Shoulder Impingement Algorithm

Ann BonsignoreBrianna CowleyAngie MoodyLaura SweeneyBrittany Youngers

Anatomy

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

Anatomy

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

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

Anatomy

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

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

Impingement Types

Mechanism of Injury

Who is at Risk

Patient Presentation

Positive/Negative Tests

Differential Diagnosis

Differential Diagnosis

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

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

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).