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Shoulder > Shoulder Impingement And RTC Tears > Flashcards

Shoulder Impingement And RTC Tears Flashcards

1
Q

Describe Need’s classification of rotator cuff pathology

A

Stage I - edema and hemorrhage; conservative tx; 40 yo

Stage IV - cuff tear arthropathy; repair, hemi-arthroplasty or TSR; >60 yo

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2
Q

What protection does the coracoacromial ligament offer?

A

Covers the subacromial bursa and RTC tendons and restricts excessive superior humeral head migration.

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3
Q

What is the Mumford procedure?

A

Excision of the distal 2cm of the clavicle.

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4
Q

What is the best way to isolate the teres minor?

A

Prone extension with ER - Ws

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5
Q

Greatest EMG activity for the RTC

A

S/L ER for infraspinatus and teres minor

Prone scaption with ER for supraspinatus

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6
Q

What is primary RTC impingement?

A

Mechanical impingement beneath the coracoacromial arch

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7
Q

What is secondary RTC impingement?

A

Relative decrease in the subacromial space caused by instability

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8
Q

What is posterior (internal) impingement?

A

When the infra and supraspinatus muscles are pinched between the posterior/superior aspect of the glenoid during a cocking position.

Often associated with anterior instability.

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9
Q

Define os acromiale

A

Unfused acromiale epiphysis

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10
Q

What is the relation of RTC tears to dislocations?

A

30% in Pts over 40

80% in pts over 60

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11
Q

Describe the American Academy of Orthopedic Surgeons grading system for RTC tears.

A

Small tear 5cm

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12
Q

Describe the reverse impingement sign.

A

If painful arc is present place the of in supine, inferiorly glide the humeral head while abducting and ER the arm. If symptoms decrease the test is positive.

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13
Q

Is Neer’s impingement test more sensitive or specific?

A

89% sensitivity

25% specificity

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14
Q

What shoulder impingement exams are more sensitive than they are specific?

A

Need impingement 82/25%
Hawkins-Kennedy impingement 92/25%
Cross over test 82/28%

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15
Q

What impingement tests are more specific than sensitive?

A

Painful arc sign 81/33%

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16
Q

For RTC tears what are the most sensitive tests?

A

Jobe
Internal rotation lag 97%
External rotation lag 70%

17
Q

What are the most specific test for RTC tears?

A 
Drop arm test 97%
Lift off sign 100%
IR lag 96%
ER lag 100%
Drop sign 100%
Teargas on 86%
Painful arc 81%
18
Q

What is the approximate sensitivity and specificity of clinical exam in predicting RTC pathology?

A

91% sensitivity

75% specificity

19
Q

What tests and factors when clustered have a 98% chance of a RTC tear?

A

At least 2 out of 3 of:
Supraspinatus weakness
Weakness in ER
Impingement sign

And

> 60 yo

20
Q

What is the relation of RTC tears to dislocations?

A

30% in Pts over 40

80% in pts over 60

21
Q

Describe the American Academy of Orthopedic Surgeons grading system for RTC tears.

A

Small tear 5cm

22
Q

Describe the reverse impingement sign.

A

If painful arc is present place the of in supine, inferiorly glide the humeral head while abducting and ER the arm. If symptoms decrease the test is positive.

23
Q

Is Neer’s impingement test more sensitive or specific?

A

89% sensitivity

25% specificity

24
Q

What shoulder impingement exams are more sensitive than they are specific?

A

Need impingement 82/25%
Hawkins-Kennedy impingement 92/25%
Cross over test 82/28%

25
Q

What impingement tests are more specific than sensitive?

A

Painful arc sign 81/33%

26
Q

For RTC tears what are the most sensitive tests?

A

Jobe
Internal rotation lag 97%
External rotation lag 70%

27
Q

What are the most specific test for RTC tears?

A 
Drop arm test 97%
Lift off sign 100%
IR lag 96%
ER lag 100%
Drop sign 100%
Teargas on 86%
Painful arc 81%
28
Q

What is the approximate sensitivity and specificity of clinical exam in predicting RTC pathology?

A

91% sensitivity

75% specificity

29
Q

What tests and factors when clustered have a 98% chance of a RTC tear?

A

At least 2 out of 3 of:
Supraspinatus weakness
Weakness in ER
Impingement sign

And

> 60 yo

Shoulder (6 decks)

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