Impingement Syndrome

Russell Carrington is a 25 year old right handed relief pitcher for the MLB team the Baltimore Orioles. Carrington has been playing baseball since he was seven years old and this was his third season in the Major Leagues. Carrington was at the mound and in the motion of throwing a fastball, when he felt a “pop” in his overhand motion. He dropped to his knees and clinched his right shoulder in pain. Athletic trainers came onto the field an upon examination Carrington stated his arm felt like it was “dead” and felt like it was “catching”. Carrington was seen by the team physician. She performed ROM exercises, strength, and stability tests on his shoulder and examined his neck and head to ensure pain wasn’t coming from a pinched nerve. She concluded that further testing and imaging was necessary. Carrington had an X-ray and MRI done on his shoulder and he was diagnosed with a type II SLAP (Superior Labrum Anterior and Posterior) lesion. He didn’t want surgery done because he would miss the remainder of the season and possibly the next, so doctors prescribed non-steroid anti-inflammatory medication and five months physical therapy to strengthen the shoulder capsule. After completion of physical therapy, the pain didn’t improve and arthroscopy surgery was recommended.

Your doctors will use an x-ray to diagnose a tear in your rotator cuff. If the tear is larger than 3 centimeters and you have been struggling with symptoms for 6 to 12 months, orthopedic surgery will be essential.

Walch et al first described the internal impingement as an intraarticular impingement of the rotator cuff in the abducted and externally rotated shoulder. With 90 degrees of both abduction and external rotation, the articular surface of the posterior superior rotator cuff becomes pinched between the labrum and the greater tuberosity.5 The authors separated the labral lesions from SLAP lesions which extended anteriorly to the biceps anchor at the supraglenoid tubercle, concluding that internal impingement may be responsible for a subset of patients with isolated posterior SLAP tears.5

Inspection of the right shoulder joint reveals atrophy. Movements are restricted with flexion to 90 degrees limited by pain and abduction to 75 degrees limited by pain. Hawkin’s test, Neer’s test, Shoulder crossover test, Empty Cans test, Lift-off test, and Apprehension test is positive. On palpation, tenderness is noted in the acromioclavicular joint and subdeltoid

Dynamic scapular dyskinesis is detected by asking the patient to raise and/or abduct both arms repeatedly in a rhythmic motion, until fatigue of the scapular stabilizers results in failure to keep the scapula well positioned in relation to the thoracic wall. Active scapular retraction and elevation are checked. The next step is to look for muscle atrophy and remember active and passive range of motion should be examined and compared with the non-injured shoulder. It is easy to detect muscle atrophy of the infraspinatus viewing from the back of the patient, whereas the supraspinatus is covered by the trapezius. Atrophy of the shoulder muscles is a common finding in patients with rotator cuff tears.

Rotator cuff surgery affects the function of the shoulder. It is very painful injury and there is loss in strength. If the rotator cuff tendon becomes inflamed or is partially torn, it can be painful and will most limit shoulder movement. This injury occurs from a sudden impact, like falling on your arm which might accrue in motocross, snowboarding, playing football, and similar collision sport. Activities that might cause overload to the tendon have a possibility to tear the tendon. Other ways a rotator cuff can tears is from old age and over use over the years.

The patient was an active participant in both contact as well as non-contact athletic activities. The patient reported occurrence of different symptoms that included; pain, weakness, instability, paresthesia, crepitus, as well as instability of the shoulder during sleep. Sulculus sign was conducted to assess the rotator interval and load and shift test for determination of the patient’s posterior stability. The doctor diagnosed positive for multidirectional instability. The patient’s multidirectional instability was not caused by a traumatic event. The patient had not exercised the joint over a long period of time, hence he had a weak shoulder joint, particularly the rotator cuff. The doctor recommended that the patient should be treated for the pain and inflammation of the shoulder caused by the multidirectional instability and then placed on physical therapy aimed for one year aimed at helping in the strengthening of the muscles of the patient that support the scapula (shoulder blade) and the rotator cuff (shoulder joint) so as to help the patient in returning to normal physical activity and also prevent an injury at the same place

Instability Impingement. This occurs in younger patients, typically 15-30 years old. The rotator cuff is irritated because the shoulder is loose in the socket. This often happens in baseball pitchers, swimmers, and other throwing athletes. Shoulder instability can be classified into two different types, dislocations and subluxations. Dislocations happen when the head of the humerus completely pops out of the socket. The first few times this happens, it is usually with significant trauma although some people can have these without any injury at all. After that, it can get easier and easier for the joint to dislocate. Most shoulder dislocations are anterior - this means that the ball pops out the front of the socket. Subluxations are the feeling that the shoulder slips slightly out of socket, then immediately comes back in place. This often happens without any major trauma. Sometimes it happens in people who are very "loose-jointed". Sometimes these happen in just one direction like out the front, "anterior", and other times they happen out multiple directions like the front and back,

