Shoulder Pain with Muscle Function Impairments Flashcards
With a patient with a Muscle Function Impairment, what are common descriptors patients may use to describe the pain?
- “Pain and weakness”
- “Sharp”
- Possible “Pinching”
They may also be in Psychological Distress
With a patient with a Muscle Function Impairment, what is the Mechanism of Injury?
It can be either acute or chronic
- Overhead Exertion
- Repetitive movements
With a patient with a Muscle Function Impairment,
what are the Agg and Easing factors?
Agg
Overhead shoulder activities
Ease
Rest; UE support
What is the 24 hour Behavior, with Muscle Function Impairment?
Better in the morning; Worse with activity
When conducting the Physical Examination with a patient with a Muscle Function Impairment, what may you find during the observation?
There may be potential atrophy
When conducting the Physical Examination with a patient with a Muscle Function Impairment, what may you find during the Shoulder ROM (AROM/PROM)?
- Sharp, catching at mid-range elevation
- Painful arc
- PROM > AROM
When conducting the Physical Examination with a patient with a Muscle Function Impairment, what may you find during Joint Mobility/Integrity?
Unremarkable
When conducting the Physical Examination with a patient with a Muscle Function Impairment, what may you find during the Muscle Performance Testing (Isometric testing and MLT)?
- Painful and weak contraction
- Pain with tensioning
When conducting the Physical Examination with a patient with a Muscle Function Impairment, what may you find during the Palpation portion?
Local Tenderness (Familiar pain)
When conducting the Physical Examination with a patient with a Muscle Function Impairment, what may you find during the Movement Analysis?
Coordination is impaired due to impaired muscle function
What muscle is most often affected with Rotator Cuff Pathology?
The Supraspinatus because of its location beneath the anterior acromion and its extensions into the infraspinatus tendon may also become involved.
What are 3 MOIs for Rotator Cuff Pathology?
- Compression
- Tensile Overload
- Macrotrauma
MOIs
With Rotator Cuff Pathology, what may cause compression of the Rotator Cuff?
This can either be a primary or secondary compression
- Primary Compression is due to reduced subacromial space
- Secondary compression occurs due to decreased GH joint stability, allowing the humeral head to compress the rotator cuff
MOIs
With Rotator Cuff Pathology, what may cause Tensile Overload?
This can either be Primary or Secondary overload
- Primary Tensile Overload occurs when the Rotator Cuff attempts to resisit Horizontal Adduction (HAD), IR, anterior translation, and distractive forces during such activities as throwing (deceleration phase) and hammering
- Secondary Tensile Overload occurs due to GH instability that places greater distractive and tensile forces on the rotator cuff and eventually failure of the tendon
MOIs
With Rotator Cuff Pathology, what may cause Macrotrauma?
Macrotrauma and subsequent tearing of the tendon result when the forces generated by the trauma exceed the tendon tensile strength
What are common symptoms reported with Rotator Cuff Pathology?
Pain, weakness, and loss of shoulder motion
The patient initially complains of dull ache radiating into upper and lower arm
What are aggs for Rotator Cuff Pathology?
Aggs:
- Activity
- At night when patient lies on affected shoulder
- Actions such as reaching above the head or putting on a coat
What is an important physical finding with Rotator Cuff Pathology?
The characteristic physical finding is Painful Arc; Pain ~50-60° of ABD
What is the Test Item Cluster for Impingement Syndrome?
- Hawkins-Kennedy Test
- Painful Arch Tests
- MMT Infraspinatus
95% post-test probability
What is the Test Item Cluster for Rotator Cuff Pathology?
- Hawkins-Kennedy Test
- Drop-Arm Test
- MMT Infraspinatus
91% post-test probability
What is the Test Item Cluster for Full-Thickness Rotator Cuff Tear?
- (+) Painful Arc Sign
- (+) Drop-Arm Test
- MMT Infraspinatus
What is the Prognosis for Muscle Function Impairment?
Likely to be favorable
- Minimum of 12 weeks until return to function
- Further improvement may take up to 24 weeks
- Referral is recommended for patients whose symptoms remain unacceptable
Non-operative care for full-thickness RTC was not significantly different in the RTC Quality of Life Index than a RTC repair operation at 5-year follow up
What are Associated Diagnosis for Rotator Cuff-Related Shoulder Pain?
- Subacromial Impingement Syndrome (SIS)
- External Impingement
- Subacromial Pathology
- Internal Impingement
What is the Theoretical MOI for Rotator Cuff-Related Shoulder Pain?
- SIS “Pinching” of the supraspinatus within the subacromial space
- Results of poor scapulohumeral rhythm
- Scapular Dyskinesis
With Rotator Cuff Muscle Strain, what will you typically find with contractile tissue testing?
- Familiar Pain with contraction (MMT)
- Familiar Pain with Tensioning (MLT)
- Familiar tenderness to palpation; more in the muscle belly.
