Rotator Cuff Tears Flashcards
What are the most common sites of rotator cuff tendon tears in order of prevalence?
- Supraspinatus
- Infraspinatus
- Subscapularis
- Teres minor (very rare)
Age-related degeneration, tension overload, and impingement can all lead to rotator cuff tendinopathy
What can rotator cuff tendinopathy then lead to?
Rotator cuff tear
What is the most common cause of rotator cuff tears over the age of 40?
Age-related degeneration
Age-related degeneration initially begins as asymptomatic ___ and progresses to ___
asymptomatic tendinopathy and progresses to rotator cuff tear
What activities are associated with age-related degeneration?
Not related to any specific activity
Subacromial impingement is the most common cause of rotator cuff tendinopathy
Does it commonly progress to a rotator cuff tear?
Typically does not progress to a rotator cuff tear in the general population
Both impingement and tension overload are common causes of rotator cuff tears in ___ people
athletic people (involved in high intensity repetitive overhead activity; <35 years old)
What are the major causes of rotator cuff tendon tears?
- Age-related degeneration
- Subacromial impingement
- Tension overload
- Major trauma
Trauma can result in a tendinopathy or directly cause ___
an acute rotator cuff tear
Major trauma is related with a minority of patients with rotator cuff tear
Where is this cause most often seen?
Older patient’s after traumatic glenohumeral joint dislocation or FOOSH
A supraspinatus tear usually begins at the ___ and progresses ___
begins at the anterior edge of the supraspinatus tendon and progresses posteriorly
What is affected by a massive tear of supraspinatus?
At least two adjacent tendons:
- Supraspinatus and infraspinatus
- Supraspinatus and subscapularis
Do the majority of rotator cuff tears heal on their own?
No, many progress in size over time
What are four reasons rotator cuff tears do not heal?
- Constant traction on the supraspinatus by weight of arm keeps torn edges apart
- Degenerative nature of most tears is not an environment for healing
- Poor vascular supply of the tendon at common site of tears
- Most tears are on the articular side (undersurface); torn fibers are surrounded by synovial fluid, disrupting healing factors
What are the chief complaints of a patient with a rotator cuff tear?
Pain or pain and weakness
Local and referred pain in similar location as subacromial impingement
What is the typical age of a patient with a rotator cuff tear?
Usually over 40, but more common over 50
Patients under 40 years old usually get a rotator cuff tear due to…
high intensity overhead athletic activity (ie. progression of impingement or tension overload)
When the onset of rotator cuff tear comes with a history of trauma (ie. FOOSH, anterior shoulder dislocation), usually the patient is…
over 40 years old
Palpation of rotator cuff tears will have the same findings as…
subacromial impingment
Which muscles are tested for strength when diagnosing a rotator cuff tear?
- Supraspinatus
- Infraspinatus/teres minor
- Subscapularis
If there is a tear of a rotator cuff tendon, how will that muscle typically test?
Tests weak on manual muscle testing (4/5 or weaker)
What is suspected if two adjacent muscles test weak on manual muscle testing of the rotator cuff?
Rotator cuff tear is very large; a massive rotator cuff tear
What is the drop arm test?
Orthopedic test for rotator cuff tear involving eccentric loading of the supraspinatus
The drop arm test has ___% sensitivity for rotator cuff tear and ___% specificity
7% sensitivity
98% specificity
If the drop arm test more sensitive or specific?
Specific (98%)
What does a positive drop arm test indicate?
What does a negative drop arm test indicate?
Positive: almost assures the diagnosis of a rotator cuff tear (high specificity)
Negative: Does not rule out rotator cuff tear (low sensitivity)
Impingement tests are often positive in ___ tears
supraspinatus tears
Impingement tests have ___% sensitivity and ___% specificity
75% sensitivity
45% specificity
Are impingement tests more sensitive or specific?
Sensitive
What does a positive impingement test indicate?
What does a negative impingement test indicate?
Positive: no assurance of rotator cuff tear diagnosis (low specificity)
Negative: helps rule out a rotator cuff tear (moderate sensitivity)
What is sensitivity?
Percentage of patients with the condition that have a positive test (true positive)
A test with 100% sensitivity will have a positive test for all patients with the condition
A negative test would ___ the diagnosis
rule out
A test with 100% specificity will have a negative test for all patients without the condition
A positive test would ___ the diagnosis
confirm
What is specificity?
Percentage of patients without the condition that have a negative test (true negatives)
What imaging may be needed if a rotator cuff tear is suspected?
MRI
What is the goal of treating a rotator cuff tear?
Decrease pain and increase function
What would be the targets of manipulation/mobilization for rotator cuff tears?
- ACJ
- SCJ
- STA
- T and C spine
When treating a rotator cuff tear, what should only be mobilized (not manipulated)?
Glenohumeral joint
In Tate (2010), treatment of both patients included ___, ___, and ___
Both patients had significant improvement without adverse reactions
A-P glides, S-I glides, and long axis traction
Gann (1998) warns to avoid ___ treating rotator cuff tears for fear of further tearing the supraspinatus
Gann acknowledges, however, that there are no studies to support her opinion
S-I glide
Gann (1998) warns to avoid S-I glide treating rotator cuff tears for fear of further tearing the ___
Gann acknowledges, however, that there are no studies to support her opinion
supraspinatus
If a patient has a known or suspected supraspinatus tear, what should be kept in mind for manual therapy?
- Prudence would suggest starting with a low-grade mobilization
- Beneficial techniques: A-P glides, S-I glides (use judgement), all performed with arm above 30 degrees abduction in scapular plane
What are some therapeutic modalities to treat a rotator cuff tear?
- Ice/heat
- Electrical stimulation
- Ultrasound
- Laser
When should a chiropractor refer a rotator cuff tear to an orthopedist?
RC tears should be seen by an orthopedist for evaluation since they do not heal without surgical repair and often get worse
If surgery is required for a rotator cuff tear, when are surgical outcomes best?
When surgery is performed early
What are some medical treatments for rotator cuff tears?
- Medication (NSAIDs)
- Subacromial corticosteroid injection
- Physical therapy
What are some surgical treatments for rotator cuff tears?
- Subacromial decompression
- Rotator cuff repair