*insert article *attachedBesides being able to see the inside of a shoulder, doctors use different physical tests to evaluate the shoulder in order to determine what type of injury and how severe an injury may be. One such test was recently developed by Dr. Carl J. Basamania at the Womack Army Medical center in Fort Bragg, N.C. The test was developed to evaluate shoulder instability in a patient. During the test the Dr. or examiner stands next to the patient who is to lay flat on his/her back. The hand of the examined should is held firmly by the examiner. The examiner then pushes against the clavicle to stabilize th scapula, while they also gently hold the pectoral muscle with their thumb in order to be able to assess relaxation. The examiner then rotates the arm form neutral to full external rotation. If the patient has AIGHL incompetence there is a lack of tightening as the arm reaches full external rotation. The test has appeared to be highly accurate and may be of value to Dr.'s and surgeons alike. After doctors have determined what type and what degree of injury a patient has sustained using various tests it is on to the next step, rehabilitation.

The shoulder girdle is an intricate anatomic structure representation to maximize three-dimensional motion of the hand and opposing thumb, and although the shoulder is often thought of as synonymous with the glenohumeral joint, it is in fact possessed of four separate joints, (acromioclavicular, sternoclavicular, glenohumeral and scapulothoracic), as well as numerous muscles and ligaments that follow synergistically to limit gesture of the upper extremity. Make headway in cross-sectional imaging over the past decade have insurrection imaging of the shoulder girdle, mainly with deem to the soft-tissue structures. Trauma to the shoulder is common. Usually injuries range from a separated shoulder resulting from a fall onto the shoulder

The shoulder region has the greatest range of motion and the least stability (Degerlendirmesi, 2014). As I have mentioned in my initial post, due to the complex anatomy of the shoulder and biomechanics of the joints and soft tissues, it is crucial that proper imaging methods should be utilized (Degerlendirmesi, 2014). One purpose of imaging is to check for the presence of a fracture or dislocation in acute cases. (Degerlendirmesi, 2014). Obtaining the patient’s history and performing a physical examination in correlation with imaging findings is vital in avoiding errant treatment of lesions in the shoulder that are asymptomatic or neglecting other pathological

Introduction: The glenohumeral joint has the most instability but most range of motion when compared to any other joint in the body. It requires the labrum, ligaments and capsule to maintain stability and function. A glenoid labrum tear disrupts this joint leading to pain and instability (Fitzcharles). Tears in the labrum are common in athletes who use repetitive motions of the shoulder, such as football quarterbacks, baseball pitchers and weightlifters. These tears can sometimes be mistaken as glenohumeral join instability, adhesive capsulitis and shoulder impingement (Painful).

Shoulder pain and associated glenohumeral joint movement dysfunctions are common and debilitating conditions(5). The most frequently occurring problems include: shoulder impingement, rotator cuff-associated disorders, glenohumeral joint instability and adhesive capsulitis(5). Proper scapular motion and stability are considered to be crucial for the shoulder to function normally(6, 7). The scapular must serve as first, a stable base for glenohumeral function, second, a site of muscle attachment and third, a link for proximal-to-distal transfer of energy(2, 6, 8). Therefore abnormal functioning of the scapular will decrease normal shoulder function and predispose the shoulder to injury ((2, 5, 9). This essay aims to review the importance of scapular control during shoulder movements, and will discuss the evidence for scapular control to rehabilitate Glenohumeral joint injuries.

2. During inspection of the patient’s affected shoulder, name at least three key clinical aspects that you need to observe on both shoulders that would suggest any pathology or abnormality on the shoulders. From the three clinical aspects that you observed, explain what each of the findings would indicate concerning the pathology of the shoulder. For example if the shoulder is

This paper is going to be over rotator cuff injuries and what to do if this occurs to an athlete. The rotator cuff consists of four muscles which are the Subscapularis, infraspinatus, teres minor, and the supraspinatus and their associated tendons that insert into the Humerus. These groups of muscles are responsible for rotating the arm internally and externally as well as abducting the shoulder. The acronym for the four muscles of the rotator cuff is known as SITS. The best treatment for symptomatic, nontraumatic rotator cuff tears is unknown. The purpose of this trial was to compare the effectiveness of physiotherapy, acromioplasty, and rotator cuff repair for this injury. The way this trial worked was that 180 shoulders with the symptomatic,