Transcript Shoulder Impingement - Active Physical Therapy | Reno

SHOULDER IMPINGEMENT
PT Intervention Strategies
By Parley Anderson, DPT
Shoulder Impingement
WHAT’S THE PROBLEM????????
https://www.youtube.com/watch?v=FAh_8erWyQw
Shoulder Impingement and
PT Treatment
What does the Research
Say?
PHYSICAL THERAPY INTERVENTIONS
Studies have shown that designing a specific evidence-based program for
each patient is more effective and beneficial compared to a more cookie
cutter approach using the same interventions for all patients with shoulder
impingement (Ebuagh et al., 2010).
Factors to be considered in prescribing interventions:
Classify the impairments believed to be causative to the individual's pain and
functional limitations.
Create an impairment based restoration program.
EXERCISES FOR SHOULDER
IMPINGEMENT
For an effective anterior shoulder stretch, place the hand over the head,
shoulder in 90° of abduction and 90° of external rotation, and lean forward
on a door frame (Ebuagh et al, 2010).
Scaption with thumb- up exercise for strengthening.
Y- exercise. Standing with the arms at the sides, move the shoulders into
extension against resistance of an elastic band. Studies have shown better
results in electromyographic activities for strengthening the trapezius muscle
(Ebaugh et al, 2010).
Eccentric Strengthening Exercises
 Full can scaption with a dumbbell (starting position must be pain-free).
 Eccentric external rotation using a dumbbell in sidelying position.
(Studies show that adding eccentric exercises to traditional shoulder rehab
protocols can increase strength and decrease pain (Maenhout et al, 2012;
Bernhardsson et al, 2011.)
PNF Paired with Trigger Point Release
 Trigger point release of the subscapularis
 Contract/relax of the subscapularis to move into greater external rotation
 PNF D2 flexion pattern
This treatment was found to decrease pain and increase glenohumeral ER
plus overhead reach (AlDajah & Unnikrishnan, 2014).
PT and Shoulder Impingement:
A New Approach
My Physical Therapy Evaluation:
 History (DOI, MOI, Past Treatments, Surgery etc)
 Establish baselines:
Pain levels/Location of Pain
ROM (Active/Passive)
Strength
Special Test/Concordant Sign/Functional Test
Develop Provisional Diagnosis
Derangement
Dysfunction
Test Hypothesis (Apply Mechanical Forces/Strategies)
Re-Assess Baselines
Confirm/Deny Hypothesis
Shoulder Impingement
Derangement:
 Symptoms rapidly changeable (i.e can get better/worse quickly)
 Symptoms can be constant or intermittent
 ROM rapidly changeable
 Can be acute, sub-acute or chronic lesion
 Can become dysfunctions over time
 Rx: Reduce the derangement
Directional Preference
 Anatomical Cause:
Disruption of Joint Surfaces
Encroachment of Meniscoids in joint space
Shoulder Impingement
Dysfunction:
 Symptoms (when present) are more consistent in nature
 Symptoms are more intermittent (no pain when tissue is on
slack)
 ROM is consistent
 Pain is usually found at End Range (stretch short/tight tissue)
 Lesion must be 10-12 weeks or older (mostly chronic lesions)
 Rx: Remodel Tissue
 Anatomical Cause
Joint adhesions/Contracture
Maladaptive muscle shortening
Scar tissue formation
Shoulder Impingement
Directional Preference
 Direction of motion/force that may do one or more of the
following
Reduce pain
Restore motion
Improve strength
Improve function
Improve concordant sign/special test
 Directional Preference
Preferred treatment strategy for derangements
May be painful to perform
May be painless to perform
May feel “good” to perform
SHOULDER EXTENSION
SHOULDER EXTENSION
INTERNAL ROTATION
INTERNAL ROTATION
INTERNAL ROTATION
HORIZONTAL ABDUCTION
HORIZONTAL ADDUCTION
https://www.wetransfer.com/downloads/2beb09622
bf9f050ac748092a7380c3c20150729111750/15be1f7b
5b748c974f7f08e6a856160320150729111750/f533eb
REFERENCES
 AlDajah, SB. & Unnikrishnan, R. (2014). Subscapularis trigger release and contract relax technique in patients with shoulder
impingement syndrome. European Scientific Journal (2014). 10(30): 408-416. Retrieved July 29, 2015, from ProQuest
database.
 Berhardsson, S., Klintberg, IH., Wendt, GK. (2011). Evaluation of an exercise concept focusing on eccentric strength training of
the rotator cuff for patients with subacromial impingement syndrome. Clinical Rehabilitation 25:69-78. Retrieved July
29, 2015, from ProQuest database.
 Ebaugh, D., Fleming, J, Seitz, A., (2010). Exercise protocol for the Treatment of Rotator Cuff Impingement Syndrome. Journal of
Athletic Training, 45(5). 483-5. Retrieved July 29,2015, from ProQuest database.
 Maenhout, AG., Mahieu, NN., DeMuynck M., DeWilde, LF., Cools, AM. (2012). Does adding heavy load eccentric training to
rehabilitation of patients with unilateral subacromial impingement result in better outcome? A randomized, clinical
trial. Knee Surgery, Sports Traumatology, Arthroscopy (2013), 21:1158-1167. Retrieved July 29, 2015, from ProQuest
database.
 Mckenzie Institue
Shoulder Impingement
p