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Shoulder Impingement Algorithm

Shoulder Impingement Algorithm. Ann Bonsignore Brianna Cowley Angie Moody Laura Sweeney Brittany Youngers. Anatomy. http://www.drnickcampos.com/health-newsletter/Shoulder%20Impingement%20Syndrome.htm. Anatomy. http://www.orthogate.org/patient-education/shoulder/impingement-syndrome.html.

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Shoulder Impingement Algorithm

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  1. Shoulder Impingement Algorithm Ann Bonsignore Brianna Cowley Angie Moody Laura Sweeney Brittany Youngers

  2. Anatomy http://www.drnickcampos.com/health-newsletter/Shoulder%20Impingement%20Syndrome.htm

  3. Anatomy http://www.orthogate.org/patient-education/shoulder/impingement-syndrome.html

  4. 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

  5. Anatomy http://ptindia.tripod.com/oct/article2.htm

  6. 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

  7. Impingement Types

  8. Mechanism of Injury

  9. Who is at Risk

  10. Patient Presentation

  11. Positive/Negative Tests

  12. Differential Diagnosis

  13. Differential Diagnosis

  14. Impingement Algorithm 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 (+)

  15. 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

  16. References Chang, 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).

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