Shoulder Overuse injury, Rotator Cuff Tear

Question 1

Acute injury to the rotator cuff does occur but most injuries are __________ such as
(a) Tendon degeneration
(b) Chronic mechanical ________
(c) Altered blood supply to the _______

Answer 1

age-related
b) impingement
c) tendons

Question 2

Tears generally originate with the ________ muscle and may progress posteriorly and anteriorly

Answer 2

supraspinatus

Question 3

Full thickness tears are uncommon in patients younger than _____, but are present in 25% of patients older than 60

Answer 3

40

Question 4

Dx/tx
Clinical Symptoms:
-(1) Chronic shoulder pain for several months
-(2) Specific injury that triggered pain
-(3) Night pain and difficulty sleeping on the affected side
-(4) Complaints of weakness, catching and grating especially overhead activities
Physical Exam
-(1) Visual
–(a) Shoulder may appear sunken, indicating atrophy of the infraspinatus
following a long- standing cuff tear
-(2) Palpation
–(a) Tenderness over greater tuberosity is usually present
–(b) Grating sensation can be felt at tip of shoulder
-(3) ROM
–(a) Usually full PROM
–(b) Some patients may maintain full AROM
–(c) Cannot raise arm with large tears. Can only shrug or hike shoulder upward
-(4) Muscle Tests
–(a) Abduction, forward flexion and external rotation may be limited
-(5) Neurovascular Tests
–(a) Usually intact
-(6) Special Tests
–(a) Positive Drop Arm test
–(b) Positive Empty Can tests

Answer 4

Rotator Cuff tear
-Treatment
(1) NSAIDs
(2) Ice
(3) Light duty to include no overhead activities
(4) Home exercise program for shoulder strengthening and stretching
(5) Physical therapy consult if failed local management
(6) Orthopedic consult if failed rehabilitation over 3 to 6 months

Question 5

Differential Diagnosis Rotator Cuff tear

Answer 5

(1) Acromioclavicular arthritis- localized pain and tenderness focal to AC joint
(2) Cervical spondylosis- neck stiffness, absent biceps reflex, sensory changes
(3) Frozen shoulder- restrictive active and passive ROM
(4) Glenohumeral joint arthritis- evident on radiographs
(5) Impingement syndrome/cuff tendinitis- similar pain but preserved active motion

Question 6

Referral Decisions/Red Flags
(1) Failure of __ weeks of nonsurgical treatment is an indication for further evaluation
(2) Acute traumatic tears should be surgically repaired immediately or no later than ____ weeks post-injury
(3) Patients younger than ___ years old should be considered for surgical repair as tears could enlarge with time

Answer 6

1) 6
2) 6
3) 55

Question 7

Diagnostic Test Considerations
(1) Radiographs needed to evaluate subacromial space for _______ and ________ due to long standing tears
(2) ______ necessary to confirm diagnosis

Answer 7

1) spurring and malalignment
2) MRI

Question 8

Differential Diagnosis Rotator Cuff tear

Answer 8

(1) Acromioclavicular arthritis- localized pain and tenderness focal to AC joint
(2) Cervical spondylosis- neck stiffness, absent biceps reflex, sensory changes
(3) Frozen shoulder- restrictive active and passive ROM
(4) Glenohumeral joint arthritis- evident on radiographs
(5) Impingement syndrome/cuff tendinitis- similar pain but preserved active motion