Shoulder Complex IV: Test 3 Flashcards by Braden Talbert

how do gradual vs acute RC tears come about

gradual = degenerative or repetitive stress

acute = high velocity, heavy lifting, or impact

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structures involved with RC tear? how are they graded?

most common = supra or infraspinatus

possibly others

graded by size and partial or full tear

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how often are labrum and LHB involved with RC tear

40-73% involved

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how can LHB or labrum be involved with traumatic RC tear

superior labral anterior/posterior (SLAP) tear
-LHB excess contraction tears labrum
-may have to surgically fixate biceps tendon (tenodesis)

Compression onto labrum with FOOSH

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how can LHB or labrum be involved with a gradual RC tear

repetitive stresses with/without abnormal mechanics

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S&S of a RC tear

worse impingement symptoms
increased pain with repeated overhead activity
painful arc around 90
weak/painful resisted (especially FLX, ABD, ER)
possible + stress test
+ special test for cuff and maybe biceps/labrum

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All tears cluster test involve what variables

> 65 years old

weak ER

night pain

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full thickness tear cluster test involves what variables

greater than or equal to 60 years old

+ painful arc, drop arm, and infraspinatus test

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test/measure for supraspinatus/infraspinatus

ER lag sign

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drop arm is a high spec test for what muscle

supraspinatus

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tests/measures for non specific tears

empty can (high sensitivity)

Jobe test

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subscapularis tests/measures

lift off

belly press

bear hug

all high specificity

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tPT Rx for RC tear

treat as worst case hyper mobility + tissue damage

early ROM with degenerative tears

MET ultimately for stabilization and tissue proliferation of muscle, tendon, and/or labrum

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biggest predictor of a tear going to sx is what

patients negative perception

regardless of size, retraction, fatty infiltration, age or pain

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effectiveness fo corticosteroid injections with RC tear

no evidence of effectiveness within 4 weeks of shot

only provides transient relief compared to placebo

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describe arthroscopic procedures with arthroplasty for RC tear

sewing of fibers back together and reattaching to bone

Full ROM is ensured while under anesthesia

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MD Rx for degenerative RC tears

PT has successful outcomes without sx (especially with small/partial tears)

surgery = good clinical outcome with P!, ROM, strength, and quality of life and sleep

radiological outcomes not as good

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PT effectiveness for acute small to medium tears

may help

if not progressing well delays are associated with poor surgical outcomes

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surgery effectiveness for small to medium acute tears

no difference from PT or slightly more beneficial

more critical in young patients due to higher activity levels

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PT effectiveness for multi tendon or massive full thickness tears

may help especially in low demand pt or those unfit for sx

increased likelihood of tear progression and arthropathy

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effectiveness fo sx for multi tendon or massive full thickness tears

challenging with various options

80% satisfaction rate

when are joint replacements usually used

with irreparable tears

when is reverse total shoulder arthroplasty (RTSA) superior

superior to hemiarthroplasty in terms of pain relief, function, and active elevation

what happens to the joint architecture with a RTSA

convex concave joint relationship is reversed

outcomes of RTSA

90% able to participate in sports without significant restriction if the activity was performed preoperatively (i.e. swim, gold, cycling)

Rehab protocol and highlights for RC tear

criterion AND time based = best bracing in 15 degrees ER TENS for pain get moving supervised PT = beneficial early isometric loading

factors for a favorable prognosis after surgery

younger male higher bone density no diabetes/obesity higher fitness level greater pre-op ROM smaller or single tear less retraction/fatty filtration no biceps/AC involvement

functional questionarires for frozen shoulder contracture syndrome

DASH = disability of the arm, shoulder, and hand ASES = American shoulder and elbow surgeons shoulder scale SPADI= shoulder pain and disability index

incidence of frozen shoulder

2-5.3% frequently misdiagnosed with any multi directional limitation in ROM

risk factors for frozen shoulder

females hypothyroidism 40-65 years of age previous adhesive capsulitis diabetes family Hx

etiology of frozen shoulder

primary = due to pathology, especially autoimmune secondary = concomitant injury and period of immobilization

pathogenesis of frozen shoulder

more often = inflammation of GH joint capsule (persistent inflammation or fibrosis) possibly also reduced joint volume

structures involved with frozen shoulder

GH capsule and ligaments joint space

symptoms of frozen shoulder

gradual/progressive functional limits with reaching, sleep, and other basic ADLs

symptoms, irritability, ROM, and end feel of stage I frozen shoulder (initial stage)

symptoms = gradual; achy at rest, sharp with use; night pain; unable to lie on involved side high irritability AROM

symptoms, irritability, ROM, and end feel of stage II frozen shoulder (freezing stage)

symptoms = constant pain especially at night high irritability mod-severe limits; AROM < PROM empty/painful end feel

symptoms, irritability, ROM, and end feel of stage III frozen shoulder (frozen stage)

symptoms = stiffness more than pain; some intermittent pain moderately irritable mod-severe limits in ROM with pain at end range; similar AROM and PROM firm end feel

symptoms, irritability, ROM, and end feel of stage IV frozen shoulder (thawing stage)

symptoms = minimal to no pain low irritability ROM gradually improves firm end feel

tests/measures for frozen shoulder

no definitive gold standard mainly by exclusion normal radiographs clinical presentation is most common evidence: early dx is very difficult due to irritability

PT Rx for frozen shoulder

POLICED pt edu -describe natural course of 4 stages -match intensity of stretching, JM with S&S as always

modalities effectiveness for frozen shoulder

cryotherapy = additional benefit to JM and modalities for Pain/ROM/function LASER=evidence for short term and long term functional changes weak if any evidence for diathermy, ultrasound, and e-stim

effectiveness of JM for pain and ROM with frozen shoulder

Grade III-V = mod evidence for short and long term benefits inconsistent benefit for ROM when added to exercise conflicting evidence

effectiveness of STM for ROM/flexibility for frozen shoulder

moderate evidence

PT MET Rx for frozen shoulder

focus primarily on elasticity and mobility increases also offset disuse, particularly with inhibited muscles multimodal approach is effective for most patients

oral steroids effectiveness for frozen shoulder

moderate evidence for short term

effectiveness for cortisone injection for frozen shoulder

short and mid term benefit short term when added to therex and JMs

effectiveness of manipulation under anesthesia for frozen shoulder

questionable effectiveness recalcitrant conditions respond well no difference to exercise alone

how long does stage I frozen shoulder last

1-2 months

the course of pain and mobility deficits for frozen shoulder may last up to how long

12-18 months

general prognosis for frozen shoulder

most patients achieve minimal symptoms/deficits with treatment

if untreated, what may occur with frozen shoulder

may resolve after 12-42 months about 50% with pain lasting out to 4.5-7 years