Rotator Cuff Tear & Frozen Shoulder - Exam 3 Flashcards
what type of activities cause a gradual or degenerative rotator cuff tear?
repetitive overhead activities
what type of activities cause an acute rotator cuff tear?
high UE velocity (throwing)
heavy lifting
impact (fall with outstretched hand FOOSH)
what are the two most common structures involved in a rotator cuff tear?
supraspinatus
infraspinatus
rotator cuff tears are graded by:
size (S, M, L)
partial/full thickness tear
when the labrum and biceps are involved with a traumatic RC tear, what occurs?
superior labral ant/post (SLAP) tear:
– long head of biceps excessively contracts and tears labrum
AND/OR
compression onto labrum from FOOSH
when the labrum and biceps are involved with a gradual RC tear, what occurs?
repetitive stresses without/with abnormal mechanics
what are symptoms of a rotator cuff tear?
worse impingement plus lose mobility and contraction
increased pain with repetitive overhead activities
what would the PT see with a rotator cuff tear?
– painful arc around:
– resisted testing:
– stress tests:
– special tests:
–painful arc around 90 deg. elevation
– weak and painful in flex, abd/ER, possibly IR
– possibly (+)
– (+) for cuff and possibly labrum and biceps
what are test parameters to determine all RC tears?
> 65 years of age
weak ER
night P!
what are test parameters to determine full thickness RC tears?
> /= 60 years
+ painful arc, drop arm (high spec. for supraspinatus tear), infraspinatus test
what 3 tests have high specificity for subscapularis tears?
lift off
belly press
bear hug
how do you treat a RC tear?
treat as the worse cases on hypermobility with tissue damage that has occurred
early ROM with degenerative tears
– accelerated recovery in most
– limited tendon healing with large tears
what are the ultimate purposes of MET for RC tear? (2)
stabilization
tissue proliferation of muscle, tendon, and/or labrum
what is the biggest predictor of a tear going to surgery? irrespective of?
patient’s negative perception
irrespective of:
- size of tear
- retraction
- fatty infiltration
- age
- pain
what are MD prescriptions for RC tear?
corticosteroid injections (short term relief)
primarily arthroscopic procedures with arthroplasty – sewing fibers back together and reattaching to bone
true or false. surgeon makes sure patient has full ROM under anesthesia
true
what are 3 Rx options for degenerative tears?
- PT - successful outcomes, esp w small or partial tears
- surgery - good outcome w P!, ROM, strength, quality of life, sleep
- radiological - not as good outcomes because structures doesn’t always have to change to be functionally better or improve symptoms
what are 2 Rx options for acute small to medium tears?
- PT - proceed w caution. if not progressing well, delays associated with poor surgical outcomes
- surgery - no difference from PT or slightly more beneficial. more critical in younger patients who need to use their arm for higher activity levels
what are 2 Rx options for multi-tendon and/or massive full thickness tears?
- PT - may help, mostly in low demand patients or those unfit for surgery but increased tear progression/arthropathy
2- surgery - challenging but ~80% satisfaction rate
when would joint replacements be used for RC tear?
irreparable tears
reverse total shoulder arthroplasty (RTSA):
– superior to hemiarthroplasty in terms of:
– joint relationship?
– outcomes?
– pain relief, function, active elevation
– convex/concave reversed (concave on convex)
– good! 90% able to participate in sports without significant restriction if activity performed preoperatively
what are rehab protocol highlights for RC tear?
– best if:
– bracing in:
– P! management:
– early vs delayed mobilization?
– early isometric loading:
– criterion and time based
– 15 deg ER
– TENS
– move them early!
– improved outcomes
what are some favorable parameters for better prognosis after RC surgery?
younger males
higher bone density
higher fitness level / no obesity
greater preoperative ROM
smaller and single tear
less fatty infiltration
no biceps/AC involvement
what are two other names for frozen shoulder contraction syndrome?
frozen shoulder
adhesive capsulitis
is frozen shoulder syndrome common? if not, what is it frequently misdiagnosed with?
no
any multidirectional limitation in ROM
what are risk factors for frozen shoulder?
female
hypothyroidism
40-65 years
previous adhesive capsulitis
diabetes
family history
what is the primary cause of frozen shoulder? secondary?
primary: pathology, particularly autoimmune conditions
secondary: concomitant injury and period of immobilization (ex: grandma falling - takes longer to heal)
what is the pathogenesis of frozen shoulder?
inflammation of GH capsule and ligaments (persistent inflammation, fibrosis)
reduced joint volume
what structures are involved in frozen shoulder?
GH capsule and ligaments
joint space
what are symptoms of frozen shoulder?
gradual and progressive P!, loss of motion
functional limitations w/ reaching, sleeping, other ADLs
what would you find in a scan and biomechanical exam for frozen shoulder?
ROM?
combined motions?
resisted/MMT?
stress test?
accessory motion?
special tests?
- loss of ER > abd > Flex > IR = capsular pattern of restriction @ GH joint
- consistent block
- possibly weak and/or P!ful depending on stage
- distraction possibly + depending on stage
- hypomobile
- (+) for impingement
Frozen shoulder stage I: initial
symptoms?
irritability?
ROM?
end feel?
- gradual onset, achy at rest, sharp with use, night P!, unable to lie on involved side
-high - AROM < PROM
- empty and painful
Frozen shoulder stage II: freezing
symptoms?
irritability?
ROM?
end feel?
– constant p!, particularly at night
– high
– moderate-severe limitations AROM < PROM
– empty and painful
Frozen shoulder stage III: frozen
symptoms?
irritability?
ROM?
end feel?
– stiffness > P! , intermittent P!
– moderate
– moderate to severe limitations with pain at end range AROM like PROM
– firm
Frozen shoulder stage IV: thawing
symptoms?
irritability?
ROM?
end feel?
– minimal to no pain
– low
– gradually improves
– firm
what is PT Rx for frozen shoulder? (2)
– POLICED
– patient education
when giving patient education for frozen shoulder what 3 things do you do?
1 - describe natural course of 4 stages
2 - promote P! free functional activity
3 - match intensity of stretching/JMs with S&S
what modalities could be prescribed for frozen shoulder?
cryotherapy - additional benefit to JM
LASER - evidence for short and long term functional changes
E stim
what kind of benefit does JM have for frozen shoulder?
mixed benefits for P! and ROM
what kind of benefit does STM have for frozen shoulder?
ROM/flexibility - moderate evidence
what does MET primarily focus on for frozen shoulder?
elasticity and mobility increases
also offset disuse, particularly with inhibited muscles
- multimodal approach is effective for most patients
what would a MD prescribe for frozen shoulder?
oral steroids
cortisone injection - gives PT windows to do more with decreased symptoms
manipulation under anesthesia –> worst case
how long does stage I last for frozen shoulder?
1-2 months (prolonged inflammatory phase)
P! and mobility deficits for frozen shoulder may last?
12-18 months
if frozen shoulder goes untreated, how long will it take to resolve itself?
12-42 months
~50% with P! out to 4.5-7 years
