SHOULDER IMPINGEMENT INTERVENTIONS MIMI GARCIAOTERO WHAT IS IT

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SHOULDER IMPINGEMENT INTERVENTIONS -MIMI GARCIA-OTERO

SHOULDER IMPINGEMENT INTERVENTIONS -MIMI GARCIA-OTERO

WHAT IS IT? • A compression of subacromial structures – -Supraspinatus tendon – -Biceps

WHAT IS IT? • A compression of subacromial structures – -Supraspinatus tendon – -Biceps long head tendon – -Subacromial bursa – -Glenohumeral capsule

POTENTIAL CAUSES • Tendonitis/tendinopathy • Bursitis • Partial/full thickness rotator cuff tears • Poor

POTENTIAL CAUSES • Tendonitis/tendinopathy • Bursitis • Partial/full thickness rotator cuff tears • Poor posture • Scapular/glenohumeral kinematics • Tight capsule/musculature • Muscular weakness • Bony

HO W DO W E DIAG NOSE I T ?

HO W DO W E DIAG NOSE I T ?

WE ASK KIRK!!!

WE ASK KIRK!!!

GENERAL TREATMENT OUTLINE (NONSURGICAL)

GENERAL TREATMENT OUTLINE (NONSURGICAL)

1. DECREASE PAIN (ACUTE PHASE) • Limit symptom producing motions – Alter work/home activities

1. DECREASE PAIN (ACUTE PHASE) • Limit symptom producing motions – Alter work/home activities • Gentle PROM – Either via patient or PT • Modalities – Ice, Estim • Analgesics (Diercks, 2014) – Corticosteroid injections – NSAIDs

2. ENCOURAGE ACTIVE RANGE OF MOTION • Pully’s • Wall walks • AAROM with

2. ENCOURAGE ACTIVE RANGE OF MOTION • Pully’s • Wall walks • AAROM with cane/ball

3. STRETCH • Anterior shoulder • Posterior shoulder • Pecs • Upper trap •

3. STRETCH • Anterior shoulder • Posterior shoulder • Pecs • Upper trap • Levator scapulae • Joint mobs (PT) – Inferior glide for abduction/flextion – Anterior glide for IR – Posterior glide for ER

4. STRENGTHEN & CONTROL Downward Lower trap scapula Levator scapulae rotators Rhomboid External rotators

4. STRENGTHEN & CONTROL Downward Lower trap scapula Levator scapulae rotators Rhomboid External rotators Infraspinatus Teres minor Posterior deltoid Protraction Serratus anterior Shoulder stabilization > general exercise (Dierks, 2014)

4. STRENGTHEN & CONTROL Downward rotators – Ys (theraband, cable machine, quadruped on swissball)

4. STRENGTHEN & CONTROL Downward rotators – Ys (theraband, cable machine, quadruped on swissball) – Ws – Scap squeezes – Rows – Isometric rows with scap retractions

4. STRENGTHEN & CONTROL External rotators - ER with cable - Starting with arm

4. STRENGTHEN & CONTROL External rotators - ER with cable - Starting with arm by side, can gradually increase elevation - Bilateral ER with theraband - Free weight with some ABD Protraction - Pushup plus - Supine punches - Wall slides with 90 degree shoulder & elbow flexion

4. STRENGTHEN & CONTROL Focus on eccentric movements? – 12 studies reviewed – 11

4. STRENGTHEN & CONTROL Focus on eccentric movements? – 12 studies reviewed – 11 showed significant decrease in pain with eccentric strengthening – 5/11 show more significant pain reduction compared to non-eccentric group – 9 studies asses strength, 7 of those demonstrated significant increase in strength for eccentric group – (Abdulla, 2015)

5. REOCCURRENCE PREVENTION • Sporting activities (>3 h/wk 10 months/year) (Dierks, 2014) • Incorporating

5. REOCCURRENCE PREVENTION • Sporting activities (>3 h/wk 10 months/year) (Dierks, 2014) • Incorporating exercise into regular routine to maintain strength • Maintain good posture • Avoiding symptom reproducing motions

REFERENCES • Diercks R, Bron C, Dorrestijn O, et al. Guideline for diagnosis and

REFERENCES • Diercks R, Bron C, Dorrestijn O, et al. Guideline for diagnosis and treatment of subacromial pain syndrome: A multidisciplinary review by the Dutch Orthopaedic Association. Acta Orthopaedica. 2014; 85(3): 314 -322. doi: 10. 3109/17453674. 2014. 920991. • Abdulla Y, Southerst D, et al. Effectiveness of the eccentric exercise therapy in physically active adults with symptomatic shoulder impingement or lateral epicondylar tendinopathy: A systematic review. Journal of Science and Medicine in Sport 2015 Oct , Volume 19 , Issue 6 , 438 - 453

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