shoulder impingement algorithm ann bonsignore brianna cowley angie moody laura sweeney brittany...
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Shoulder Impingement Algorithm
Ann BonsignoreBrianna CowleyAngie MoodyLaura SweeneyBrittany Youngers
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Anatomy
http://www.drnickcampos.com/health-newsletter/Shoulder%20Impingement%20Syndrome.htm
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Anatomy
http://www.orthogate.org/patient-education/shoulder/impingement-syndrome.html
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Biomechanics
The shoulder complex is designed for mobility
The Rotator Cuff (RTC) muscles snub the humeral head into the shallow glenoid fossa during arm elevation
Glenohumeral ligaments and capsule provide stability and limit excessive motion
Congenital or degenerative changes can cause the acromion process to become curved or hooked
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Anatomy
http://ptindia.tripod.com/oct/article2.htm
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Biomechanics
Scapulohumeral rhythm results from movement at four joints Glenohumeral Scapulothoracic Acromioclavicular Sternoclavicular
Correct scapulohumeral rhythm is a 2:1 ratio of glenohumeral to scapulthoracic motion during arm abduction Preserves the length tension relationship of the
muscles of the glenohumeral joint (GHJ) Prevents impingement between the humerus and
acromion
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Impingement Types
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Mechanism of Injury
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Who is at Risk
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Patient Presentation
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Positive/Negative Tests
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Differential Diagnosis
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Differential Diagnosis
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Jobe (+)Neer (+)Hawkins (+)Apprehension (+)Yocum (+)
Neer (+)Apprehension (+)Hawkins (-)Jobe (-)
Relocation (-)
Relocation (+)Release pain (+)
Relocation (+)Release pain (+)
Full Can (+)Painful Arc (+)
Internal rotation is decreased (+)
O’Brien (+)Speed’s (+)
Load and Shift (+)Sulcus Sign (+)Apprehension/Relocation (+)
Impingement Algorithm
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Take Home Message
Shoulder pain is very common
Don’t limit your hypothesis to impingement only, rule out other pathologies
Using this algorithm can help you quickly and accurately rule in and out the diagnosis
Selecting the correct impingement type will help guide your treatment plan
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ReferencesChang, W. (2004). Shoulder impingement syndrome. Physical Medicine and
RehabilitationClinics of North America,15, 493-510.
Cools, A.M. & C. D. (2008). Screening the athlete's shoulder for impingement symptoms: a clinical reasoning algorithm for early detection of shoulder pathology. British Journal of Sports Medicine, 42, 628-635.
Dutton, M. (2008) Orthopaedic Examination, Evaluation, and Intervention. 2nd ed. New York, New York: McGraw Hill Incorporated.
Heyworth, B. (2008). Internal impingement of the shoulder. American Journal of Sports Medicine, 37(5),1024-37. doi: 10.1177/0363546508324966
Impingement Syndrome: Primary & Secondary impingement. (n.d.). Retrieved April 17, 2013, from North Austin Sports Medicine.
Kamkar, A., Irrgang, J. J., & Whitney, S. L. (1993). Nonoperative Management of Secondary Shoulder Impingement Syndrome. Journal of Orthopaedic and Sports Physical Therapy, 17(5), 212-224.
Thompson, D. (2000, November 5). Shoulder elevation involves. Retrieved April 17, 2013, from Shoulder elevation involves: http://moon.ouhsc.edu/dthompso/namics/scapryme.htm
Vind, M., Bogh, S., Larsen, C., Knudsen, H., Sogaard, K, & Juul-Kristensen, B. (2011). Inter-examiner reproducibility of clinical tests and criteria used to identify subacromial impingement syndrome. British Medical Journal, 1(1).