mechanosensitivity is present in multiple tissues. Localization of one specific tissue or involved structure via special tests can be difficult. Diagnostic imaging for patients with impingement symptoms is considered necessary for patients only when red flags are present, when there is a history of trauma, and when a minimum of three months of conservative treatment results in no improvement (Requejo-Salinas et al., 2022). Healthcare Consideration: The development of impingement syndrome/rotator cuff–related shoulder pain is thought to be at least somewhat dependent of the shape of the acromion. The three most common morphologies of the acromion are flat, curved, and hooked (Creech & Silver, 2023). Self-Assessment Quiz Question #4 Pain with resistance to which movements is considered key for the diagnosis of impingement syndrome/rotator cuff–related shoulder pain?
The test is positive if pain and weakness is present, indicating supraspinatus weakness and/or impingement (Cotter et al., 2018). ● Hawkins-Kennedy impingement sign : This test is performed with the patient standing. The examiner places the patient’s shoulder in 90 degrees of shoulder flexion with 90 degrees of elbow flexion. The examiner passively internally rotates the arm. The test is positive if the patient has pain with internal rotation (Flynn et al., 200). ● The painful arc sign : While standing, the patient elevates the arm in the scapular plane and then slowly reverses this motion. The test is positive if there is pain between 60 and 120 degrees of elevation (Flynn et al., 2008). ● Infraspinatus muscle test : While standing and with the arm at their side, the patient flexes the elbow to 90 degrees. From this position, the examiner directs a force into internal rotation and the patient resists it. The test is positive if there is pain or weakness with resisted internal rotation. It should be noted that the efficacy of special tests in diagnosing impingement syndrome/rotator cuff–related shoulder pain is called into question by Requejo-Salinas et al. (2022) due to the inability of these special tests to isolate and specifically stress a single anatomic structure. When several anatomic structures are concurrently alerted,
a. Shoulder abduction and internal rotation. b. Shoulder flexion and internal rotation. c. Shoulder abduction and external rotation. d. Shoulder abduction and internal rotation.
ARTHRITIS
Glenohumeral joint arthritis With a prevalence rate of between 4% and 26%, osteoarthritis of the glenohumeral joint is a common condition (Rees et al., 2021). It is characterized by degeneration of the articular cartilage and subchondral bone with narrowing of the glenohumeral joint space (Rees et al., 2021). An important feature of this condition is decreased range of motion in all directions, especially passive external rotation (Thomas et al., 2016). The pain associated with this condition can be debilitating. Loss of shoulder range of motion is progressive over many years and can lead to significant functional deficits (Thomas et al., 2016). Glenohumeral joint arthritis is present in approximately 20% of adults older than age 65 years. Age is considered the main risk factor for glenohumeral joint arthritis (Ansok & Muh, 2018). Other risk factors include being female, history of shoulder trauma, obesity, Caucasian race, rotator cuff tear, shoulder instability, crystalline arthropathy (or gout), and sickle cell disease (Feger et al., 2023). Acromioclavicular joint arthritis Osteoarthritis of the acromioclavicular joint is considered one of the most common pathologies of the shoulder (Farrell et al., 2019). This condition causes pain and limits the functional capacity of the shoulder. A significant symptom is pain localized to the acromioclavicular joint that may extend into the trapezius and anterior deltoid muscles. It is aggravated by lifting objects and reaching across the body. This makes activities such as cleaning, putting away groceries, and dressing difficult. Weightlifters and rugby players often experience excessive stress or injury to the joint with their sports-related activities. Additionally, those with occupational tasks that require repeated overhead lifting such as mechanics or stock room associates are more prone to arthritis in the AC joint. Objective examination features includes localized tenderness at the acromioclavicular joint, a positive cross-body adduction stress test, a positive acromioclavicular resisted extension
Clinical Presentation The typical presenting symptoms for osteoarthritis of the shoulder are progressive, activity-related pain that is deep in the joint and is often reported by patients as occurring posteriorly. As this condition progresses, night pain becomes common (Millett et al., 2008). Pain is present at rest for many patients and can interfere with sleep. Loss of range of motion can create significant functional limitations, especially in reaching overhead and behind. Crepitus with range of motion may occur (Millett et al., 2008) Diagnosis of glenohumeral arthritis is confirmed via plain x-ray imaging, where degenerative changes can be seen via anteroposterior and axillary views (Thomas et al., 2016). test, and a positive active compression (O’Briens test) or Paxinos test. Radiographs commonly show hypertrophic arthritic changes at the acromioclavicular joint (Farrell et al., 2019). Special tests for acromioclavicular joint involvement: ● Acromioclavicular resisted extension test : To perform this test, the examiner stands behind the seated patient. The examiner passively moves the shoulder into 90 degrees of flexion with internal rotation with 90 degrees of elbow flexion. The examiner places their hand on the patient’s flexed elbow and asks them to horizontally adduct the arm against isometric resistance. The test is positive if it creates pain in the acromioclavicular joint. This test can be used to differentiate between acromioclavicular joint involvement and impingement syndrome (Cook & Hegedus, 2013).
Page 22
EliteLearning.com/Physical-Therapy
Powered by FlippingBook