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Clinical Interventions 2 > Rotator Cuff Pathology > Flashcards

Rotator Cuff Pathology Flashcards

1
Q

What tendon is most commonly injured? Followed by ___________ and ______________

A

supraspinatus, infraspinatus, upper aspect of subscapularis

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2
Q

Rotator cuff tears usually occur at the ______________ due to ____________

A

musculotendinous junction; poor vascularization

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3
Q

Pathogenesis of Rotator cuff tear?

A

traumatic injury, aging, repetitive use or injury, tendon hypovascularity, and subacromial impingement

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4
Q

Types of tears

A

partial and full thickness

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5
Q

Partial thickness tear

A

fraying of an intact tendon

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6
Q

Full thickness tears

A

through and through tears; small or larger involving majority of tendon and tendon remains attached to humeral head; may also involve complete detachment from the humeral head

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7
Q

Typically get surgery for _______ tears

A

full thickness

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8
Q

Sensitivity

A

the likelihood of obtaining a positive test when the tested condition is truly present

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9
Q

Specificity

A

the likelihood of obtaining a negative test when the tested condition is truly absent

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10
Q

A clinical test is considered to be diagnostically accurate if it has a positive likelihood ratio greater than _______ and/or a negative likelihood ratio less than ____________

A

10; 0.1

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11
Q

What tests are more commonly used for RTC tear?

A

Supraspinatus test (Empty can test), full can test, drop arm test, infraspinatus test, and hornblower’s test (teres minor test)

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12
Q

What tests are used less commonly for RTC tear?

A

Rent sign, lift-off test, bear hug test, belly-press test, and palpation?

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13
Q

What tests are more valid for RTC tear?

A

Empty can, teres minor, rent sign, lift-off, belly-press test, and palpation

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14
Q

The Neer test and Hawkins-Kennedy Test are commonly used in clinical practice to determine _____________________

A

whether or not impingement exists along with a rotator cuff tear

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15
Q

Supraspinatus test (empty can test) pt position

A

Standing or seated. Arm elevated 90 deg in scapular plane and IR (also good to do at 30-45 deg elevation)

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16
Q

Supraspinatus test (empty can test), the resistance is applied in what direction and the pt is asked to resist

A

inferior

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17
Q

Positive Supraspinatus test (empty can test)

A

elicits pain and/or weakness when resistance is applied

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18
Q

The Full can test, tests which muscle?

A

Supraspinatus

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19
Q

Full can test pt position

A

Standing or seated. Arm elevated 90° in scapular plane & externally rotated 45°.

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20
Q

Full can test, resistance is applied in a _____________ direction and pt is asked to resist

A

Inferior

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21
Q

Positive Full can test

A

elicit pain and/or weakness when resistance is applied

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22
Q

rent sign pt position

A

Seated with the arm passively positioned in full shoulder extension & with 90° elbow flexion

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23
Q

rent sign procedure

A

Examiner palpates the anterior aspect of the edge of the acromion while passively internally & externally rotating the shoulder looking for a defect (rent)

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24
Q

positive rent sign

A

there is a palpable depression greater than one finger width along with possible discomfort

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25
Q

What muscle is being tested with the lift-off test?

A

subscapularis

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26
Q

Lift-off test pt position

A

Standing or seated. Arm is placed behind the patient’s back with the dorsum of the hand on the mid-lumbar area & the elbow flexed to 90°

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27
Q

Lift-off test resistance is applied to the _______ aspect of the forearm while the pt attempts to __________________

A

distal; lift the arm off of the back

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28
Q

Positive lift-off test

A

elicits pain and/or weakness when resistance is applied

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29
Q

What muscle is the bear hug test testing?

A

subscapularis

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30
Q

Pt position for the bear hug test

A

Standing or seated, place hand of tested arm on the contralateral shoulder

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31
Q

Bear hug test procedure

A

Resistance is applied to the palmar aspect of the hand in a superior direction in an attempt to externally rotate the shoulder.

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32
Q

Positive bear hug test

A

elicit pain &/or weakness when resistance is applied

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33
Q

Belly press test: muscle being tested

A

subscapularis

34
Q

Belly-press test pt position

A

Standing or seated. Place the tested arm’s palmar aspect of the hand on the stomach

35
Q

Belly-press test procedure

A

Resistance is applied to the palmar aspect of the hand in a anterior direction; patient resists external rotation

36
Q

Positive Belly-press test

A

elicit pain and/or weakness when resistance is applied

37
Q

What muscles are being tested with the palpation testing?

