Shoulder rotator cuff pathology Flashcards
Hx
24 yr old F, shoulder pain after badminton, pain over ant aspect R shoulder, aggravated by overhead movement, eased with rest, disturbs sleep if lies on r side, no PMHx
look
nil of note
feel
tenderness over ant aspect glenohumeral joint [site of insertion of rotator cuff tendons]
active movement
painful full ROM [arc of pain on abduction]
passive movement
less pain on passive ROM
normal end feel
no crepitus
resisted movement
painful but normal power
pain esp on resisted movements of abduction and lateral rotation
aBduction - assesses supraspinatus
lateral rotation - infraspinatus/ teres minor
medial rotation - subscapularis
special tests
scarf test for AC joint
empty can test = painful
apprehension test for instability in ligamnets
DDx
rotator cuff tear
adhesive capsulitis
glenohumeral arthritis
cervical radiculopathy
Why is rotator cuff tear likely?
hx sudden onet pain overhead movement no Hx of trauma
exam arc of pain on active ROM, pain/weakness on resisted testing
why is adhesive capsulitis and glenohumeral arthritis unlikely?
no restriction to active or passive ROM
why is cervical radiculopathy unlikely?
no pain going from neck down to below elbow
no sensory disturbances
no motor weakness
no reflex loss
investigations if dx in doubt
Xray
MRI
U/S
Xray
RARELY DONE
CALCIFIC TENDONITIS
CALCIFICATION IN CORACOHUMERAL LIGAMENT
PROXIMAL MIGRATION OF HUMERUS IF CHRONIC ROTATOR CUFF TEAR
MRI
evaluates muscle quality
size
shape
degree of retraction of tear
U/S
most effectent and cost-effective dx
