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MSK 1 - Shoulder > Shoulder Complex- RC Tear thru FSCS > Flashcards

Shoulder Complex- RC Tear thru FSCS Flashcards

1
Q

What are risk factors/etiologies for a rotator cuff tear?

A
  • Gradual or degenerative tears including with repetitive overhead activities
  • Acute tears, higher UE velocity, heavy lifting, impact (FOOSH)
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2
Q

What are the most common structures involved with a rotator cuff tear?

A

Supra or infraspinatus muscles
- possibly others

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3
Q

What are rotator cuff tears graded by?

A

size - S, M, L
partial or full thickness tear

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4
Q

What can cause a partial tear?

A

Excessive compression underneath tendon, wears away fibers

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5
Q

How often are the labrum and biceps involved with rotator cuff tears?

A

40-75% involved

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6
Q

What is a SLAP tear?

A

Superior Labral anterior/posterior tear

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7
Q

What causes a SLAP tear?

A

Long head of biceps excessively contracts and tears labrum

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8
Q

What may we have to have done to repair a SLAP tear?

A

surgically fixate biceps tendon (aka tenodesis)

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9
Q

What other trauma aside from a SLAP tear can cause a labrum and biceps tear?

A

Compression onto labrum with FOOSH

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10
Q

What are symptoms of a rotator cuff tear?

A

like impingement (INFLAMMATION) plus…
- acute or persistent
- hx of pop, click , or catch (high spec for labral tear)
- increased pain with repetitive overhead activities

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11
Q

What are signs of a rotator cuff tear?

A

Like impingement plus…
- painful arc around 90 degrees of elevation
- resisted/ MMT weak and painful
* flx & rotator cuff, particularly abd / ER/ possibly IR
- combined motions - possible inconsistent block
- stress tests possibly positive

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12
Q

What are some special test signs of a rotator cuff tear? How effective?

A

LR + = 9.84 if all positive, LR- = .54 if all negative
- over 65 yo
- weak ER
- night pain

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13
Q

What are indicators of a full thickness tear? How effective?

A

LR+ =28 if all positive, LR- = .09 if all negative
- over 60 yo
- positive painful arc, drop arm, and infraspinatus test

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14
Q

What is a test for the supra and infraspinatus? LR?

A

ER lag sign

LR+ = 5-28

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15
Q

What is a special test for. supraspinatus?

A

Drop arm - high spec (RULE OUT)

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16
Q

What are some tests for non-specific tears?

A

Empty can - high sens (RULE IN)
Jobe test - LR+=7.36; LR-=.1

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17
Q

What are some special tests for subscapularis?

A

Lift off - high spec (rule out)
Belly press (LR+ = 12.5-20)
Bear hug (LR+ = 7.23)

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18
Q

What special tests could possibly be positive (what structures)with a tear ?

A

For labrum and biceps

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19
Q

What is our patient rX for a rotator cuff tear?

A

Early ROM with degenerative tears

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20
Q

What is the ultimate purpose of MET for a rotator cuff tear?

A

Stabilization
Tissue proliferation for involved tissues

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21
Q

What is the biggest predictor of a tear going to sx?

A

A patients negative perception

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22
Q

What is the patients negative perception effecting surgery irrespective of?

A

size of tear
retraction
fatty inflitration
age
pain

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23
Q

What is retraction?

A

Tear of a tendon or muscle that is rather elastic, tear it and have it roll up, retracts away from attachment

  • if there a while, loses ability to heal
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24
Q

What is the effectiveness of corticosteroid injections with rotator cuff tears?

A

No evidence of effectiveness within 4 weeks of shot
- only provides transient relief

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25
Q

What are the primary types of procedures done for RC tears?

A

Arthroscopoic (viewing) with arthroplasty (reconstruction)

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26
Q

What do the surgical procedures for RC tears include?

A

sewing fibers back together and reattaching to bone
- leave capsule and ligaments
- FULL ROM under anesthesia

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27
Q

What are the PT outcomes for degenerative tears?

A

Successful outcomes, like surgery, and especially for those with small or partial tears or those unfit for sx

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28
Q

What is the surgical outcome for degenerative tears?

A

Good clinical outcome with pain, ROM, strength, quality of life, and sleep

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29
Q

What type of outcomes are not as good as clinical outcomes?

A

Radiological

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30
Q

What are the PT outcomes for acute small to medium tears?

A

may help
if not progressing well, delays associated with poor surgical outcomes

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31
Q

What is the outcome of surgery with acute small to medium tears?

A

No difference from PT or slightly more beneficial
- more critical in younger patients due to higher activity levels

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32
Q

What is the PT outcome for those with multi-tendon and/or Massive full thickness tears?

A

May help, particularly in low demand patients or those unfit for sx

Increased likelihood of tear progression and arthropathy

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33
Q

What are the surgical outcomes for multi-tendon and/or massive full thickness tears?

A

Challenging with various options
~80% satisfaction rate

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34
Q

When are shoulder joint replacements mostly used?

