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Subacromial Shoulder Impingement (Assessment (HK = most effective, MMTs.…
Subacromial Shoulder Impingement
Intrinsic Impingement
Relating to direct rotator cuff tendon involvement from within the SA space
Closely associated with tendinopathy
Different approach to extrinsic +++
Extrinsic Impingement
External anatomical/biomechanical factors and their influence on the SA space
considerations:
scapula positioning/tilt
thoracic posture
scapula stabiliser MMTs (e.g. rhomboids, UT, LT
scapulohumeral rhythm/quality during AROM
posterior musculature length
Rotator Cuff Strength
Accromion shape?
In clinical experience, extrinsic impingement appears more common
Background Information
SA space anatomical contents:
SA bursa
SA bursa can become thickened and sore especially with long term impingement
Rotator Cuff tendons
RC tendons become heterogeneous, weakened, dysfunctional. = poor GH stability
GH capsule superior portion
LHB tendon insertion
Compromise: External rotators weaken secondary to central changes, biceps over works, levator scap over works, posture gets worse
SA impingement should be treated separately to patients with instability aetiology
Treatment
Direct shoulder treatment
Manual therapy mobilisations
Bursal frictions
directly surrounding soft tissue release e.g. biceps work
retraction/deload strapping
proprioceptive work
facilitation of correct ST rhythm
Non-direct shoulder treatment
thoracic mobilisations
SNAGS
adjascent muscle stretching
Cspine neural optimisation
USS, heat, ice
rest from aggravating activities
Ergonomic optimisation
Advice and Education +++. Consider time periods
Assessment
HK = most effective
MMTs. (account for fatigue perspective)
palpation - can feel bursal thickening
observation
scapula position 1 - 3 holds
AROM
yergason's for biceps involvement (secondary)
posterior capsule MLT