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MSK Exam 3 > Rotator Cuff (RC) Tear > Flashcards

Rotator Cuff (RC) Tear Flashcards

1
Q

What are risk factors for a rotator cuff tear?

A
  • 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)
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2
Q

What are the structures involved in a rotator cuff tear?

A
  • MOST commonly the supra- or infraspinatus muscles
  • sometimes others
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3
Q

How are rotator cuff tears graded?

A
  • By size (I.e. small, medium, large)
  • Partial/ full thickness tear
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4
Q

In 40-73% of people what two other structures are involved with rotator cuff tears?

A
  • Labrum
  • Biceps
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5
Q

What is a SLAP tear?

A
  • Superior Labral Anterior/ Posterior Tear
  • Long head of the biceps excessively contracts and tears the labrum
  • May have to surgically fixate the biceps tendon
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6
Q

What is it called when you have to surgically fixate the biceps tendon?

A

A tenodesis

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7
Q

A SLAP tear is one traumatic way for the labrum and biceps to be involved in a rotator cuff tear, what is another?

A

Compression onto the labrum with a FOOSH

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8
Q

Symptoms for a rotator cuff tear are like an impingement, what does this mean?

A

There is too much movement

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9
Q

T/F: Rotator cuff tears have an acute or persistent presentation.

A

True

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10
Q

What kind of history is a high specificity for a labral tear? (what will they tell you/ what will you hear)

A

History of a pop, click, or catch

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11
Q

Do rotator cuff tears have increased or decreased pain with repetitive overhead activities?

A

Increased

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12
Q

What kind of impingement will MOST likely occur with rotator cuff tears?

A

Hypermobile

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13
Q

Rotator cuff tears will have a painful arc around what degree of elevation?

A

90 degrees

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14
Q

What will you find with resisted/ MMT for rotator cuff tears?

A
  • Weak and painful
  • Flexion is the worst
  • Abduction and ER will be particularly bad and possibly IR
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15
Q

What will you find with combined motions?

A

Possible inconsistent block

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16
Q

Will your stress tests be + or - ?

A

Possibly +

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17
Q

(+) special tests will show what for all tears?

A
  • LR+ : 9.84 if all (+)
  • LR- : .54 if all (-)
  • Greater than 65 years of age
  • Weak external rotation
  • Night pain
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18
Q

(+) special tests will show what for full thickness tears?

A
  • 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
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19
Q

The external rotation lag sign tests what muscles?

A
  • Supraspinatus
  • Infraspinatus
  • LR+ : 5-28
20
Q

The drop arm test has a high specificity for a rotator cuff tear and tests what muscle?

A

Supraspinatus

21
Q

What tests measure for non-specific tears?

A
  • Empty can (high sensitivity)
  • Jobe Test (LR+ : 7.36; LR- : 1)
22
Q

What tests have high specificity and test for the subscapularis?

A
  • Lift off
  • Belly Press (LR+ : 12.5-20)
  • Bear Hug (LR+ :7.23)
23
Q

What is the PT Rx for a rotator cuff tear?

A
  • 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
24
Q

What is the biggest predictor of a tear going to surgery?

A

A patients negative perception, irrespective of size of the tear, retraction, fatty infiltration, age, or pain

25
Q

Are corticosteroid injections helpful for RC tears?

A
  • No evidence of effectiveness within 4 weeks of shot
  • Only provides transient relief compared to placebo
26
Q

What are MDs doing during a primarily arthroscopic (viewing) procedure with an arthroplasty (reconstruction)?

A
  • Sewing fibers back together and reattaching them to bone
  • Leaving the capsule and ligaments
  • Seeing if the pt has full ROM under anesthesia
27
Q

What kind of outcomes are seen with PT for degenerative tears?

A

Successful outcomes, like surgery, and especially for those with small or partial tears or those unfit for surgery

28
Q

What kind of outcomes are seen with surgery for degenerative tears?

A
  • Good clinical outcome with pain, ROM, strength, quality of life, and sleep
  • Radiological outcomes are not as good as clinical outcomes
29
Q

What kind of outcomes are seen with PT for acute small to medium tears?

A
  • May help
  • However, if they are not progressing well, delays are associated with poor surgical outcomes
30
Q

What kind of outcomes are seen with surgery for acute small to medium tears?

A
  • No difference from PT or slightly more beneficial
  • More critical in younger patients due to higher activity levels
31
Q

What kind of outcomes are seen with PT for multi-tendon and/ or massive full thickness tears?

A
  • May help, particularly in low demand patients or those unfit for surgery
  • However, there is an increased likelihood for tear progression and arthropathy
32
Q

What kind of outcomes are seen with surgery for multi-tendon and/ or massive full thickness tears?

A
  • Challenging with various options
  • About 80% satisfaction rate
33
Q

When are shoulder joint replacements usually used?

A

With irreparable tears and less with age-related changes

34
Q

The reverse total shoulder arthroplasty (rTSA) is superior to the hemiarthroplasty in what ways?

A
  • Pain relief
  • Function
  • Active elevation
35
Q

What kind of arthrokinematic motion does the reverse total shoulder have?

A

Concave humeral head moving on a convex scapula (this is reversed from how it usually is)

36
Q

Is the rotator cuff usually left intact during a total shoulder?

A

Yes, with the possible exception of the supraspinatus due to retraction/ damage

37
Q

What is the overall goal of PT with total shoulder replacments?

A
  • Make movement more efficient as with all shoulder conditions
  • Avoid hyperextended position/motion
38
Q

What are the restrictions at 0-6 weeks for a shoulder replacement?

A
  • POLICED including immobilization with sling out of the house
  • Waist level and mid-line AROM restrictions
  • NO pushing, pulling, or lifting (same as sternal)
39
Q

How often should someone be doing ROM when they are 0-6 weeks postop total shoulder?

A

Progressive ROM 2x a day: this may be delayed up to 4 weeks for better healing without negative consequences

40
Q

What kind of exercises could you provide your 0-6 week postop total shoulder pt?

A
  • AAROM: pendulums, standing pulley or supine flexion, supine IR/ER
  • Stretching into ER
  • Scapular PREs (progressive resistance exercises)
41
Q

At 6-8 weeks postop total shoulder what should you be taking away and what should you be adding to your Rx?

A
  • DC sling
  • Add a sitting pulley
  • Add isometric shoulder PREs in neutral
  • Add standing AROM into flexion
  • Add across then up the back PROM
42
Q

At 8-12 weeks postop total shoulder what should you be adding to your Rx?

A

Progressive isotonic shoulder PREs

43
Q

At 12-16 weeks postop total shoulder what should you be adding to your Rx?

A
  • Add in gym type exercises
  • Most pts are able to play golf at 4 months (if they want to)
44
Q

What kind of outcomes are seen with total shoulder arthroplastys?

A
  • 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)
45
Q

What are some of the main things to highlight with your rehab protocol for rotator cuff tears? (there are 7)

A
  • 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
46
Q

What groups have a more favorable prognosis after surgery for a rotator cuff tear?

A
  • 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

MSK Exam 3 (9 decks)

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