2. Shoulder Pain Impingement Syndrome

SHOULDER PAIN IMPINGEMENT SYNDROME

SHOULDER IMPINGEMENT 

Suprahumeral impingement     

Supraspinatus Infraspinatus Subscapularis Long head Biceps tendon Subacromial bursa

Sugijanto,

Nyeri pada bahu Impingement syndrome FUNGSI, DISABILITAS DAN SEHAT

Anatomic impairment Cuff muscle AC Joint

Bursa subacromial

osteophyte

Supraspinatus

Subscapularis, infraspinatus, Inflamation

GH Instability

Pectoralis minor, levator scapulae

SLAP Lesion

Serratus anterior

Inflamationcalc formation

Contextual factors Internal External factors factors

Tightness

Functional impairment

Weakness

Scapular dyskinesis

Activity limitation

Internal impingement

Inflamation

Over head activity

Tighthypertrophy External impingement

Shoulder pain

The used of arm in ADL

Participation restriction Work Sport Recreation

PEMERIKSAAN FISIOTERAPI YG DIBUTUHKAN Diutamakan pemilihan evidence untuk:  Pemeriksaan Impingement (5):     

Painful arc Jobe’s test Neer test Hawkin Kennedy test External rotation isometric test

MUSCLE &TENDON Painful arc Supraspinatu s tendon Infrapinatus tendon

MUSCLETENDON

Subsapular tendon

Isometric abd test Palpation in borgol

Painful arc

Isometric ext rot Palpation in sphinx

Painful arc

Isometric ext rot Palpation in sphinx

Long head biceps tendon

Painful arc

Isometric int rot Palpation in netral Sugijanto,



Pemeriksaan Specific tissue (3x15) 

Tendon M Supraspinatus: Jobe’s/Empty can test  Isometric Abduction MLPP  Palpation posisi borgol 



Tendon M Infraspinatus: Isometric External rotation  Palpation posisi Sphynx 



Tendon M. Subscapularis Abdominal press test  Isometric Internal rotation  Palpation posisi Netral, diatas tepi 

TENDON SUPRASPINATUS EVIDENCE BASE TEST  Empty can test  Abduction resisted test  Palpasi posisi borgol

Sugijanto,

TENDON SUBSCAPULARIS EVIDENCE BASE TEST  Abdominal press test  Internal rotation resisted test  Palpasi posisi netral  medial sulcus bicipitalis

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TENDON INFRASPINATUS External rotation lag sign  Isometrik rotasi eksternal  Palpasi posisi sphynx 

Sugijanto,

SUBACROMIAL BURSITIS Subacromial bursa Painful arc

NeerHawkins test Palpation in extension

Sugijanto,



Pemeriksaan Scapular diskinetic Abduction-elevation  Static abducted position  Finding: 

Scapular Tipping (pectoralis minor tightness);  Scapular Shrugging (Scalenus tightness);  Scapular Winging (Serratus anterior weakness) 

Pemeriksaan SLAP  Pemeriksaan Glenohumeral instability 

 

Aprehension test Relocation test

MUSCLE &TENDON Scapular Tipping

Abductionelevation

Palpation lower angel on the scapula Contract relax stretch test of pectoralis minor m

SCAPULAR DYSFUNTION

Scapular winging

Abductionelevation

Palpation to medial margin Strength test for serratus anterior m

Scapular shrugging

Abductionelevation

Palpation to medial margin of the scapula CRS Levator scapular m Sugijanto,

SCAPULAR DYSFUNCTION ACCORDING TO KIBLER Tipping Winging Shrugging

Type 1 dyskinesie Prominentie angulus inferior “tipping”

Type 2 dyskinesie Prominentie margo medialis scapulae “winging

Type 3 dyskinesie Prominentie angulus superior scapulae mediorotatiestand “shrugging”

Sugijanto,

MUSCLE &TENDON Scapular Tipping

Abductionelevation

Palpation lower angel on the scapula Contract relax stretch test of pectoralis minor m

SCAPULAR DYSFUNTION

Scapular winging

Abductionelevation

Palpation to medial margin Strength test for serratus anterior m

Scapular shrugging

Abductionelevation

Palpation to medial margin of the scapula CRS Levator scapular m Sugijanto,

FISIOTERAPI YG DIBUTUHKAN MODALITAS DAN METODA  Anatomic Impairment target: US dan/atau transverse friction pd tendon atau bursa  Peregangan capsul superior, mobilization under caudal traction (MWM) 



Functional Impairment target: Scapulothoracal stabilization  Postural correction 



Disability target

ALAT UKUR/EVALUASI FISIOTERAPI YG DIBUTUHKAN Pengukuran nyeri  Pengukuran Stability  Pengukuran ROM,  Analisis scapulohumeral rhytm  Analisis scapulothoracal rhytm  Pengukuran movement disfunction  Pengukuran disabilitas 

PROCESS OF PHYSIOTHERAPY FOR MUSCLE IMPAIRMENT Pasif: terbatas springy Nyeri kontrak si

Isometric : Nyeri

Palpasi: Nyeri hipertoni a CRS test: Nyeri memende k

Relaksasi otot Transverse friction/ manipulation Stretching / C.R.S Myofascial release StabilizationStrengthening Sugijanto, exc

INTERVENSION  Intervensi: Supraspinatus



Transverse friction posisi ttt,



Stretching,



Caudal traction/translation dan



Codmann pendular exercise

 Scapulothoracal Infraspinatus

Subscapular

movement

function

Caudal traction

Sugijanto,

Sugijanto,

Sugijanto,

Sugijanto,

INTERVENSI 

  

Transverse friction Static inferior traction Codman pendular exercise Scapulothoracal movement function

Sugijanto,

UPPER TRAPEZIUS PERFORMANCE Test in shortened length (break test)  If cannot hold in test position 1015 = long upper trapezius  If cannot hold in whole range – weak 

Sugijanto,

LEVATOR SCAPULAR SHORTEN Saat abduksi elevasi terjadi Shrugging  Contract relax stretch test positif 

Sugijanto,

INTERVENSI

Stretching for Pectoralis minor  Strengthening for Serratus anterior  Stretching for Levator scapula 

Sugijanto,

GLENOHUMERAL INSTABILITY 

Joint instability  



Capsular stretch test  



Passive instability Active instability Apprehension test Relocation test (Load and sift test)

Isometric stability test

Sugijanto,

ANTERIOR AND POSTERIOR APPREHENSION TESTS  Anterior

Apprehension Test

 Posterior

Apprehension Test

Sugijanto,

RELOCATION TEST

 Uses

external rotation and posteriorly directed pressure to allow for increased external rotation Sugijanto,

SLAP LESION Slap test  Athroscopy 

Sugijanto,

TERAPI LATIHAN 

Latihan    

Postural correction Stabilization Stretching Mobilization

Sugijanto,