RTC tears and pathology

Question 1

Where do most RTC tears occur in a muscle? Why?

Answer 1

musculotendinous junction due to poor vascularization

Question 2

(true/false) Full thickness tears can also involved complete detachment of the tendon from the humeral head

Answer 2

true

Question 3

(+) LR is considered as diagnostically accurate when it is ____.

Answer 3

> 10

Question 4

(-) LR is considered as diagnostically accurate if it is ___.

Answer 4

< 0.1

Question 5

The _____ Test & _____ Test are commonly used in clinical practice to determine whether or not impingement exists along with a rotator cuff tear.

Answer 5

NEER
Hawkins-Kennedy

Question 6

What is a test specifically for a teres minor tear?

Answer 6

Hornblower’s sign

Question 7

What is a valid test for a supraspinatus tear?

Answer 7

Empty can test

Question 8

What does a full can test look for?

Answer 8

supraspinatus tear

Question 9

What does a drop arm test look for?

Answer 9

full thickness tear of the supraspinatus

Question 10

What does a lift off test look for?

Answer 10

subscapularis tear

Question 11

What does a bear hug test look for?

Answer 11

subscapularis tear

Question 12

What does a belly press test look for?

Answer 12

subscapularis tear

Question 13

What is the best indicators of a full thickness rotator cuff tear?

Answer 13

palpation (high specificity and sensitivity)

Question 14

What are the diagnostic tests that can accurately diagnose a full thickness RTC tear?

Answer 14

palpation
hornblower’s sign
empty can
rent sign
lift off test
belly press test

Question 15

What is the CPR for RTC impingement?

Answer 15

(+) HK test
Painful arc
weak Infraspinatus/ER

Question 16

What is the CPR cluster for RTC tear/pathology?

Answer 16

(+) drop arm
painful arc
weak infraspinatus/ER

Question 17

What is considered as the gold standard of diagnostic imaging for RTC tears?

Answer 17

diagnostic arthroscopy (most valid and reliable but is invasive)

Question 18

definition: X-Ray or MRI with injected contrast medium.

Answer 18

arthrography

Question 19

definition: magnetic fields & pulses of radio wave energy to produce images of soft tissue.

Answer 19

MRI

Question 20

definition: uses a high frequency transducer to record images of the tendons.

Answer 20

ultrasound

Question 21

What modalities ARE supported for RTC rehabilitation?

Answer 21

Cryotherapy
E-stim (no US)
manual therapy

Question 22

External rotary force increased by ___% when performed with Neuromuscular electrical stimulation (NES) during rehabilitation.

Answer 22

22%

Question 23

Force production was (decreased/increased) regardless of age, size of tear, intensity of current, or the number of days post op when using electrical stimulation.

Answer 23

increased

Question 24

What is the location used for e-stim of the RTC?

Answer 24

infraspinatus belly and inferior to the scapular spine

Question 25

What is a good diagnosis for scapular mobilizations?

Answer 25

manual therapy

Question 26

When performing manual therapy in the acute phase, you must use the (open/close)-packed position

Answer 26

open packed

Question 27

Early (active/passive) ROM exercises after RC surgery is beneficial.

Answer 27

passive ROM

Question 28

What are the benefits of continuous passive motion (CPM)?

Answer 28

improves ROM decrease pain improve strength limits adhesions shortened hospital stay cost affective

Question 29

For rehabilitation BEFORE a RTC repair, what motions should you avoid?

Answer 29

overhead motions

Question 30

What should be done for maximum protection for days 1-2 of post-op?

Answer 30

sling cryotherapy medication pendulums if tolerated PROM if tolerated

Question 31

What motions should you avoid during the acute phase of healing s/p RTC repair?

Answer 31

PROM: IR, ABD, and HADD AROM: IR/ER, ABD, HADD resisted: IR/ER

Question 32

What are the goals for maximum protection during days 3-4 of post-op?

Answer 32

- promote healing - reduce swelling - pain control - increase ROM - slow atrophy - HEP

Question 33

What are the goals for maximum protection during weeks 1-2 of post-op?

Answer 33

- promote healing - reduce swelling - pain control - increase ROM - HEP

Question 34

What are the goals for maximum protection during weeks 2-4 of post-op?

Answer 34

- promote healing - reduce swelling - pain control - increase ROM - postural exercises - HEP

Question 35

What are the goals for maximum protection during weeks 4-6 of post-op?

Answer 35

- promote healing - monitor swelling - pain control - increase ROM - postural exercises - scapular stabilization - HEP

Question 36

What are the goals for maximum protection after week 12 of post-op?

Answer 36

- complete and painless ROM - UE strength and endurance - NM control - improve GH and scapular motion - provide functional and sport specific training

Question 37

Full ROM s/p RTC repair should be reached between weeks ___ - ____.

Answer 37

10-12

Question 38

RTC and shoulder exercises should be started during weeks __-__ s/p repair as tolerated.

Answer 38

6-12

Question 39

Although arthrography and arthroscopy are both good diagnotic imaging choices, What diagnostic imaging choices are more commonly used due to being less invasive but still accurate?

Answer 39

MRI and US (although MRI is the best choice out of the two)

Question 40

What exercises should definitely be used for RTC rehabilitation?

Answer 40

1. Full can (ABD: 90, FLX: 30, neutral supraspinatus ROT) 2. ER in S/L 3. shoulder shrugs 4. Prone Y's and T's