A

With irrepairable tears

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35
Q

When are shoulder joint replacements less often used?

A

Less with age related changes

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36
Q

Why is a reverse total shoulder arthroplasty superior to hemiarthroplasty?

A

Pain relief, function, active elevation

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37
Q

What happens to the biomechanics during a reverse total shoulder arthroplasty?

A

Convex/Concave joint relationship reversed

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38
Q

Is the RC left intact with a reverse total shoulder?

A

Yes typically, with the possible exception of supraspinatus due to retraction/damage

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39
Q

What can a total shoulder arthroplasty do overall?

A

Make movement more efficient as with all shoulder conditions

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40
Q

What should be avoided post total shoulder?

A

hyperextended position/motion

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41
Q

What is the patient rx for 0-6 weeks post total shoulder?

A

POLICED including immobilization with sling out of the house
- waist level and mid-line AROM restrictions
- no pushing, pulling, lifting

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42
Q

What is the ROM restriction with total shoulders 0-6 weeks post op?

A

Progressive ROM 2x a day, may be delayed up to 4 weeks for better healing without negative consequences

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43
Q

What exercises are included in progressive ROM for 0-6 week post TSA?

A

AAROM
- pendulums
-standing pulley or supine flexion
- supine IR/ER
Stretching into ER
Scapular PREs

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44
Q

Why could progressive ROM be delayed post total shoulder?

A

Have to make sure no delay in healing
- a lot of times in older individuals with bone density issues

45
Q

Can you move the shoulder girdle after total shoulder surgery?

A

YES, use muscles of shoulder girdle to work not the shoulder joint
- ie : retracton depression etc

46
Q

What is the patient rx for 6-8 weeks post total shoulder?

A

DC sling
Add:
- sitting pulley
- isometric shoulder PREs in neutral
- standing AROM into flexion
- Across then up the back PROM

47
Q

What is the patient rx for 8-12 weeks post total shoulder?

A

isotonic shoulder PREs

48
Q

What is the patient rx for 12-16 weeks post total shoulder?

A

Add in gym type exercises
** most able to play golf at 4 months

49
Q

What are the outcomes of a total shoulder arthroplasty?

A

Good to excellent results
90% able to participate in sports without significant restriction if activity was performed preoperatively

50
Q

What are some rehab protocol highlights for rotator cuff tears?

A
  • request surgial report - not all same
  • best if criterion and time based
  • Bracing in 15 degrees of ER
  • TENS for pain management
  • get them moving
  • supervised PT beneficial
  • early isometric loading improved outcomes
51
Q

What are the outcomes of early vs delayed mobilization with rotator cuff tears for post of?

A

similar outcomes - GET THE PATIENT MOVING

52
Q

What can make prognosis after surgery more favorable

A

*Younger age
*biological male
* higher bone density
* No diabetes/ obesity
* higher fitness levels
* greater pre-operative ROM
* Smaller and single tear
* less retraction / fatter infiltration
* no biceps/ AC involvement

53
Q

What are some functional questionnaries for Frozen Shoulder Contraction Syndrome?

A
  • DASH - Disabilities of the arm, shoulder and hand
  • ASES - American shoulder and elbow surgeons shoulder scale
  • SPADI - Shoulder Pain and Disability Index
54
Q

What are other names for Frozen Shoulder Contraction Syndrome (FSCS)?

A

Adhesive capsulitis
Frozen Shoulder

55
Q

What is the incidence of frozen shoulder?

A

1-5.3%

56
Q

What causes frozen shoulder to be frequently misdiagnosed?

A

any multi - directional limitation in ROM

57
Q

What are risk factors for frozen shoulder?

A

40-65 years of age
Biological female
Previous adhesive capsulitis
family history

58
Q

What is associated with frozen shoulder?

A

Systemic low grade inflammation
- hypothyroidism
- diabetes

59
Q

What is frozen shoulder most often due to?

A

Pathology, particularly autoimmune conditions (i.e. - diabetes, hypothyroidism, etc.)

60
Q

What is the secondary etiology of frozen shoulder?

A

Concomitant (naturally accompanying or associated) injury and period of immobilization

61
Q

What is the pathogenesis of frozen shoulder?

A
  • More often inflammation of GH capsule and ligaments
  • persistent inflammation
  • fibrosis such as contracture
  • reduced joint volume
62
Q

What type of impingement is most likely to occur?

A

Hypomobility

63
Q

What structures are involved with frozen shoulder contracture syndrome?

A

GH capsule and ligaments
Joint space

64
Q

What are the symptoms of frozen shoulder contracture syndrome?

A

like impingement plus…
- gradual and progressive pain and loss of motion
- functional limitations with reaching, sleeping and other basic ADLs

65
Q

What are some signs we would find of frozen shoulder contracture syndrome?

A
  • ROM - typically a loss of ER then Abduction then Flexion then internal rotation
  • Combined motions - consistent block
  • Resisted/MMT possibly weak and/or painful depending on stage
  • Accessory motion testing - hypomobile
  • Special tests positive for impingement
66
Q

What is the order that ROM is lost with frozen shoulder contraction syndrome

A

typically a loss of ER then Abduction then Flexion then internal rotation

67
Q

What are the symptoms of stage 1 frozen shoulder contraction syndrome?

