Rotator Cuff Injury

Question 1

What are the most common causes of shoulder problems?

Answer 1

• Subacromial impingement
• Calcific tendonitis
• Rotator cuff tears
• Rotator cuff arthropathy

Question 2

What are the symptoms of rotator cuff injury?

Answer 2

• Shoulder pain worse on abduction

- Pain and weakness

Question 3

What are the signs of rotator cuff injury?

Answer 3

• Subacromial impingement pain on abduction between 60-120 degrees
• Rotator cuff tears pain in first 60 degrees
• Tenderness over anterior acromion

Question 4

What is rotator cuff arthropathy?

Answer 4

Specific pattern of shoulder degenerative joint disease that results from a rotator cuff tear leading to abnormal glenohumeral wear and subsequent migration of the glenohumeral head. Diagnosis with shoulder x-rays.

Question 5

What are the treatments for a shoulder injury?

Answer 5

• Conservative: simple analgesia and physiotherapy
• Injection: steroid and local anaesthetic injection into subacromial space will act as both analgesia and anti-inflammatory.
• Surgery e.g. in supraspinatus/rotator cuff tear, arthropathy

Question 6

What is the most common nerve injured in a shoulder dislocation?

Answer 6

Axillary nerve as it wraps around the humerus and can be tested with sensation in the regimental badge area and deltoid contraction.

Question 7

What test is used to test to the supraspinatus?

Answer 7

Empty can test - abduct arm and medially rotate (thumb pointing down), examiner presses down on arm

Question 8

What test is used to test to the subscapularis?

Answer 8

Lift off test - patient sitting down and bring dorsum of hand to lumbar spine and push away examiners hand

Question 9

What test is used to test for acromioclavicular pathology/impingment?

Answer 9

Scarf test - ask patient to touch opposite shoulder with hand, can be reinforced by applying pressure on the elbow

Question 10

What test is used to test to the infraspinatus/teres minor?

Answer 10

External rotation against resistance

Question 11

What is the Hawkins-Kennedy test?

Answer 11

• Shoulder abducted to 90, elbow flexed to 90 with palm facing down
• Rotate shoulder so that palm goes down
• Pain suggest supraspinatus impingement

Question 12

What are the shoulder muscles and their function?

Answer 12

• Supraspinatus - abduction, suprascapular nerve
• Infraspinatus - external rotation, suprascapular nerve
• Teres minor - external rotation, axillary nerve
• Subscapularis - internal rotation, upper and lower subscapular nerves

Question 13

What conditions can cause restriction in abduction?

Answer 13

• OA

- Frozen shoulder

Question 14

What are the features of frozen shoulder?

Answer 14

• PMH of diabetes/thyroid disease predisposes to frozen shoulder/adhesive capsulitis
• Plain XR not showing OA changes will lead to diagnosis of frozen shoulder
• Middle glenohumeral ligament is important in the restrictive element of frozen shoulder

Question 15

What are the features of a rotator cuff tear?

Answer 15

• Traumatic or degenerative
• Complete tears or partial (on the bursal or articular surface of the tendon or as an intrasubstance tear)
• Associated with impingement of the shoulder both as a cause of tendon wear and as a secondary symptom
• Majority of tears involve the supra +/- infraspinatus tendon
• Asymptomatic tears should not undergo treatment

Question 16

What are the signs on examination for frozen shoulder?

Answer 16

• Painful, stiff movement

- Limited movement in all directions, with loss of external rotation and abduction

Question 17

How do you manage a shoulder dislocation?

Answer 17

• If the dislocation is recent then reduction may be attempted without any analgesia/sedation (anterior can use Kocher technique reduction)
• However, other patients may require analgesia +/- sedation to ensure the rotator cuff muscles are relaxed