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Clinical Interventions 2 > Rotator Cuff Pathology > Flashcards

Rotator Cuff Pathology Flashcards

1
Q

What tendon is most commonly injured? Followed by ___________ and ______________

A

supraspinatus, infraspinatus, upper aspect of subscapularis

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2
Q

Rotator cuff tears usually occur at the ______________ due to ____________

A

musculotendinous junction; poor vascularization

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3
Q

Pathogenesis of Rotator cuff tear?

A

traumatic injury, aging, repetitive use or injury, tendon hypovascularity, and subacromial impingement

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4
Q

Types of tears

A

partial and full thickness

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5
Q

Partial thickness tear

A

fraying of an intact tendon

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6
Q

Full thickness tears

A

through and through tears; small or larger involving majority of tendon and tendon remains attached to humeral head; may also involve complete detachment from the humeral head

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7
Q

Typically get surgery for _______ tears

A

full thickness

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8
Q

Sensitivity

A

the likelihood of obtaining a positive test when the tested condition is truly present

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9
Q

Specificity

A

the likelihood of obtaining a negative test when the tested condition is truly absent

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10
Q

A clinical test is considered to be diagnostically accurate if it has a positive likelihood ratio greater than _______ and/or a negative likelihood ratio less than ____________

A

10; 0.1

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11
Q

What tests are more commonly used for RTC tear?

A

Supraspinatus test (Empty can test), full can test, drop arm test, infraspinatus test, and hornblower’s test (teres minor test)

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12
Q

What tests are used less commonly for RTC tear?

A

Rent sign, lift-off test, bear hug test, belly-press test, and palpation?

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13
Q

What tests are more valid for RTC tear?

A

Empty can, teres minor, rent sign, lift-off, belly-press test, and palpation

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14
Q

The Neer test and Hawkins-Kennedy Test are commonly used in clinical practice to determine _____________________

A

whether or not impingement exists along with a rotator cuff tear

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15
Q

Supraspinatus test (empty can test) pt position

A

Standing or seated. Arm elevated 90 deg in scapular plane and IR (also good to do at 30-45 deg elevation)

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16
Q

Supraspinatus test (empty can test), the resistance is applied in what direction and the pt is asked to resist

A

inferior

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17
Q

Positive Supraspinatus test (empty can test)

A

elicits pain and/or weakness when resistance is applied

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18
Q

The Full can test, tests which muscle?

A

Supraspinatus

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19
Q

Full can test pt position

A

Standing or seated. Arm elevated 90° in scapular plane & externally rotated 45°.

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20
Q

Full can test, resistance is applied in a _____________ direction and pt is asked to resist

A

Inferior

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21
Q

Positive Full can test

A

elicit pain and/or weakness when resistance is applied

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22
Q

rent sign pt position

A

Seated with the arm passively positioned in full shoulder extension & with 90° elbow flexion

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23
Q

rent sign procedure

A

Examiner palpates the anterior aspect of the edge of the acromion while passively internally & externally rotating the shoulder looking for a defect (rent)

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24
Q

positive rent sign

A

there is a palpable depression greater than one finger width along with possible discomfort

