Shoulder Pain with Muscle Function Impairments

Question 1

With a patient with a Muscle Function Impairment, what are common descriptors patients may use to describe the pain?

Answer 1

• “Pain and weakness”
• “Sharp”
• Possible “Pinching”

They may also be in Psychological Distress

Question 2

With a patient with a Muscle Function Impairment, what is the Mechanism of Injury?

Answer 2

It can be either acute or chronic

• Overhead Exertion
• Repetitive movements

Question 3

With a patient with a Muscle Function Impairment,
what are the Agg and Easing factors?

Answer 3

Agg
Overhead shoulder activities

Ease
Rest; UE support

Question 4

What is the 24 hour Behavior, with Muscle Function Impairment?

Answer 4

Better in the morning; Worse with activity

Question 5

When conducting the Physical Examination with a patient with a Muscle Function Impairment, what may you find during the observation?

Answer 5

There may be potential atrophy

Question 6

When conducting the Physical Examination with a patient with a Muscle Function Impairment, what may you find during the Shoulder ROM (AROM/PROM)?

Answer 6

• Sharp, catching at mid-range elevation
• Painful arc
• PROM > AROM

Question 7

When conducting the Physical Examination with a patient with a Muscle Function Impairment, what may you find during Joint Mobility/Integrity?

Answer 7

Unremarkable

Question 8

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)?

Answer 8

• Painful and weak contraction
• Pain with tensioning

Question 9

When conducting the Physical Examination with a patient with a Muscle Function Impairment, what may you find during the Palpation portion?

Answer 9

Local Tenderness (Familiar pain)

Question 10

When conducting the Physical Examination with a patient with a Muscle Function Impairment, what may you find during the Movement Analysis?

Answer 10

Coordination is impaired due to impaired muscle function

Question 11

What muscle is most often affected with Rotator Cuff Pathology?

Answer 11

The Supraspinatus because of its location beneath the anterior acromion and its extensions into the infraspinatus tendon may also become involved.

Question 12

What are 3 MOIs for Rotator Cuff Pathology?

Answer 12

• Compression
• Tensile Overload
• Macrotrauma

Question 13

MOIs

With Rotator Cuff Pathology, what may cause compression of the Rotator Cuff?

Answer 13

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

Question 14

MOIs

With Rotator Cuff Pathology, what may cause Tensile Overload?

Answer 14

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

Question 15

MOIs

With Rotator Cuff Pathology, what may cause Macrotrauma?

Answer 15

Macrotrauma and subsequent tearing of the tendon result when the forces generated by the trauma exceed the tendon tensile strength

Question 16

What are common symptoms reported with Rotator Cuff Pathology?

Answer 16

Pain, weakness, and loss of shoulder motion

The patient initially complains of dull ache radiating into upper and lower arm

Question 17

What are aggs for Rotator Cuff Pathology?

Answer 17

Aggs:
- Activity
- At night when patient lies on affected shoulder
- Actions such as reaching above the head or putting on a coat

Question 18

What is an important physical finding with Rotator Cuff Pathology?

Answer 18

The characteristic physical finding is Painful Arc; Pain ~50-60° of ABD

Question 19

What is the Test Item Cluster for Impingement Syndrome?

Answer 19

• • Hawkins-Kennedy Test
• • Painful Arch Tests
• MMT Infraspinatus

95% post-test probability

Question 20

What is the Test Item Cluster for Rotator Cuff Pathology?

Answer 20

• • Hawkins-Kennedy Test
• • Drop-Arm Test
• MMT Infraspinatus

91% post-test probability

Question 21

What is the Test Item Cluster for Full-Thickness Rotator Cuff Tear?

Answer 21

• (+) Painful Arc Sign
• (+) Drop-Arm Test
• MMT Infraspinatus

Question 22

What is the Prognosis for Muscle Function Impairment?

Answer 22

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

Question 23

What are Associated Diagnosis for Rotator Cuff-Related Shoulder Pain?

Answer 23

• Subacromial Impingement Syndrome (SIS)
• External Impingement
• Subacromial Pathology
• Internal Impingement

Question 24

What is the Theoretical MOI for Rotator Cuff-Related Shoulder Pain?

Answer 24

• SIS “Pinching” of the supraspinatus within the subacromial space
• Results of poor scapulohumeral rhythm
• Scapular Dyskinesis

Question 25

With Rotator Cuff Muscle Strain, what will you typically find with contractile tissue testing?

Answer 25

- Familiar Pain with contraction (MMT) - Familiar Pain with Tensioning (MLT) - Familiar tenderness to palpation; more in the muscle belly.