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SHOULDER IMPINGEMENT (GAPS IN KNOWLEDGE (New technology/treatment…
SHOULDER IMPINGEMENT
ETIOLOGY
: Related to posture, associated with other shoulder pathologies/inflammatory conditions
Neers Theory - reduction in subacromial space
DEFINITION
: Most frequent cause of shoulder pain. Typically overuse/repetitive strain injury, multifactorial and complex. More a syndrome than a diagnosis. Biomechanics plays a big role (related to movement patterns). Subacromial bursa gets impinged in space, and can impact supra spinatous tendon. Can cause tendinopathy. Debate over terminology.
DEMOGRAPHIC
Altthletes: Especially involving in throwing/overhead/weight lifting type acitivities
Middle ages M>F
Workforce
Risk factors
Overuse
Poor buomechanics
Male
Hypermobility syndromes
Prior injury
Types
Internal
: Eg acromion shape, tendinopathies
External
: Eg Postural
PHYSIOTHERAPY
Assessment
Back
: ROM, curves
Ribs
: Movement
Scapula
: winging?, movement in arm elevation
Biomechanics
: UL activity, scapulothoracic and humeral rhythm
Special tests
: shoulder and other to rule in/out ie neurological, quadrant
Objective measures
: MMT, ROM**, HBH, HBB, Fx reach, lifting, observation, palpation, neurological
Symptoms
Painful Arch (relieved with adduction)
Positive empty can, isometric resisted ER, hawkins kennedy test
Pain, especially related to overhead activity/IR
Usually weakness, not always
Neck
: ROM, Musculature
Treatment
Taping
Triggerpoint
Scapula Exercises
Biomechanic retraining
Thoracic mobilisations
POLICE: Initially. Protect, optimally load, ice, compress, elevate
Task Modification
TENS/US
HEP: Theraband, scap positioning
Stretches: Traps, thoracic spine, posterior cuff
Evidence
Tests
: Painful arch, Neers and resisted ER good for ruling in or our impingement. Better when done together, and if 3 or more are positive out of 5 (Hawkins Kennedy, etc)
Quality: Heterogenous,
not enough. Inconclusive re postural component
Manual Therapy
: Limited evidence of efficacy
Mobilisation/Exercise:
Evidence it decreases pain and improves function in short term, and is as effective as surgery
GAPS IN KNOWLEDGE
New technology/treatment emergence
Specialists
Current guidelines/recommendations
New Evidence
Prognosis
Medical Interventions