Rotator Cuff (RC) Tear Flashcards
What are risk factors for a rotator cuff tear?
- Gradual or degenerative (tendinosis) tears including with repetitive overhead activities
- Acute tears for things like high upper extremity velocity (I.e. throwing), heavy lifting, and impact (I.e. with a fall on an outstretched hand - FOOSH)
What are the structures involved in a rotator cuff tear?
- MOST commonly the supra- or infraspinatus muscles
- sometimes others
How are rotator cuff tears graded?
- By size (I.e. small, medium, large)
- Partial/ full thickness tear
In 40-73% of people what two other structures are involved with rotator cuff tears?
- Labrum
- Biceps
What is a SLAP tear?
- Superior Labral Anterior/ Posterior Tear
- Long head of the biceps excessively contracts and tears the labrum
- May have to surgically fixate the biceps tendon
What is it called when you have to surgically fixate the biceps tendon?
A tenodesis
A SLAP tear is one traumatic way for the labrum and biceps to be involved in a rotator cuff tear, what is another?
Compression onto the labrum with a FOOSH
Symptoms for a rotator cuff tear are like an impingement, what does this mean?
There is too much movement
T/F: Rotator cuff tears have an acute or persistent presentation.
True
What kind of history is a high specificity for a labral tear? (what will they tell you/ what will you hear)
History of a pop, click, or catch
Do rotator cuff tears have increased or decreased pain with repetitive overhead activities?
Increased
What kind of impingement will MOST likely occur with rotator cuff tears?
Hypermobile
Rotator cuff tears will have a painful arc around what degree of elevation?
90 degrees
What will you find with resisted/ MMT for rotator cuff tears?
- Weak and painful
- Flexion is the worst
- Abduction and ER will be particularly bad and possibly IR
What will you find with combined motions?
Possible inconsistent block
Will your stress tests be + or - ?
Possibly +
(+) special tests will show what for all tears?
- LR+ : 9.84 if all (+)
- LR- : .54 if all (-)
- Greater than 65 years of age
- Weak external rotation
- Night pain
(+) special tests will show what for full thickness tears?
- LR+ : 28 if all (+)
- LR- : .09 if all (-)
- Greater than or equal to 60 years of age
- Positive painful arc, drop arm, and infraspinatus test
The external rotation lag sign tests what muscles?
- Supraspinatus
- Infraspinatus
- LR+ : 5-28
The drop arm test has a high specificity for a rotator cuff tear and tests what muscle?
Supraspinatus
What tests measure for non-specific tears?
- Empty can (high sensitivity)
- Jobe Test (LR+ : 7.36; LR- : 1)
What tests have high specificity and test for the subscapularis?
- Lift off
- Belly Press (LR+ : 12.5-20)
- Bear Hug (LR+ :7.23)
What is the PT Rx for a rotator cuff tear?
- Definitely for GH joint hypermobility but ensure all joints efficiently move
- Early ROM with degenerative tears
- MET ultimate purpose is stabilization and tissue proliferation for involved tissues
What is the biggest predictor of a tear going to surgery?
A patients negative perception, irrespective of size of the tear, retraction, fatty infiltration, age, or pain
Are corticosteroid injections helpful for RC tears?
- No evidence of effectiveness within 4 weeks of shot
- Only provides transient relief compared to placebo
What are MDs doing during a primarily arthroscopic (viewing) procedure with an arthroplasty (reconstruction)?
- Sewing fibers back together and reattaching them to bone
- Leaving the capsule and ligaments
- Seeing if the pt has full ROM under anesthesia
What kind of outcomes are seen with PT for degenerative tears?
Successful outcomes, like surgery, and especially for those with small or partial tears or those unfit for surgery
What kind of outcomes are seen with surgery for degenerative tears?
- Good clinical outcome with pain, ROM, strength, quality of life, and sleep
- Radiological outcomes are not as good as clinical outcomes
What kind of outcomes are seen with PT for acute small to medium tears?
- May help
- However, if they are not progressing well, delays are associated with poor surgical outcomes
What kind of outcomes are seen with surgery for acute small to medium tears?
- No difference from PT or slightly more beneficial
- More critical in younger patients due to higher activity levels
What kind of outcomes are seen with PT for multi-tendon and/ or massive full thickness tears?
- May help, particularly in low demand patients or those unfit for surgery
- However, there is an increased likelihood for tear progression and arthropathy
What kind of outcomes are seen with surgery for multi-tendon and/ or massive full thickness tears?
- Challenging with various options
- About 80% satisfaction rate
When are shoulder joint replacements usually used?
With irreparable tears and less with age-related changes
The reverse total shoulder arthroplasty (rTSA) is superior to the hemiarthroplasty in what ways?
- Pain relief
- Function
- Active elevation
What kind of arthrokinematic motion does the reverse total shoulder have?
Concave humeral head moving on a convex scapula (this is reversed from how it usually is)
Is the rotator cuff usually left intact during a total shoulder?
Yes, with the possible exception of the supraspinatus due to retraction/ damage
What is the overall goal of PT with total shoulder replacments?
- Make movement more efficient as with all shoulder conditions
- Avoid hyperextended position/motion
What are the restrictions at 0-6 weeks for a shoulder replacement?
- POLICED including immobilization with sling out of the house
- Waist level and mid-line AROM restrictions
- NO pushing, pulling, or lifting (same as sternal)
How often should someone be doing ROM when they are 0-6 weeks postop total shoulder?
Progressive ROM 2x a day: this may be delayed up to 4 weeks for better healing without negative consequences
What kind of exercises could you provide your 0-6 week postop total shoulder pt?
- AAROM: pendulums, standing pulley or supine flexion, supine IR/ER
- Stretching into ER
- Scapular PREs (progressive resistance exercises)
At 6-8 weeks postop total shoulder what should you be taking away and what should you be adding to your Rx?
- DC sling
- Add a sitting pulley
- Add isometric shoulder PREs in neutral
- Add standing AROM into flexion
- Add across then up the back PROM
At 8-12 weeks postop total shoulder what should you be adding to your Rx?
Progressive isotonic shoulder PREs
At 12-16 weeks postop total shoulder what should you be adding to your Rx?
- Add in gym type exercises
- Most pts are able to play golf at 4 months (if they want to)
What kind of outcomes are seen with total shoulder arthroplastys?
- Good to excellent results
- 90% are able to participate in sports without significant restriction if activity was preformed preoperatively (I.e. swimming, golf, cycling, fitness training)
What are some of the main things to highlight with your rehab protocol for rotator cuff tears? (there are 7)
- Request the surgical report: not all named surgeries are the same
- Best if you are criteria and time based
- Bracing at 15 degrees external rotation
- TENS for pain management
- Similar outcomes with early vs delayed mobilization, so get them moving
- Supervised PT is beneficial
- Early isometric loading leads to improved outcomes
What groups have a more favorable prognosis after surgery for a rotator cuff tear?
- Younger age
- Biological males
- Higher bone density
- No diabetes/ obesity
- Higher fitness level
- Greater preoperative ROM
- Smaller and single tear
- Less retraction/ fatty infiltration
- No biceps/ AC involvement
