Shoulder Impingement Explained

[@aejaycoronel4690]

thank you very much....no more headaches on shoulder special tests....in just 4mins you solved my crisis.. more power to both of you

[@Physiotutors]

You're welcome! Just realized that Ann Cools withdrew a bit from her theory and although shoulder special tests still have a place, it is most probably impossible to figure out which part of the rotator cuff is affected with the different tests.

[@tomtenthij5676]

@@Physiotutors Thank you!

[@berengeredelgado6951]

There is literally a video for everything! I love this channel! Keep up the great work. Also, thank you for helping students like me :-)

[@Physiotutors]

We try ☺️

[@TeeSK13]

thanks a lot sir this video is so informative and very useful. keep on working, and making more a useful video.I have to support you all. Thank you again sir

[@Physiotutors]

+Tzer Swift thanks a lot for the nice words! Spread the word and thanks for your support

[@viviebojilov6]

Amazing video, favorite one yet. I would love more diagnostic cluster videos based on conditions!

[@Physiotutors]

Happy you like it Vivie. Be aware that it is based on Cools from 2008, so a bit outdated!

[@williameldon8768]

Ending my second year of PT school and these are great for review before going on orthopedic clinical rotation. I enjoy the citations of high-level studies in your videos and emphasis on evidence-based practice. Thanks for contributing your videos to our profession. Subscribed. Cheers from CA.

[@Physiotutors]

+William Eldon Hey William! Thanks for The kind words! we put a lot of effort and thought into the videos and it was of upmost importance to us to include proper referencing to allow you as students to understand where we get information from

[@tomtenthij5676]

Thank you So much for this video!

[@jolicska]

you guys are incredibly helpful! thank you and god bless!

[@acxezknightnite1377]

Great video to refresh knowledge. Thank you for this.

[@akhterhamid2137]

very informative .....thanks physiotutor

[@Physiotutors]

You’re welcome 😊

[@mathikumar3204]

Very useful information thank you

[@Corykurk]

Extremely informative videos and channel. Thank you for the clarity and quality of your videos.

[@Physiotutors]

+Capnkurko Thanks a lot! We appreciate you taking the time to leave us feedback and thx for following!

[@akshayaakshaya7920]

It was to the point....well explained

[@jonielshuke4054]

This video is superb and explains in great detail different causes/pathologies of impingement!

[@Physiotutors]

Happy you like it Jay! Be aware that this is still based on the old term of shoulder impingement, which is a correct term for internal impingement and maybe still for primary impingement. Research has shown that we should rather talk about subacromial pain syndrome for secondary external impingement. The algorithm by Cools et al. (2008) is based on mechanistic reasoning, but hasn't been validated and probably will never be as it's very hard to be specific with shoulder tests.

[@niahpossog5997]

You are a lifesaver.

[@Physiotutors]

thanks! Glad we could help Niah

[@rickelderman228]

Well done Andreas.

[@Physiotutors]

+Rick Elderman Thank you very much Rick! We hope that the new ESP students are up to last year's standards ;)

[@nourelmarghany1406]

Very useful .. I can find here what I have been searching for

[@陈克-r7w]

That chart is amazing and it is exactly what I am looking for to narrow down the condition. Great channel.

[@Physiotutors]

Glad you like our video and thank you for subscribing and your compliment!

[@wusteven3301]

Thank you for the information. I need to read again and again.

[@Physiotutors]

You're welcome! Don't get too hung up on it as Cools et al. are not really promoting it anymore as it's very difficult to determine the exact structure that is responsible for pain in the shoulder. So validity is low.

[@jayantachowdhury6741]

Good treatment

[@janmohammadkhalid7591]

Thank you sir. If you explain slowly it is batter.

[@jonielshuke4054]

Very informative and an impressive lay out of the video! Excellent job sir!

[@Physiotutors]

Thanks and you're welcome Jay!

[@sashafarrier5106]

I love you guys! Thanks for the wonderful videos!!

[@Physiotutors]

Love the comment Sasha!;)

[@RapidBlindfolds]

where can we find this diagram presented at 3:43?

[@hodasherif7479]

thank you so much from 2021♥️

[@Ido-Levy]

Great info! thanks a lot

[@HafizahHoshni]

Thank you so much for your freaking absolutely amazing videos.10/12/2018 😃😃

[@كهعص]

Thanks very nice channel

[@Physiotutors]

Thanks!

[@zulfiqarali-rw7ry]

thank you for this , made everything so easy.

[@Physiotutors]

You're welcome. Be aware that this theory is based upon the article from Ann Cools from 2008. More recent evidence suggests that we are unable to really tell what specific structure is causing pain in our patient's shoulders.

