1 STRENGTH

Question 1

What is stage 1 of impingement?

Answer 1

< 25 years old

Accute inflammation

Edema

Hemorrhage in RC

Reverseable and non operative

Question 2

Stage 2 impingement

Answer 2

25-40 years

progression from acute edema and hemorrhage to fibrosis and RC tendinitis

Concervative management

Question 3

Stage 3

Answer 3

40+ years

mechanical disruption of tendons (tears)

Osteophytes under acromion

Thickening of coracoacromial arch

SURGERY

Question 4

Where are the locations of RC tears and what is the most common?

Answer 4

Bursal = exterior

Articular (interior) = most common - symptomatic

Midstubstance

Question 5

What is the natural progression of a RC tear?

Answer 5

1. Partial thickness of RC tear secondary to tendon overload
2. Poor healing potential + environment
3. RC insufficiency due to pain and inhibition
4. Superior migration of humeral head = inc forces
5. Degeneratie changes in under surface of subacromial space
6. Impingement syndrome and progression of full thickness RC tear
7. Degenerative joint

Question 6

Cuff Tear Arthopathy

Answer 6

Acetabularization of upper glenoid and coracoacromial arch

Femoralization of proximal humerus

Torn cuff lets humerus move against acromion

Question 7

What are indications for TSR?

Answer 7

pain from desctructive arthritis

• OA RA or traumatic arthritis

Avascular necrosis

Severe loss of UE strength

Limitations of ADL function secondary to pain