Rotator cuff pathology (strain, tear, tendinopathy) Flashcards
What is Jobe’s test testing?
Supraspinatus tendinopathy
What muscles are used in external rotation of the shoulder?
teres minor
infraspinatus
What muscles are used in internal rotation of the shoulder?
subscapularis
What muscle is used in shoulder abduction?
Supraspinatus
What are the causes of rotator cuff injury?
Acute trauma
Degenerative disease due to repetitve stress or loss of blood supply
How common are rotator cuff tears?
28% in patients ≤60 years old and 54% in patients >60 years old
What are the clinical features of rotator cuff tears?
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
Which test is specific for teres minor tears?
Hornblower’s test
Which test is specific for supraspinatus tears?
Jobe’s test - empty can test
Which test is specific for subscapularis tears?
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.
What is a positive finding on belly press test?
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
Which test for rotator cuff impingement is shown?
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
What is this test?
Hawkins impingement test
What is the management of rotator cuff tears?
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
What are the complications of rotator cuff injury and its management?
- Arthropathy
- Adhesive capsulitis - usually after massive tears
- NSAID related side effects
- Re-rupture after surgery
What is the overall prognosis with rotator cuff injury?
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
What investigations are done to diagnose rotator cuff injury?
- 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
Why is lidocaine 1% injection used diagnostically in rotator cuff injury?
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.
Which test is specific for infraspinatus pathology?
Testing external rotation against resistance
What is the Hawkins/Kennedy test and what does it test for?
Tests for subacromial impingement syndrome
Apply pressure as shown and move the arm medially and repeat.
What is Yocum’s test and what does it test for?
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
What is the purpose of the scarf test?
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
