LG4.2 Rotator Cuff/Tennis Elbow/Carpal Tunnel Syndrome – Dr. Robinson Flashcards
What are the muscles of the rotator cuff?
- Supraspinatous
- Infraspinatous
- Teres minor
- Subscapularis
What is the first and second most likely muscles to tear in the rotator cuff?
1) Supraspinatous
2) Subscapularis
What are the characteristics of the supraspinatus?
- Abducts humerus
- Controls roll/glide of humeral head, allows 6mm between head and acromion
What is the shared function of the Subscapularis and infraspinatus?
-Compression force, hold humeral head, interglenoid fossa
What is the MOI for a rotator cuff injury?
Acute trauma, chronic impingement, tendonitis, or tear
What are the risk factors for a rotator cuff injury?
-Age
-Vascularity
-Occupation
-Posture
-Hooked acrominon
-Smoking
Onesity
How does a rotator cuff injury present?
Pain and weakness
How is a rotator cuff injury diagnosed?
H+P, MRI (definitive)
What is the treatment for a rotator cuff injury?
- Nonsurgical via rehab
- NSAIDS
- Corticosteriods
- Lidocaine
- Surgical based on severity and age
What is another name for Tennis elbow?
Lateral epicondylitis
What is the MOI of Tennis elbow?
- Heavy racket
- Grip size, tight stings, metal raket, user error, repetitive extensor use
What is the most comely indicated muscle in tennis elbow?
- Extension carpi radialis brevis
- Insertson 3rd metacarpal
What is the pathology of tennis elbow?
Tendinitis (inflammatory) to Tendinosis (no blood to ECRB tendon)
What are the risk factors for tennis elbow?
ages 40-50, occupation involving forearm twisting
How is tennis elbow diagnosed?
- History is insidious
- Localized with pain gripping
- Physical is point tender
- Pain with passive wrist flexion
- Resisted active wrist extension
- 3rd digit flexion and chair test
How do you treat tennis elbow?
RICE, brace, cross massage, NSAIDS, injections, surgery by releasing the ECRB tendon
What is the MOI of carpal tunnel syndrome?
- Uncommon: Carpal dislocation, space lesion
- Common: Inflammation and ergonomics
What is presentation of carpal tunnel syndrome?
- Parasthesia and/or pain in median nerve
- distribution
- finger flexion
- worse at night, can awake you from sleep
- Pain in wrist movement
What are the risk factors for carpal tunnel syndrome?
- Obesity
- Female
- Diabetes
- Hypothyroidism
- RA
How do you diagnosis carpal tunnel syndrome?
- Based on history and presentation
- Vizulization of thenar atrophy
- Positive Tinel’s sign or Phalen Maneuver
What is the progression of carpal tunnel syndrome?
Intermittent symptoms at first, but leads to thenar wasting
What is Electrodiagnostic testing?
- Nerve conduction to dx CTS
- Electromyography to rule out CTS
What is the treatment of carpal tunnel syndrome?
- Nonsurgical via wrist splint (holds in slight flexion)
- Corticosteroids
- Surgical if motor loss or thenar atrophy
What is the consequences of the tenuous blood supply to the rotator cuff tendons?
- Avascular zone on head of humorous cause delay in healing and increase with age
- Some regions of the tendon have naturally tenuous blood supply, reducing the intrinsic ability for healing after small injuries.
What is the consequence of a hooked acromion?
- Shoulder impingement
- Inflammation of the tendons of the rotator cuff or the bursa that sites between the rotator cuff and the roof of the shoulder.
What are coexisting factors of carpal tunnel syndrome?
- Diabetes
- Hypothyrodism
- Rheumatoid arthritis
What structures go through the carpal tunnel?
- Median nerve
- 4 flexor digitorm profundus tendons
- 4 flexor digitorum superficialis tendons
- 1 flexor pollicis longus tendon