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25
What muscle is being tested with the lift-off test?
subscapularis
26
Lift-off test pt position
Standing or seated. Arm is placed behind the patient’s back with the dorsum of the hand on the mid-lumbar area & the elbow flexed to 90°
27
Lift-off test resistance is applied to the _______ aspect of the forearm while the pt attempts to __________________
distal; lift the arm off of the back
28
Positive lift-off test
elicits pain and/or weakness when resistance is applied
29
What muscle is the bear hug test testing?
subscapularis
30
Pt position for the bear hug test
Standing or seated, place hand of tested arm on the contralateral shoulder
31
Bear hug test procedure
Resistance is applied to the palmar aspect of the hand in a superior direction in an attempt to externally rotate the shoulder.
32
Positive bear hug test
elicit pain &/or weakness when resistance is applied
33
Belly press test: muscle being tested
subscapularis
34
Belly-press test pt position
Standing or seated. Place the tested arm’s palmar aspect of the hand on the stomach
35
Belly-press test procedure
Resistance is applied to the palmar aspect of the hand in a anterior direction; patient resists external rotation
36
Positive Belly-press test
elicit pain and/or weakness when resistance is applied
37
What muscles are being tested with the palpation testing?
Supraspinatus, infraspinatus, teres minor, & subscapularis
38
Palpation has been reported to have both high ____________ and high _____________ values
sensitivity and specificity
39
Although not technically viewed as an orthopedic special test, evidence shows that palpation is amongst the best indicators of a _______________
full thickness rotator cuff tear
40
Clinical prediction rule for impingement/SAPS
+ Hawkins Kennedy test, painful arc sign, and infraspinatus MMT
41
RTC tear/pathology clinical prediction rule
+ drop arm test, painful arc sign, and infraspinatus MMT
42
Diagnostic arthroscopy
surgically invasive diagnostic technique, gold standard, most valid and reliable, but not the primary choice for diagnostic test because it is invasive
43
Sensitivity and specificity of diagnostic arthroscopy
100%
44
Arthrography
MRI with injected contrast medium
45
Advantage of an arthrography
reliable in detecting tears
46
Disadvantages of arthrographies
Does not provide information on the extent of the tear, may be time consuming, and exposes the pt to radiation
47
Sensitivity of arthrography
50%
48
Specificity of arthrography
96%
49
MRI
uses magnetic fields and pulses of radio wave energy to produce images of soft tissue
50
Advantages of MRI
Provides a detailed image of soft tissues, more consistent in specificity and sensitivity, can detect location and extent of the tear, and accurately depicts muscle atrophy
51
Disadvantages of MRI
May be costly, time consuming, not tolerated by all patients, and contraindicated with certain implanted devices
52
MRI sensitivity*
81-91%
53
MRI specificity*
70-95%
54
Ultrasound
uses a high frequency transducer to record images of the tendons
55
US advantages
can provide valid and reliable results when performed by an experienced and trained technician, less invasive and well tolerated by pts, 3x less expensive, less time consuming, and provides real-time imaging*
56
US disadvantages
Reliability is technician dependent, less sensitive for detecting partial thickness tears, may not be able to accurately depict muscle atrophy
57
US sensitivity*
57-100%
58
US specificity*
50-100%
59
Factors that affect PT prognosis
Age - over 65 may have poorer results, diabetes, history of smoking, NSAIDS, extent of RC degeneration, fatty deposits, tear size, prior RC repairs, preoperative active motion, deltoid status, prior RC status, surgery/repair type, and overall fitness
60
There is an initial strong ____________ response after RC repair that decreases with time and age
vascular
61
what is the lowest vascularity of the RC
anchor site in bone
62
highest vascularity of RC
Peritendinous region
63
Modalities that are supported for RC
cryotherapy, electrical stimulation and manual therapy
64
modalities that are not supported for RC
heat and ultrasound
65
____________ decreased pain in patients with impingement that may occur with RC injury
mobilizations
66
_____________ for re-education of scapular mobility, especially upward rotation
scapular mobs
67
Avoid the ____________, if open-repair, and _____________ when doing MT to this area
suture line, stressing the repaired tendon
68
Early ___________ exercises after RC surgery is beneficial. Perform without disrupting the RC ___________ and prevent ___________ from occuring
PROM, repair site, adhesions
69
RC prehab: only perform ____________ and avoid ________________
what pt can tolerate; overhead motions
70
For RC prehab you should improve the strength of undamaged RC muscles which are:
Infraspinatus, teres minor, and subscapularis
71
Prehab: improve posture by targeting which muscles:
traps, Serratus anterior, lev scap, rhomboids, and lats
72
Prehab: improve surrounding musculature including:
Biceps, triceps, delts, pec major and minor, and scapular stabilizers
73
The orthopedic special tests that are most accurate in diagnosing a full thickness rotator cuff tear are:
palpation, hornblower's sign, empty can test, rent sign, lift-off test, and belly press
74
Arthroscopy and arthrography are both good diagnostic choices but they are not commonly used because they are _____________
invasive
75
MRI and US are more realistic choices that have both been documented as ______________
accurate
76
US is _______ expensive and ___________ tolerated but the technician dependency of the test decreases its' reliability therefore making _____________ a better choice
less; better; MRI
77
Recovery from rotator cuff surgery is dependent on several factors including _____________________
age of the patient, size of the tear, health of the patient, & type of surgery
78
Overall goals of RC rehabilitation
decrease pain and inflammation, increasing ROM and strength, and restore function
79
Following RC surgery, PROM increases:
shoulder range of motion and limits development of adhesions without disrupting repair site
80
Factors to consider
patient age, tear size, fatty atrophy grade pre-op and comorbidities such as: tobacco use, diabetes, and workers comp
81
What contributes to delayed motion
larger tear size, older age, and comorbidities that increase likelihood of re-tear/poor outcomes

Clinical Interventions 2 (3 decks)

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