A

Gradual onset, achy at rest, sharp with use, night pain common, unable to lie on involved side

68
Q

What is the irritability of stage 1 frozen shoulder contraction syndrome?

A

High

69
Q

What would we find with ROM with stage 1 frozen shoulder contraction syndrome?

A

AROM significantly less than PROM

70
Q

What is the end feel with stage 1 frozen shoulder contraction syndrome?

A

Empty and painful

71
Q

What are the symptoms of stage II frozen shoulder contraction syndrome?

A

Constant pain, particularly at night

72
Q

What is the irritability of stage II frozen shoulder?

A

HIGH

73
Q

What would we find with ROM of stage II frozen shoulder?

A

Moderate - severe limitations in AROM less than PROM

74
Q

What is the end feel of stage II frozen shoulder?

A

Empty and painful

75
Q

What are the symptoms of stage III frozen shoulder contraction syndrome?

A

Stiffness more than pain & intermittent pain

76
Q

What is the irritability of stage III frozen shoulder contraction syndrome?

A

Moderate

77
Q

What would we find with ROM with stage III frozen shoulder contraction syndrome?

A

Moderate to severe limitations with pain at end range
- AROM like PROM

78
Q

What would be the end feel with stage III frozen shoulder contraction syndrome?

A

Firm

79
Q

What are the symptoms of stage IV frozen shoulder contraction syndrome?

A

Minimal to no pain

80
Q

What do we call stage III of frozen shoulder contraction syndrome?

A

Thawing

81
Q

What is the irritability of stage IV frozen shoulder contraction syndrome?

A

LOW

82
Q

What would we find with ROM with stage IV frozen shoulder contraction syndrome?

A

Gradually improves

83
Q

What is the end feel of stage IV frozen shoulder contraction syndrome?

A

Firm

84
Q

What are tests and measures for frozen shoulder done by?

A

Exclusion

85
Q

What can we use as tests and measures for frozen shoulder?

A

Normal radiographs
clinical presentation

86
Q

What is the most common way we are able to test frozen shoulder?

A

Through clinical presentation
- early dx very difficult due to irritability

87
Q

What is the patient rx for frozen shoulder contraction syndrome?

A

POLICED
Pt education

88
Q

What would patient education with frozen shoulder contraction syndrome include?

A

Describe natural course of 4 stages
promote pain free functional activity
Match intensity of stretching/JMs with S&S

89
Q

What are some modalities for frozen shoulder contraction syndrome?

A

Cryotherapy
LASER
JMs
STM

90
Q

What is cryotherapy good for with frozen shoulder contraction syndrome?

A

Additional benefit to JM and modalities for pain/ROM/function

91
Q

What is LASER good for with frozen shoulder?

A

Evidence for short term and long term functional changes

92
Q

What is the benefit of JMs for frozen shoulder contraction syndrome?

A

Benefits pain and ROM

93
Q

What is the evidence for benefits for JMs on grades III and IV frozen shoulder contraction syndrome?

A

Moderate evidence for short and long term benefits

94
Q

When do JMs have inconsistent benefit with frozen shoulder contraction syndrome?

A

When added to exercise in shoulders with gradual onset

95
Q

What kind of evidence for JMS with frozen shoulder contraction syndrome is there ?

A

WEAK

96
Q

What type of evidence is there for STM with frozen shoulder contraction syndrome?

A

moderate

97
Q

What do we use STM for with frozen shoulder contraction syndrome?

A

ROM/Flexibility

98
Q

What does MET primarily focus on with frozen shoulder contraction syndrome?

A

Elasticity and mobility increases
- also offset disuse, particularly with inhibited muscles as you need to control improving mobility

99
Q

What is the strategy that is effective for MOST patients with frozen shoulder contraction syndrome?

A

Multimodal approach

100
Q

What is the evidence for use of oral steroids with frozen shoulder contraction syndrome?

A

Moderate evidence for SHORT term

101
Q

What is the benefit of a cortisone injection with frozen shoulder contraction syndrome?

A

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

102
Q

What is the effectiveness of manipulation under anesthesia?

A

Quesitonable
- no difference to exercise alone
- recalcitrant ( having an obstinately uncooperative attitude toward authority or discipline??) conditions respond well

103
Q

What MD rx is not supported for RCTs?

A

Capsular release

104
Q

How long does stage I last of frozen shoulder?

A

~1-2 months

105
Q

How long can the course of pain and mobility deficits last with frozen shoulder?

A

12-18 months

106
Q

How many achieve minimal symptoms and defecits?

A

Most

107
Q

If untreated, frozen shoulder can resolve after how long?

A

12-42 months

108
Q

How many are without pain in the future with untreated frozen shoulder?

A

~50% with pain out to 4.5-7 years

MSK 1 - Shoulder (5 decks)

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