Rotator cuff pathology (strain, tear, tendinopathy)

Question 1

What is Jobe’s test testing?

Answer 1

Supraspinatus tendinopathy

Question 2

What muscles are used in external rotation of the shoulder?

Answer 2

teres minor

infraspinatus

Question 3

What muscles are used in internal rotation of the shoulder?

Answer 3

subscapularis

Question 4

What muscle is used in shoulder abduction?

Answer 4

Supraspinatus

Question 5

What are the causes of rotator cuff injury?

Answer 5

Acute trauma

Degenerative disease due to repetitve stress or loss of blood supply

Question 6

How common are rotator cuff tears?

Answer 6

28% in patients ≤60 years old and 54% in patients >60 years old

Question 7

What are the clinical features of rotator cuff tears?

Answer 7

Shoulder pain

Shoulder weakness

Loss of active ROM

Positive tests for rotator cuff injury

Night pain

Deltoid pain - radiates down forearm; deltoid cannot compensate for the rotator cuff

Question 8

Which test is specific for teres minor tears?

Answer 8

Hornblower’s test

Question 9

Which test is specific for supraspinatus tears?

Answer 9

Jobe’s test - empty can test

Question 10

Which test is specific for subscapularis tears?

Answer 10

Gerber’s lift off test - The test is considered to be positive if the patient cannot resist, lift the hand off the back or if she/he compensates by extending the elbow and shoulder

NB: the belly press test can also be used in patients who have too much pain or a limited range of motion.

Question 11

What is a positive finding on belly press test?

Answer 11

Subscapularis muscle dysfunction if the patient compensates the movement through started wrist flexion, shoulder adduction and shoulder extension

NB: elbow should not be moving back at all and wrist should not be flexing

Question 12

Which test for rotator cuff impingement is shown?

Answer 12

Neer impingement test - examiner keeps one hand on the patient’s scapula to prevent rotation. As the patient’s arm is elevated by the examiner, reproduction of pain is a positive test for impingement

Question 13

What is this test?

Answer 13

Hawkins impingement test

Question 14

What is the management of rotator cuff tears?

Answer 14

Depends on patients and severity of tear.

Younger active patients –> surgery + physiotherapy

Sedentary, older patients –> conservative management

Conservative management consists of 4 weeks of:

• NSAIDs
• Ice
• Stretches
• +/- corticosteroid injection
• +/- physio
• +/- surgical repair

Question 15

What are the complications of rotator cuff injury and its management?

Answer 15

• Arthropathy
• Adhesive capsulitis - usually after massive tears
• NSAID related side effects
• Re-rupture after surgery

Question 16

What is the overall prognosis with rotator cuff injury?

Answer 16

Surgical repair provides a good functional result and high level of patient satisfaction.

For patients with low functional demands, however, non-surgical rehabilitation is often preferable and can provide a good outcome as well

Question 17

What investigations are done to diagnose rotator cuff injury?

Answer 17

• XR - usually normal; may show opacities if calcific tendonitis present
• Definitive diagnosis of rotator cuff tear is made with advanced imaging, although history and examination can provide a reliable presumptive diagnosis for most tears.*

Other investigations:

• Lidocaine 1% injection into subacromial bursa
• MRI - investigation of choice
• US - US is a better modality than MRI if there is prior metal hardware
• CT

Question 18

Why is lidocaine 1% injection used diagnostically in rotator cuff injury?

Answer 18

To distinguish true weakness from weakness caused by pain, a pain-relieving injection of 1% lidocaine into the subacromial bursa should be followed by retesting of rotator cuff strength.

Question 19

Which test is specific for infraspinatus pathology?

Answer 19

Testing external rotation against resistance

Question 20

What is the Hawkins/Kennedy test and what does it test for?

Answer 20

Tests for subacromial impingement syndrome

Apply pressure as shown and move the arm medially and repeat.

Question 21

What is Yocum’s test and what does it test for?

Answer 21

AKA Yocum maneouvre - shoulder rotator cuff impingement/subacromial impingement syndrome

The arm is forced to ADDuction and the elbow is flexed until the hand is over the contralateral shoulder. The examiner does not apply pressure

Question 23

What is the purpose of the scarf test?

Answer 23

AKA cross-body adduction test, is used to assess the integrity of the acromioclavicular (AC) joint.

The test is performed by passively bringing the patient’s arm into 90 degrees of forward flexion, with their elbow also flexed to 90 degrees. The examiner then horizontally adducts the flexed arm across the patient’s body, bringing their elbow towards the contralateral shoulder, keeping their other hand on the scapula