Rotator Cuff Tendinopathy Flashcards
__-__% of the general population suffers from shoulder pain
16-34
Is inflammation present in RC tendinopathy?
Minimal role early on
What patieint populations are at risk for RC tendinopathy?
manual laborers and those whose work involves a great deal of repetitive motion
True or False
In the general population as well, rotator cuff disease is the most common cause of shoulder pain
True
What tendon is the most frequently injured?
supraspinatus
Other than job activities what are 4 other risk factors for RC tendinopathy?
- anatomic variants
- older age
- high BMI
- instability or hypermobility of the glenohumeral joint (not due to muscle weakness)
What does the supraspinatus do?
abduction and external rotation
What does the infraspinatus do?
abduction and external rotation
What does the teres minor do?
abduction and external rotation (especially when the arm is abducted to 90 degrees)
What does the subscapularis do?
internal rotation, also assists in abduction and adduction
True or False
There is a definitive pathophysiology and mechanism of injury for rotator cuff tendinopathy
False
What are the 2 theories of the pathophysiology and MOI for rotator cuff tendinopathy?
- Biomechanical factors
- Vascular factors
What does an alternative approach to describing the mechanism of injury involve?
- intrinsic factors, directly related to the tendon
- extrinsic factors, related to surrounding structures
What are 7 differential diagnoses to RC tendinopathy?
- cervical radiculopathy
- acromioclavicular osteoarthritis
- subacromial bursitis
- bicipital tendinopathy
- rotator cuff tear
- glenoid labrum tear
- adhesive capsulitis
Describe the clinical presentation of a patient with RC pathology
- Shoulder pain with overhead activity
- Pain at night (especially when lying on the affected shoulder)
- Weakness
- Decline in performance
Where do patients describe pain at?
lateral deltoid
What does the physical examination reveal?
- muscle atrophy of the affected muscle
- tenderness upon palpation
- referred neck pain
- painful ROM above 90 degrees of abduction, or pain with internal rotation
Pain that occurs between __-__ degrees of active abduction marks a positive arc test
60-120
What tests examines the supraspinatus?
“empty can” (Jobe’s strength) test
What tests examines the infraspinatus?
resisted ER strength test
What tests examines the subscapularis?
Push off (Gerber’s) test
What are the 2 special tests to assess shoulder impingement?
- Neer
- Hawkins-Kennedy
What is considered the gold standard for the initial evaluation of tendon disorders?
musculoskeletal ultrasound
Is musculoskeletal ultrasound highly specific or sensitive?
sensitive
When should orthopedic referral be obtained?
if nonoperative therapy fails to provide relief within six to nine months or a diagnosis of rotator cuff tear is made
What are the 3 basic surgical interventions?
- debridement
- acromioplasty with debridement
- rotator cuff repair
What does acute therapy involve?
- Cryotherapy
- Rest
- NSAIDS
- Electrical stimulation, phonophoresis and iontophoresis
- Therapeutic Ultrasound
- Laser
What does subacute therapy involve?
- Glucocorticoids
- Topical Glyceryl trinitrate
- Experimental therapy
What do topical glyceryl trinitrates do?
They cause local vasodilation, increasing blood flow to the damaged tendon
What are the 3 complications associated with RC tendinopathy?
- Significant loss of shoulder ROM
- Adhesive capsulitis
- Tendon tears
The likelihood of these complications increases with what?
age
