Rotator Cuff Related Pain

Question 1

PTS is more common in which sex?

Answer 1

Males

Question 2

This is unilateral shoulder girdle pain that is worse at night

Answer 2

Parsonage Turner Syndrome (idiopathic brachial pexopathy, brachial neuritis, neuralgic amyotrophy)

Question 3

PTS will be different from TOS in what ways?

Answer 3

Constant pain and negative TOS tests

Question 4

PTS is treated in PT by…

Answer 4

Focus on restoring strength seen in MMT

Question 5

Multiple episodes of similar symptoms to parsonage turner is likely

Answer 5

Hereditary neuralgic amyotrphy

Question 6

Calcific tendinitis typically affects what age group and sex?

Answer 6

40-60 yo and females

Question 7

CT is likely due to what?

Answer 7

Metabolic issues like DM and hypothyroidism, genetics

Question 8

What is the onset of CT like? What time of day is it worse? Where is pain?

Answer 8

Severe spontaneous pain
Worse in AM
Anterior shoulder like bicipital groove or posterior shoulder inferior to spine of the scapula

Question 9

CT is different from AC in what ways?

Answer 9

Worse in the AM and AC has increasing ER limitations with increase should abduction

Question 10

CT is different from biceps tendonopathy in what ways?

Answer 10

Biceps tendinopathy doesn’t have ROM impairments

Question 11

What are conservative Tx for CT?

Answer 11

Extracorporeal shockwave therapy, steroid injection or percutaneous needling. Ionto is not effective

Question 12

External impingement is when

Answer 12

Rotator cuff muscles, tendons and bursa rub against the anterior 1/3 of the acromion

Question 13

Type one acromion is

Answer 13

Flat

Question 14

Type 2 acromion is

Answer 14

Curved

Question 15

Type 3 acromion is

Answer 15

Hooked (RCT are most common)

Question 16

Internal impingement is when

Answer 16

The underside of the muscles are pinched between the humeral head and glenoid

Question 17

Bursal sided rotator cuff tears are due to

Answer 17

Impingement

Question 18

Articular sided tears are due to

Answer 18

Internal impingement

Question 19

Posterior impingement is the most common primary impingement. What motions cause this?

Answer 19

Shoulder abduction, ER and horizontal hyper abduction.

-tight posterior band of the GH ligament can contribute

Question 20

Secondary impingement is due to

Answer 20

Shoulder instability whether it is due to lax ligaments, poor dynamic control, or excessive demands due to overhead throwing

Question 21

Possible shoulder impingement CPR
4 items

Answer 21

1. Positive Hawkins Kennedy
2. Painful arc
   3 positive infraspinatus MMT for weakness or pain
   4 positive ER lag sign

Looking for 2 out of 3 for 90% probability

Question 22

What symptoms does posterior impingment have?

Answer 22

Location is posterior shoulder, pain with throwing, weakness and decreased throwing performance

Question 23

What are some intrinsic factors for RCT?

Answer 23

1. Age: collagen thinning and decreased vascularity
2. DM and smoking decrease vascularity and delivery of oxygen
3. Hyperlipidemia: fatty deposits in tendons which can’t handle stress and loading as well
4. Genetics

Question 24

Full thickness rotator cuff CPR

Answer 24

Age over 65
ER weakness
Night pain
-all three needed for tear

Question 25

Park et all rotator cuff CPR

Answer 25

1. Painful arc
2. Weakness or pain with infraspinatus MMT
3. Positive drop arm test

3= 91%
2= 69%

Question 26

_% of people over the age of 65 have a RCT

Answer 26

55

Question 27

_% of asymptomatic people under the age of 65 have partial or full RCT

Answer 27

40