
Term
when does the avascular zone increase
Definition
with age
Term
when does blood flow to the rotator cuff diminish
Definition
after age 60
Term
besides age, what else decreases blood flow?
Definition
compression/impingement, positioning
Term
what positions cause decreased blood flow
Definition
adduction and abduction
Term
when does impingement decrease blood flow
Definition
when there is no inferior rotation in abduction, it causes compression
Term
why does avascular zone increase with adduction
Definition
tension mashes blood out.
Term
does abduction or adduction cause greater avascular zone
Definition
adduction
Term
why does abduction allow for slightly more blood flow than adduction
Definition
abduction causes a little less tension and more loose packed position. With just a little abduction, there is not yet compression.
Term
what is tendinitis
Definition
inflammation of the tendon
Term
what is tendinosis
Definition
condition of the tendon which doesn't necessarily involve inflammation; chronic degradation of muscle tendon without inflamation
Term
tendinitis or tendinosis in what things cause impingement
Definition
supraspinatus, biceps, infraspinatus
Term
what other etiologies besides tendinitis/osis lead to impingement
Definition
calcific deposits on the bottom of acromion, subacromial bursitis, rotator cuff tear
Term
what age usually gets impingement in Neer Clinical Stage I
Definition
younger 20's
Term
what usually causes impingement syndrome Neer Clinical Stage I
Definition
repetitive overhead activity
Term
what is the cc for impingement syndrome Neer Clinical Stage I
Definition
dull ache after activity. Hard to localize at this early point
Term
what will you find in physical exam for Impingement Syndrome Neer Clinical Stage I
Definition
poor scapulohumeral rhythm, point tenderness at GT supraspinatus insertion, tender anterior acromial edge, painful arc at 60-120 deg abd, + impingement sign, normal x-ray
Term
what is the outcome for impingement syndrome Neer Clinical Stage I?
Definition
reversible if you modify activity
Term
what age usually gets impingement in Neer Clinical Stage II
Definition
20's-40's
Term
what is the cc for impingement syndrome Neer Clinical Stage II
Definition
dull ache during and after activity. Hard to localize. Night pain
Term
in what positions would a patient with impingement have night pain
Definition
on bad side and supine (stretches anteriorly)
Term
advice for treatment for impingement causing night pain
Definition
sleep with pillow under armpit angled down towards belly button
Term
what problems are happening in Clinical Stage II
Definition
fibrosis and tendinitis
Term
what will you find in physical exam for Impingement Syndrome Neer Clinical Stage II
Definition
poor scapulohumeral rhythm, + impingement signs, strength loss associated with pain, catching sensation at 100 deg, A/PROM
Term
what will you see on imaging in Stage II
Definition
sclerosis, osteophytes, AC changes to compensate for lack of elevation at GH joint
Term
is impingement reversible in stage II?
Definition
no. Too late to prevent pain by rest/stopping activity.
Term
what will happen if you don't treat stage 2
Definition
pathology to rotator cuff will occur or pt will stop using their arm, leading to frozen shoulder
Term
if someone has had pain for 2 weeks, what stage are they
Definition
Neers I
Term
what is the typical age of patients with Neers III
Definition
>40 yo (70% of tears are in pts >40)
Term
what is the history of Neers III
Definition
chronic history of problems associated with Neers I, II
Term
how is night pain in Neers III
Definition
worse
Term
what can accelerate the process of getting to Neers III
Definition
sudden strain
Term
pathologies of Neers III
Definition
osteophytes, tendon rupture, always tears supraspinatus, can advance to tearing infraspinatus, may involve joint capsule
Term
how do we know that the tendon has ruptured
Definition
weak and painless after initial pain. Severe weakness with no pain is really bad
Term
what will you find in physical exam for Impingement Syndrome Neer Clinical Stage III
Definition
scapulohumeral rhythm changed, prolonged pain sometimes without provocation, weak and painless, AROM more limted than PROM, AC joint involvement, sometimes adhesive capsulitis, sclerosis and osteophytes on xray, supraspinatus tears more common than bicep tendon rupture
Term
in Neer III, what is the ratio of supraspinatus tears to biceps tendon tears
Definition
7 to 1
Term
what is Neer III, basically?
Definition
rotator cuff tear
Term
what are the 2 main causes of rotator cuff tears
Definition
extension of impingement or sudden force without history of severe degeneration
Term
how to diagnose rotator cuff injury
Definition
arthrogram, positive drop test, positive supraspinatus tests, resisted flexion weak, posterior tender points, loss of AROM with intact PROM
Term
should treatment for Neer I be conservative or surgical
Definition
conservative
Term
what are some treatments for Neer I
Definition
postural correction; exercises for scapulohumeral rhythm: serratus, lower trap, rhomboids, upper trap, levator; rotator cuff strengthening exercises; modify affecting activity
Term
anti-inflammatory treatments for Neer I
Definition
US/estim, ice following compromising activity, rest, NSAID
Term
how long will therapy last for Neer 2
Definition
1-2 months.
Term
treatments for Neer 2
Definition
same exercises as Neer 1. postural correction. Evaluate for surgery
Term
modalities to use in Neer 2
Definition
US, estim, ice, phonophoresis, iontophoresis, heat, friction massage to break up scar tissue fibers that don't line up with the tendon
Term
which patients are candidates for surgery
Definition
Neer 3, active, involved in overhead activity
Term
what modalities/exercises to use for Neer 3
Definition
same as 1 and 2
Term
what kinds of surgery for Neer 3
Definition
arthroscopic: decompression/acromioplasty; partial to total acromionectomy; primary repair of tear
Term
how to treat rotator cuff tear post surgery
Definition
progress with exercises per protocol
Term
goal for impingement syndrome exercises
Definition
normal scapulohumeral rhythm and proper seating of humeral head
Term
impingement syndrome exercises for ROM
Definition
pendulum, wand, wall walking, shoulder wheel
Term
who can do progressive resistance exercises
Definition
someone who has NOT just had surgery and is Neer's I
Term
should we push through shoulder pain
Definition
no
Term
why should progressive resistance exercises be performed below 90 deg
Definition
to prevent impingement/hypovascularization
Term
at what position should PRE be done
Definition
resting position or 30-45 deg abduction
Term
when can you increase elevation of PRE
Definition
as symptoms allow
Term
what PRE to concentrate on
Definition
ER, scapular control
Term
sequence for PRE
Definition
submax isometrics; submax concentrics; full concentrics; submax eccentrics; eccentrics
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