C5. Tendinopatia da coifa dos rotadores Flashcards
Coifa dos roteadores envolve dano no tendão supraespinhoso
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Músculo supraespinhoso - abdução e rotação externa do ombro
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Músculo infraespinhoso- abdução e rotação externa do ombro
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Músculo redondo menor - abdução e rotação externa do ombro
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Músculo subescapular - rotação interna do ombro, abdução e adução
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Teste de injeção de lidocaína - subadromial pode aliviar a dor e distinguir entre tendinopatia da coifa dos roteadores e gota
Tendinopatia exibe comprimento normal com alívio de dor ao contrário da gota
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Tratamento agudo
Analgesia
Descanso - agrava sintomas as atividades
AINES
Fisioterapia
- amplitude de movimentos dos exercícios
- alongar e fortalecimento
- combinação da mobilização e do ex
- ## reabilitação para fortalecer a cintura escapular
Orthopedic surgical referral is obtained if nonoperative therapy fails to provide relief within six to nine months or a diagnosis of a clinically significant rotator cuff tear is made.
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Jobe’s test
(or the “empty can” test) assesses supraspinatus function. The patient places a straight arm in about 90 degrees of abduction and 30 degrees of forward flexion, and then internally rotates the shoulder completely. The clinician then attempts to adduct the arm while the patient resists. Pain without weakness suggests tendinopathy; pain with weakness is consistent with tendon tear.
External rotation test
The infraspinatus muscle is primarily responsible for external rotation of the shoulder. The muscle can be tested by having the patient attempt to externally rotate against resistance, as shown in the photograph above. The shoulder is held in adduction and the elbow bent to 90 degrees during testing.
Push off or Gerber’s test
The subscapularis is the rotator cuff muscle primarily responsible for internal rotation. Its strength can be assessed using the push-off, or Gerber’s, test. This test is performed by having the patient place one hand behind his back and push posteriorly against resistance.
Neer test
The “passive painful arc maneuver” shown above involves passively flexing the glenohumeral joint while simultaneously preventing shoulder shrugging. The test is often referred to as the Neer test, and is used to assess shoulder impingement.
Hawkins Kennedy test for shoulder impingement
The Hawkins Kennedy test is used to assess shoulder impingement. In this test the clinician stabilizes the shoulder with one hand and, with the patient’s elbow flexed at 90 degrees, internally rotates the shoulder using the other hand. Shoulder pain elicited by internal rotation represents a positive test.