Labral Tears And Impingement Syndrome

Question 1

Tendons of what muscles insert on the labrum?

Answer 1

RTC muscles and long head of biceps

Question 2

What part of labrum is affected in SLAP lesion?

Answer 2

Superior Labrum in the Anterior to Posterior direction

Question 3

What provocative test is used to test labrum?

Answer 3

O’ Brien’s test

Question 4

Describe O’Brien’s test

Answer 4

Have patient forward flex arm against resistance with thumb down in 15 deg adduction, then repeat with arm supinate. If there is pain with thumb down, but then improves when supinated, this is positive test

Question 5

Most common cause of shoulder pain

Answer 5

Impingement syndrome

Question 6

3 stages of subacromial impingement

Answer 6

1. Edema
2. Tendinitis
3. Tear

Question 7

Location of most common area that RTC tendon tears occur

Answer 7

1 cm from insertion site of supraspinatus tendon, which is the critical zone of hypovascularity

Question 8

Patients with what type of acromion have higher risk of RTC tears

Answer 8

Type 2 and 3 (curved and hooked)

Question 9

What phase of swimming stroke does pain occur in someone with RTC impingement?

Answer 9

Catch phase

Question 10

Most reliable provocative test for impingement

Answer 10

Neer’s test

Question 11

In painful arc sign, what degrees of abduction do you start getting pain

Answer 11

Between 60 and 120 degrees = pain

Question 12

When doing the empty can test, why is it important to have arm internally rotated?

Answer 12

It forces the GT under the acromion

Question 13

4 main things you will see on X-ray in chronic rotator cuff tear

Answer 13

1. Superior migration of humeral head
2. Flattening of GT
3. Subacromial sclerosis and osteophytes
4. Wearing of glenoid, coracoid, AC joint, acromion

Question 14

Gold standard image to look at rotator cuff

Answer 14

MRI

Question 15

What is shoulder arthrogram good for?

Answer 15

Looking at full thickness RTC tears

Question 16

What are 3 phases of rehab treatment of RTC tears

Answer 16

Acute phase
Recovery Phase
Functional Phase

Question 17

When rehabbing a RTC tear, how long is the acute phase and recovery phase

Answer 17

Acute = 4 weeks
Recovery = months

Question 18

What do you do during acute phase, recovery phase and functional phase of RTC rehab?

Answer 18

acute = RICE, modalities
Recovery = ROM, strengthening
Functional = activity-specific exercises

Question 19

Indications for surgical treatment

Answer 19

• tears that fail conservative treatment

Question 20

Disadvantage of surgical treatment of shoulder impingement

Answer 20

ROM is not restored