EXAM 3 - RC Flashcards
what does the supra help with
the deltoid with abd
it produced a superior compressive force and stablize it directly against the fossa
what depresses the humeral head
subscap
infra
teres minor
why muscle provide dynamic stability to the shoulder
infra, teres minor, subscapularis
transvere force couple
subscap
and
infra and teres minor
function of the transverse force couple
they pull the humeral head into the glenoid
frontal plane force couple
deltoid
and
depressors - inf RC (infra, teres minor, subsacp)
what is the function of the frontal force couple
prevent the humeral head from sliding up
what is codmans critical zone
this is an area of freq. tears at the insertion of the rotator cuff tendons onto the greater tubercle of the humeral head
small tears are critical zone vascular
showed an increase in vascularity
larger tears in the critical zone vascular
failure fo the healing process and decrease vascularity
what is an extrinsic mech of a RC
orginates external from the tendon - compression or shear
subacromial impingement
internal impingement
what is a intrinsic mech of a RC
orginates within the tendon - degenerative process, associated with aging
tendon - vascularity, bio, mechnical properties, morphlogies, genetics
age and RC
25% of people in their 50s have RC tears
rapture what pop
o Ruptures can occur in active young healthy pop
Attritional tears demographics
o Age > 50
o Lateral shoulder/arm pain
o Visible atrophy
o Pain at night
o Weakness
Examination - Attritional tears
PROM maintained, AROM limited
Abductor weakness
Altered scapular humeral rhythmn
Acute tears demographics
o Ruptures can occur in active young healthy pop
o Traumatic event - FOOSH
o Development of cute pain and weakness depends on the location and size of the tear
Acute tears exam
AROM more limited the PROM
Pain and weakness with resisted tests
RC tear imaging options
xray
MRI
ultrasound
arthoscopy
arthrogram
what is a arthrogram
a type of imaging test used to look at a joint, such as the shoulder, knee, or hip.
what are they looking for in standard x-rays
superior migration of the humeral head
If the RC is not attached there is nothing depressing the humeral head
what are the options with RC tears
non-op management
deccompressor without repair
repair
where is the most common site for full thickness RC tears
post ant RC
what muscle part of the RC is most torn
supraspinatus followed by infra
what kind of tear has the best prognosis
crescent shaped - AP
what kind of tear is worse U shaped or L shaped
L/reverse - prognosis is fair
what are the three presentation of RC tear that we were given
full/partial thickness
collins classfication - depends on type of tendon and location
cofield clasification
is PT good for medium to small full thickness tear
strong evidence support PT and surgical intervention
how can you have a small or medium full thickness tear
only one of the tendons can tear
not everything in the RC
- Corticosteroid injections
moderate evidence of single injection for short term improvement, More than once can be pretty hard on the shoulder
what are the three surgery options
arthroscopy
open
mini open
what happens if we have a larger incision site
incision site – longer recovery time
- That is why surgeons try to go arthroscopic first
risk factors for RC
o Smoking
o Repeated steroid injections
o Systemic disease: RA, gout, neuromuscular disorders
