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MSK- Spine and Upper Limb > Impingement Syndrome and Rotator Cuff Tears > Flashcards

Impingement Syndrome and Rotator Cuff Tears Flashcards

1
Q

Impingement syndrome is seen typically in what age group?

A

30s-40s

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2
Q

Rotator cuff tears are seen typically in what age group?

A

50s-60s

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3
Q

What is impingement syndrome?

A

The tendons of the rotator cuff are compressed in the tight subacromial space during movement, producing pain

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4
Q

What tendon is most likely to be affected in impingement syndrome?

A

Supraspinatus

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5
Q

Patients with impingement syndrome will typically have pain when? What is this known as? What muscle is this related to?

A

Between 60-120 degrees abduction (variable)- painful arc, related to the deltoid muscle

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6
Q

Why do patients with impingement syndrome get painful arc?

A

This occurs as an inflamed part of the tendon passes through the subacromial space

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7
Q

What are the most likely causes of impingement syndrome in a younger patient?

A

Tendonitis/subacromial bursitis

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8
Q

What is the most likely cause of impingement syndrome in a middle aged patient?

A

Hooked acromion rotator cuff tear

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9
Q

What is the most likely cause of impingement syndrome in an older patient?

A

AC joint OA with inferior osteophyte

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10
Q

Pain from impingement typically radiates where?

A

Deltoid and upper arm

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11
Q

Where may tenderness be felt in impingement syndrome?

A

Below the lateral edge of the acromion

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12
Q

What clinical test will recreate the pain of impingement syndrome? Briefly describe the test.

A

Hawkins-Kennedy test: internally rotate the flexed shoulder

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13
Q

When considering a diagnosis of impingement syndrome, what is important to exclude?

A

Cervical radiculopathy

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14
Q

Are investigations required in order to start treatment for impingement syndrome?

A

No

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15
Q

What is the first line management for impingement syndrome?

A

Conservative: NSAIDs, analgesics, physiotherapy, subacromial injections

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16
Q

How many subacromial injections may be required in impingement syndrome?

A

Up to 3

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17
Q

Cases of impingement syndrome which do not benefit from conservative management could benefit from what?

A

Subacromial decompression surgery

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18
Q

What is the point of subacromial decompression surgery in impingement syndrome?

A

To create more space for the tendon to pass through

19
Q

How can subacromial decompression surgery be performed?

A

Open, or with minimally invasive arthroscopic techniques

20
Q

What describes impingement?

A

The imbalance of forces in the coronal plane

21
Q

In order to abduct the limb, the deltoid needs power to be offset by force from where?

A

Inferior

22
Q

What happens if there is an imbalance between the deltoid and rotator cuff?

A

Elevation of the humerus and narrowing of the subacromial space

23
Q

The tendons of the rotator cuff usually tear when? Why is this?

A

With little or no trauma, as a consequence of degenerative change

24
Q

What is a classic history of a rotator cuff tear?

A

A sudden jerk in a patient > 40 with subsequent pain and weakness

25
Q

Rotator cuff tears are very uncommon in young people. What may they occur as a result of?

A

Significant injury, including shoulder dislocation

26
Q

Can you get different degrees of rotator cuff tears?

A

They can be partial or full thickness

27
Q

Rotator cuff tears usually involve which muscle?

A

Supraspinatus

28
Q

Large rotator cuff tears can extend into which muscles?

A

Subscapularis and infraspinatus

29
Q

In rotator cuff tears, weakness of initiation of abduction implies damage to which muscle?

A

Supraspinatus

30
Q

In rotator cuff tears, weakness of internal rotation implies damage to which muscle?

A

Subscapularis

31
Q

In rotator cuff tears, weakness of external rotation implies damage to which muscle?

A

Infraspinatus

32
Q

What clinical sign may be seen when looking at a patient with a rotator cuff tear?

A

Supraspinatus wasting

33
Q

Rotator cuff tears can be confirmed with which investigations?

A

Ultrasound or MRI

34
Q

What are the non-operative management options for a rotator cuff tear?

A

Physiotherapy and subacromial injections

35
Q

What is the role of physiotherapy in rotator cuff tears?

A

To strengthen the remaining cuff muscles, to compensate for the loss of supraspinatus

36
Q

Which patients with a rotator cuff tear require quick investigation and physiotherapy? Why?

A

Patients in their 50s/60 to prevent them from having a massive tear

37
Q

What surgical management can be used for rotator cuff tears?

A

Rotator cuff repair with subacromial decompression

38
Q

What is the role of surgery for rotator cuff tears?

A

To improve/maintain strength and prevent subsequent arthritis from chronic cuff deficiency

39
Q

What is the failure rate of rotator cuff repair surgery? Why?

A

1/3rd of cases fail to repair because the tendon is so diseased or the tear is too large and the tendon is retracted too far

40
Q

What are the long term results of rotator cuff repair surgery?

A

These are not well known

41
Q

In the short term following rotator cuff repair surgery, how long will patients need a sling for? For how long will they be unable to drive? For how long will they be unable to lift heavy objects?

A

Sling for 6 weeks, no driving for 8-10 weeks, no heavy lifting for 12 weeks

42
Q

What is the recovery from rotator cuff repair surgery like?

A

Prolonged physiotherapy and recovery time, with a 30-40% chance of re-tear at 1 year

43
Q

What are intrinsic causes of rotator cuff problems?

A

Degeneration and tendon vascularity

44
Q

What is the extrinsic cause of rotator cuff problems?

A

Compression

MSK- Spine and Upper Limb (13 decks)

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