Impingement Syndrome and Rotator Cuff Tears Flashcards
Impingement syndrome is seen typically in what age group?
30s-40s
Rotator cuff tears are seen typically in what age group?
50s-60s
What is impingement syndrome?
The tendons of the rotator cuff are compressed in the tight subacromial space during movement, producing pain
What tendon is most likely to be affected in impingement syndrome?
Supraspinatus
Patients with impingement syndrome will typically have pain when? What is this known as? What muscle is this related to?
Between 60-120 degrees abduction (variable)- painful arc, related to the deltoid muscle
Why do patients with impingement syndrome get painful arc?
This occurs as an inflamed part of the tendon passes through the subacromial space
What are the most likely causes of impingement syndrome in a younger patient?
Tendonitis/subacromial bursitis
What is the most likely cause of impingement syndrome in a middle aged patient?
Hooked acromion rotator cuff tear
What is the most likely cause of impingement syndrome in an older patient?
AC joint OA with inferior osteophyte
Pain from impingement typically radiates where?
Deltoid and upper arm
Where may tenderness be felt in impingement syndrome?
Below the lateral edge of the acromion
What clinical test will recreate the pain of impingement syndrome? Briefly describe the test.
Hawkins-Kennedy test: internally rotate the flexed shoulder
When considering a diagnosis of impingement syndrome, what is important to exclude?
Cervical radiculopathy
Are investigations required in order to start treatment for impingement syndrome?
No
What is the first line management for impingement syndrome?
Conservative: NSAIDs, analgesics, physiotherapy, subacromial injections
How many subacromial injections may be required in impingement syndrome?
Up to 3
Cases of impingement syndrome which do not benefit from conservative management could benefit from what?
Subacromial decompression surgery
What is the point of subacromial decompression surgery in impingement syndrome?
To create more space for the tendon to pass through
How can subacromial decompression surgery be performed?
Open, or with minimally invasive arthroscopic techniques
What describes impingement?
The imbalance of forces in the coronal plane
In order to abduct the limb, the deltoid needs power to be offset by force from where?
Inferior
What happens if there is an imbalance between the deltoid and rotator cuff?
Elevation of the humerus and narrowing of the subacromial space
The tendons of the rotator cuff usually tear when? Why is this?
With little or no trauma, as a consequence of degenerative change
What is a classic history of a rotator cuff tear?
A sudden jerk in a patient > 40 with subsequent pain and weakness
Rotator cuff tears are very uncommon in young people. What may they occur as a result of?
Significant injury, including shoulder dislocation
Can you get different degrees of rotator cuff tears?
They can be partial or full thickness
Rotator cuff tears usually involve which muscle?
Supraspinatus
Large rotator cuff tears can extend into which muscles?
Subscapularis and infraspinatus
In rotator cuff tears, weakness of initiation of abduction implies damage to which muscle?
Supraspinatus
In rotator cuff tears, weakness of internal rotation implies damage to which muscle?
Subscapularis
In rotator cuff tears, weakness of external rotation implies damage to which muscle?
Infraspinatus
What clinical sign may be seen when looking at a patient with a rotator cuff tear?
Supraspinatus wasting
Rotator cuff tears can be confirmed with which investigations?
Ultrasound or MRI
What are the non-operative management options for a rotator cuff tear?
Physiotherapy and subacromial injections
What is the role of physiotherapy in rotator cuff tears?
To strengthen the remaining cuff muscles, to compensate for the loss of supraspinatus
Which patients with a rotator cuff tear require quick investigation and physiotherapy? Why?
Patients in their 50s/60 to prevent them from having a massive tear
What surgical management can be used for rotator cuff tears?
Rotator cuff repair with subacromial decompression
What is the role of surgery for rotator cuff tears?
To improve/maintain strength and prevent subsequent arthritis from chronic cuff deficiency
What is the failure rate of rotator cuff repair surgery? Why?
1/3rd of cases fail to repair because the tendon is so diseased or the tear is too large and the tendon is retracted too far
What are the long term results of rotator cuff repair surgery?
These are not well known
In the short term following rotator cuff repair surgery, how long will patients need a sling for? For how long will they be unable to drive? For how long will they be unable to lift heavy objects?
Sling for 6 weeks, no driving for 8-10 weeks, no heavy lifting for 12 weeks
What is the recovery from rotator cuff repair surgery like?
Prolonged physiotherapy and recovery time, with a 30-40% chance of re-tear at 1 year
What are intrinsic causes of rotator cuff problems?
Degeneration and tendon vascularity
What is the extrinsic cause of rotator cuff problems?
Compression
