Painful Arc Syndrome: Impingement, Rotator Cuff Tears & PT MCQs

Painful Arc Syndrome (Impingement)

Painful Arc Syndrome (Subacromial Impingement) occurs when soft tissues (Supraspinatus tendon, Subacromial bursa) are pinched under the acromion arch during abduction.

[Image of Painful Arc Range 60-120 degrees]

1. The Painful Range

• 0-60 degrees: Painless (Deltoid lifts arm).
• 60-120 degrees: PAIN. The greater tuberosity passes under the acromion, compressing inflamed tissues.
• 120-180 degrees: Painless (Pain disappears as the tuberosity clears the arch).

2. Neer's Classification

• Stage 1 (Edema/Hemorrhage): < 25 years. Reversible. Treated conservatively.
• Stage 2 (Fibrosis/Tendinitis): 25-40 years. Repeated episodes. Scarring.
• Stage 3 (Bone Spurs/Cuff Tears): > 40 years. Acromial spurs tear the cuff. Surgery often needed.

3. Special Tests

Essential Tests:
1. Neer's Impingement Test: Passive flexion while stabilizing scapula.
2. Hawkins-Kennedy: Passive internal rotation at 90 degrees flexion.
3. Empty Can Test: For Supraspinatus tear/weakness.

4. Physiotherapy

• Acute: Ice, Ultrasound, Rest (avoid overhead activities).
• Rehab: Strengthen Scapular Stabilizers (Trapezius, Serratus) and Rotator Cuff depressors (Infraspinatus) to pull the head down.
• Surgery: Subacromial Decompression (Acromioplasty) if spurs are present.

25 Practice MCQs

Q1. The typical range of the painful arc is:

Answer: A). The mid-range where the tuberosity is closest to the acromion.

Q2. Which tendon is most commonly impinged?

Answer: B). It runs directly in the subacromial space.

Q3. Neer's Stage 1 is characterized by:

Answer: A). Typical in young athletes.

Q4. The Hawkins-Kennedy test involves:

Answer: A). Jams the greater tuberosity against the coracoacromial ligament.

Q5. The shape of the acromion most associated with tears is:

Answer: C). The hook acts like a knife on the cuff tendon.

Q6. Pain appearing at 170-180 degrees (very end range) usually indicates:

Answer: B). The "High Painful Arc".

Q7. The "Empty Can" test assesses:

Answer: A). Abduction in scapular plane with internal rotation.

Q8. Which bursa is involved in impingement?

Answer: A). It lies between the acromion and the cuff.

Q9. Drop Arm Test is positive if:

Answer: A). Indicates a massive Rotator Cuff tear.

Q10. Calcific Tendinitis is:

Answer: A). Very painful, seen on X-ray.

Q11. The primary function of the Rotator Cuff is:

Answer: A). Counteracts the upward pull of the Deltoid.

Q12. Subacromial Decompression involves:

Answer: A). Increases the space for the tendon.

Q13. Lift-off test checks for:

Answer: B). Patient lifts hand off the lower back (Internal Rotation).

Q14. Which vascular area of the Supraspinatus is prone to degeneration?

Answer: A). 1cm from insertion, blood supply is poor.

Q15. Scapular Dyskinesis (winging) contributes to impingement by:

Answer: A). Upward rotation of scapula is vital to clear the acromion.

Q16. Speed's Test checks for:

Answer: A). Often co-exists with impingement.

Q17. Injection test (Neer's Impingement Test) uses:

Answer: A). If pain disappears after injection, it confirms impingement.

Q18. Which exercise helps strengthen the Lower Trapezius?

Answer: A). Essential for scapular stability.

Q19. A massive cuff tear can lead to:

Answer: A). The head rubs against the acromion, destroying the joint.

Q20. Night pain is a hallmark of:

Answer: A). Often wakes the patient up.

Q21. MRI is best for visualizing:

Answer: A). Gold standard for cuff tears.

Q22. Internal Rotation Lag Sign checks for:

Answer: A). If hand drops back to spine, it's positive.

Q23. Post-op rehab for Cuff repair typically delays active motion for:

Answer: A). To allow tendon-to-bone healing.

Q24. "Popeye deformity" indicates:

Answer: A). The muscle belly bunches up distally.

Q25. External Rotation Lag Sign checks for:

Answer: A). Inability to hold arm in ER.