[@ebtihal-3437]

clear explanation Dr Andreas .can you please discuss the role of physiotherapy in the treatment program and what are general guidelines to follow?

[@Physiotutors]

Unfortunately, there are no general guidelines to treat shoulder impingement. As you can see there can be several reasons why your patient's can suffer from impingement syndrome. So it is very diverse, but often is a combination between deloading the affected structure first, strengthening the scapular stabilizers and external rotators, mobilizing the thoracic spine and often dorsal capsule of the GH joint and gradually increase the load again.

[@derekd1997]

Extremely helpful video, thank you. Just one question: the chart divides impingement symptoms into External subacromial impingement or Internal posterosuperior glenoid impingement. What about Internal anterosuperior glenoid impingement?

[@Physiotutors]

Hey Derek, glad to hear! This video is based on the research of Ann Cools from 2008 and they quote: "Based on the location of the impingement, anterosuperior and posterosuperior glenoid impingement have been described. Since anterosuperior glenoid impingement is less common, and literature is scarce, it is not discussed further in this paper." We know that this algorithm is taught a lot in schools and we found it useful to help break it down. However, we ourselves have moved away from it with increasing clinical expertise and knowledge, especially based on the latest evidence there are numerous articles that challenge a lot of concepts like: - The theory of 'impingment' in general (e.g.: www.tandfonline.com/doi/abs/10.1179/1743288X11Y.0000000027) - The idea that we are able to make a structural diagnosis (e.g. www.ncbi.nlm.nih.gov/pubmed/23633343)

[@tomtenthij5676]

It is a great video guys! But where do i place Anterosuperior Glenoid Impingement

[@tomtenthij5676]

Another question, why is the jobe test positive in External subacromial impingement when the jobe test supports anteflexion and internal rotation? Same goes for Hawkins, is it because of the resisted ABduction?

[@tomtenthij5676]

Passively because of the movement, my guess would be that this wouldn't provoke any symptoms because of the origin of the cause of disease

[@shristidas3339]

U made it so easy

[@Physiotutors]

+Shristi Das thanks! That's the goal

[@brittathomas4820]

Hi Guys, great video. The end diagram where it mentions neer + ant or neer + post, does that mean where the patient feels the pain either anterior or posterior? sorry just a little confused there!

[@Physiotutors]

Yes exactly. Please be aware that this model is from 2008 and it is not backed by hard evidence but rather expert opinion by Ann Cools

[@mohamedelmohamdy743]

could you tell me a textbook to get more about orthopedics please .

[@sarazayed9475]

thank u for this video .. may I ask u to talk about frozen shoulder?

[@Physiotutors]

we have. its on our channel. Search physiotutors frozen shoulder

[@GoodByeSkyHarborLive]

For anterosuperior glenoid impingment, is it not between the anterosuperior glenoid rim and lesser tuberosity of humerus? And how does slap lesion contribute to internal impingement like anterosuperior impingement?

[@islammedhat3421]

Thanks Doc

[@Physiotutors]

Ur welcome Islam!

[@ploirodon]

Are you using the same form of rehab (the 4 videos in the playlist) for all the mentioned sub-types of SAPS? Thanks for great content!

[@Physiotutors]

The algorithm shown here by Cools et al is quite outdated by today’s understanding The exercise Progression is pretty much how we progress a patient with SAPS

[@ploirodon]

@@Physiotutors Oh thats good to know. Do you consider labelling videos that are outdates due to more recent evidence so we know not to rely on them or study them any longer? I've seen you remaking some videos once they're not up to current evidence or your standards any longer which is great!

[@陈克-r7w]

What do you recommend to read to get further information for other conditions of the body? like how to and what test to do to identify the condition on hip, lumbar, leg etc. Coz the pain could come from nerve compression, muscular tension, organ or bone.

[@Physiotutors]

Check out our book section on our webpage: www.physiotutors.com/books/ The book "Orthopedic Assessment" covers basically all musculoskeletal conditions and how to test and differentiate them. Furthermore, check out the different videos on our channel, read research articles (for example on pubmed.com) and do a Bachlor's degree or Master's degree in physio if you don't already have one!;)

[@陈克-r7w]

I think I will do that degree in the future. Now I am doing the diploma of remedial massage.

[@sherlockamro2491]

Is this form work untill now??, if no tell me please if there is any alternative one.

[@crislyponteras2013]

why is it scommonly associate with painful arc syndrome the patient who are 40 years above?

[@HeyIntegrity]

Is coracoid impingement the same as anterosuperior impingement? Which position. In a bench press what would make it worse, i am guessing the end range of motion? for anterosuoerior impingement, what exactly is the "subscapulsris retract". Is this just the subscapulsris tendon and the deep surface meaning the tendon fibers on top? In this case the impingement would just wear and tear away the subscapularis tendon, thinning it? In posterosuperior impingement, the proposed pathology is wearing away the infra/supra tendon by the posterior labrum?

