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Extremities Technique II > Rotator Cuff Tears > Flashcards

Rotator Cuff Tears Flashcards

1
Q

What are the most common sites of rotator cuff tendon tears in order of prevalence?

A
  1. Supraspinatus
  2. Infraspinatus
  3. Subscapularis
  4. Teres minor (very rare)
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2
Q

Age-related degeneration, tension overload, and impingement can all lead to rotator cuff tendinopathy
What can rotator cuff tendinopathy then lead to?

A

Rotator cuff tear

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3
Q

What is the most common cause of rotator cuff tears over the age of 40?

A

Age-related degeneration

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4
Q

Age-related degeneration initially begins as asymptomatic ___ and progresses to ___

A

asymptomatic tendinopathy and progresses to rotator cuff tear

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5
Q

What activities are associated with age-related degeneration?

A

Not related to any specific activity

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6
Q

Subacromial impingement is the most common cause of rotator cuff tendinopathy
Does it commonly progress to a rotator cuff tear?

A

Typically does not progress to a rotator cuff tear in the general population

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7
Q

Both impingement and tension overload are common causes of rotator cuff tears in ___ people

A

athletic people (involved in high intensity repetitive overhead activity; <35 years old)

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8
Q

What are the major causes of rotator cuff tendon tears?

A
  • Age-related degeneration
  • Subacromial impingement
  • Tension overload
  • Major trauma
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9
Q

Trauma can result in a tendinopathy or directly cause ___

A

an acute rotator cuff tear

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10
Q

Major trauma is related with a minority of patients with rotator cuff tear
Where is this cause most often seen?

A

Older patient’s after traumatic glenohumeral joint dislocation or FOOSH

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11
Q

A supraspinatus tear usually begins at the ___ and progresses ___

A

begins at the anterior edge of the supraspinatus tendon and progresses posteriorly

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12
Q

What is affected by a massive tear of supraspinatus?

A

At least two adjacent tendons:

  • Supraspinatus and infraspinatus
  • Supraspinatus and subscapularis
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13
Q

Do the majority of rotator cuff tears heal on their own?

A

No, many progress in size over time

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14
Q

What are four reasons rotator cuff tears do not heal?

A
  1. Constant traction on the supraspinatus by weight of arm keeps torn edges apart
  2. Degenerative nature of most tears is not an environment for healing
  3. Poor vascular supply of the tendon at common site of tears
  4. Most tears are on the articular side (undersurface); torn fibers are surrounded by synovial fluid, disrupting healing factors
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15
Q

What are the chief complaints of a patient with a rotator cuff tear?

A

Pain or pain and weakness
Local and referred pain in similar location as subacromial impingement

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16
Q

What is the typical age of a patient with a rotator cuff tear?

A

Usually over 40, but more common over 50

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17
Q

Patients under 40 years old usually get a rotator cuff tear due to…

A

high intensity overhead athletic activity (ie. progression of impingement or tension overload)

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18
Q

When the onset of rotator cuff tear comes with a history of trauma (ie. FOOSH, anterior shoulder dislocation), usually the patient is…

A

over 40 years old

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19
Q

Palpation of rotator cuff tears will have the same findings as…

A

subacromial impingment

20
Q

Which muscles are tested for strength when diagnosing a rotator cuff tear?

A
  • Supraspinatus
  • Infraspinatus/teres minor
  • Subscapularis
21
Q

If there is a tear of a rotator cuff tendon, how will that muscle typically test?

A

Tests weak on manual muscle testing (4/5 or weaker)

22
Q

What is suspected if two adjacent muscles test weak on manual muscle testing of the rotator cuff?

A

Rotator cuff tear is very large; a massive rotator cuff tear

23
Q

What is the drop arm test?

A

Orthopedic test for rotator cuff tear involving eccentric loading of the supraspinatus

24
Q

The drop arm test has ___% sensitivity for rotator cuff tear and ___% specificity

A

7% sensitivity
98% specificity

25
Q

If the drop arm test more sensitive or specific?

A

Specific (98%)

26
Q

What does a positive drop arm test indicate?
What does a negative drop arm test indicate?

A

Positive: almost assures the diagnosis of a rotator cuff tear (high specificity)
Negative: Does not rule out rotator cuff tear (low sensitivity)

27
Q

Impingement tests are often positive in ___ tears

A

supraspinatus tears

28
Q

Impingement tests have ___% sensitivity and ___% specificity

A

75% sensitivity
45% specificity

29
Q

Are impingement tests more sensitive or specific?

A

Sensitive

30
Q

What does a positive impingement test indicate?
What does a negative impingement test indicate?

A

Positive: no assurance of rotator cuff tear diagnosis (low specificity)
Negative: helps rule out a rotator cuff tear (moderate sensitivity)

31
Q

What is sensitivity?

A

Percentage of patients with the condition that have a positive test (true positive)

32
Q

A test with 100% sensitivity will have a positive test for all patients with the condition
A negative test would ___ the diagnosis

A

rule out

33
Q

A test with 100% specificity will have a negative test for all patients without the condition
A positive test would ___ the diagnosis

A

confirm

34
Q

What is specificity?

A

Percentage of patients without the condition that have a negative test (true negatives)

35
Q

What imaging may be needed if a rotator cuff tear is suspected?

A

MRI

36
Q

What is the goal of treating a rotator cuff tear?

A

Decrease pain and increase function

37
Q

What would be the targets of manipulation/mobilization for rotator cuff tears?

A
  • ACJ
  • SCJ
  • STA
  • T and C spine
38
Q

When treating a rotator cuff tear, what should only be mobilized (not manipulated)?

A

Glenohumeral joint

39
Q

In Tate (2010), treatment of both patients included ___, ___, and ___
Both patients had significant improvement without adverse reactions

A

A-P glides, S-I glides, and long axis traction

40
Q

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

A

S-I glide

41
Q

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

A

supraspinatus

42
Q

If a patient has a known or suspected supraspinatus tear, what should be kept in mind for manual therapy?

A
  • 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
43
Q

What are some therapeutic modalities to treat a rotator cuff tear?

A
  • Ice/heat
  • Electrical stimulation
  • Ultrasound
  • Laser
44
Q

When should a chiropractor refer a rotator cuff tear to an orthopedist?

A

RC tears should be seen by an orthopedist for evaluation since they do not heal without surgical repair and often get worse

45
Q

If surgery is required for a rotator cuff tear, when are surgical outcomes best?

A

When surgery is performed early

46
Q

What are some medical treatments for rotator cuff tears?

A
  • Medication (NSAIDs)
  • Subacromial corticosteroid injection
  • Physical therapy
47
Q

What are some surgical treatments for rotator cuff tears?

A
  • Subacromial decompression
  • Rotator cuff repair

Extremities Technique II (8 decks)

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