[@anvitatelang6780]

How to diagnose impingement in a patient who is having adhesive capsulitis ?

[@Physiotutors]

kzbin.info/www/bejne/a6vTiZWsestsoJI

[@sinmingchiu6096]

What's SAT and SRT? Thank you

[@Physiotutors]

Scapular Assistance Test (SAT) and Scapular Retraction Test (SRT)

[@ii_lei_ii-lei3646]

Ich finde das Video gelungen und selber als Physio den „Algorithmus“ sehr brauchbar. Was ich mir jedoch auffällt in letzter Zeit: viele meiner Gird (Werferschulter diagnostiziert) Patienten geben bei den Befünden positive Jobe, Neer, Hawkings und apprehension Testresultate an, jedoch mit posterior-superior betonten Schmerzen. Das würde nun weder für subacromiales oder posteriosuperiores Impingement sprechen. Was meint ihr? Gruss

[@Physiotutors]

Vielen Dank! Laut Cools wären ja bei einem posterosuperiorem Impingement der Jobe und Hawkins negativ. Wir sind praktisch mit dem Algorithmus "aufgewachsen", aber verwenden ihn selbst nicht mehr, da er mehr ein theoretisches Konstrukt darstellt und keine Validität hat. Es gibt leider keine Tests, die uns mit hoher Spezifizität zeigen können, welche Struktur wirklich für den Schulterschmerz unseres Patienten verantwortlich ist. Also schwierig echt zu sagen welcher Strukture tatsächlich verantwortlich ist im Fall deiner Patienten.

[@ii_lei_ii-lei3646]

Danke für die Antwort. Welche Tests verwendet ihr denn nun, um ein posterior-superiores Impingement zu "bestätigen" (Wahrscheinlichkeit zu erhöhen, dass es sich um eines handelt)?

[@Physiotutors]

Musste selbst suchen, da ich selbst noch keinen Schulterpatienten mit bestätigtem posterosuperiorem Impingement hatte. Also Leschinger et al. (2017) sagen zumindest dasselbe wie Cools, dass die Standard-Tests - vor allem der Neer mit posteriorem Schmerz - ebenfalls positiv sind: www.ncbi.nlm.nih.gov/pmc/articles/PMC5585665/ Sieht wohl so aus, dass die Diagnose wie so oft eine Kombi aus guter Anamnese und Tests ist: www.ncbi.nlm.nih.gov/pmc/articles/PMC5155252/ Meister et al. (2004) haben das Posterior Impingement Sign (Im Prinzip die Late Cocking Phase beim werfen) evaluiert und haben eine Sens von 75,5% und Spec von 85% gefunden. Wenn nur die non-contact Verletzungen evaluiert wurden sogar eine Sens von 95% und eine Specs von 100%: www.ncbi.nlm.nih.gov/pubmed/15379239

[@mattschneider7546]

So how does all of the information in this video compare to some of your newer videos about shoulder impingement being a myth? Should the information in this video be considered out dated due to what was said in the myth video?

[@Physiotutors]

Absolutely

[@mariamaboumia9284]

What about big stress

[@Physiotutors]

Are you talking about stress or mechanical stress?

[@GudduTomar-rv9rm]

Hello Doc. I have shoulder impingement for last 1.5 year . I don't have pain in normal activities or i can say under hand activities. But when i suddenly rotate my Hand(Humerus bone) inward it suddenly Pops into rotator cuff . I can't throw anything, can't sleep on shoulder, i have pain and rubbing sensation while rotating the hand.. kindly help me ... I am avoiding steroid injection Should i go for it and will steroid cure it?

[@rosem3978]

What does encroachment mean!

[@Physiotutors]

Narrowing

[@chrisjames4754]

I wish my stupid ass doctor knew this much about shoulders.

[@Physiotutors]

Doctors have to know a lot on a broad spectrum

[@megabiscoito78]

What do you mean with subscapularis retract?

[@Physiotutors]

a retract of the subscapularis tendon after a tear which then get impinged

[@kanagalakshmi2268]

Sir SLAP lession means????

[@Physiotutors]

Superior labral tear from anterior to posterior.

[@kanagalakshmi2268]

@@Physiotutors thank you sir

[@meller13]

Time to delete some of your outdated videos

[@ruairilynchinjuryclinic852]

Hi love your videos! Where would i get more information on the source you used for the impingement symtoms diagram. Thanks

[@Physiotutors]

Hey there is a link in the video description to the article! Have a great day and thanks for your feedback

[@李明融-t6y]

Thank you so much