A

Supraspinatus, infraspinatus, teres minor, & subscapularis

38
Q

Palpation has been reported to have both high ____________ and high _____________ values

A

sensitivity and specificity

39
Q

Although not technically viewed as an orthopedic special test, evidence shows that palpation is amongst the best indicators of a _______________

A

full thickness rotator cuff tear

40
Q

Clinical prediction rule for impingement/SAPS

A

+ Hawkins Kennedy test, painful arc sign, and infraspinatus MMT

41
Q

RTC tear/pathology clinical prediction rule

A

+ drop arm test, painful arc sign, and infraspinatus MMT

42
Q

Diagnostic arthroscopy

A

surgically invasive diagnostic technique, gold standard, most valid and reliable, but not the primary choice for diagnostic test because it is invasive

43
Q

Sensitivity and specificity of diagnostic arthroscopy

A

100%

44
Q

Arthrography

A

MRI with injected contrast medium

45
Q

Advantage of an arthrography

A

reliable in detecting tears

46
Q

Disadvantages of arthrographies

A

Does not provide information on the extent of the tear, may be time consuming, and exposes the pt to radiation

47
Q

Sensitivity of arthrography

A

50%

48
Q

Specificity of arthrography

A

96%

49
Q

MRI

A

uses magnetic fields and pulses of radio wave energy to produce images of soft tissue

50
Q

Advantages of MRI

A

Provides a detailed image of soft tissues, more consistent in specificity and sensitivity, can detect location and extent of the tear, and accurately depicts muscle atrophy

51
Q

Disadvantages of MRI

A

May be costly, time consuming, not tolerated by all patients, and contraindicated with certain implanted devices

52
Q

MRI sensitivity*

A

81-91%

53
Q

MRI specificity*

A

70-95%

54
Q

Ultrasound

A

uses a high frequency transducer to record images of the tendons

55
Q

US advantages

A

can provide valid and reliable results when performed by an experienced and trained technician, less invasive and well tolerated by pts, 3x less expensive, less time consuming, and provides real-time imaging*

56
Q

US disadvantages

A

Reliability is technician dependent, less sensitive for detecting partial thickness tears, may not be able to accurately depict muscle atrophy

57
Q

US sensitivity*

A

57-100%

58
Q

US specificity*

A

50-100%

59
Q

Factors that affect PT prognosis

A

Age - over 65 may have poorer results, diabetes, history of smoking, NSAIDS, extent of RC degeneration, fatty deposits, tear size, prior RC repairs, preoperative active motion, deltoid status, prior RC status, surgery/repair type, and overall fitness

60
Q

There is an initial strong ____________ response after RC repair that decreases with time and age

A

vascular

61
Q

what is the lowest vascularity of the RC

A

anchor site in bone

62
Q

highest vascularity of RC

A

Peritendinous region

63
Q

Modalities that are supported for RC

A

cryotherapy, electrical stimulation and manual therapy

64
Q

modalities that are not supported for RC

A

heat and ultrasound

65
Q

____________ decreased pain in patients with impingement that may occur with RC injury

A

mobilizations

66
Q

_____________ for re-education of scapular mobility, especially upward rotation

A

scapular mobs

67
Q

Avoid the ____________, if open-repair, and _____________ when doing MT to this area

A

suture line, stressing the repaired tendon

68
Q

Early ___________ exercises after RC surgery is beneficial. Perform without disrupting the RC ___________ and prevent ___________ from occuring

A

PROM, repair site, adhesions

69
Q

RC prehab: only perform ____________ and avoid ________________

A

what pt can tolerate; overhead motions

70
Q

For RC prehab you should improve the strength of undamaged RC muscles which are:

A

Infraspinatus, teres minor, and subscapularis

71
Q

Prehab: improve posture by targeting which muscles:

A

traps, Serratus anterior, lev scap, rhomboids, and lats

72
Q

Prehab: improve surrounding musculature including:

A

Biceps, triceps, delts, pec major and minor, and scapular stabilizers

73
Q

The orthopedic special tests that are most accurate in diagnosing a full thickness rotator cuff tear are:

A

palpation, hornblower’s sign, empty can test, rent sign, lift-off test, and belly press

74
Q

Arthroscopy and arthrography are both good diagnostic choices but they are not commonly used because they are _____________

A

invasive

75
Q

MRI and US are more realistic choices that have both been documented as ______________

A

accurate

76
Q

US is _______ expensive and ___________ tolerated but the technician dependency of the test decreases its’ reliability therefore making _____________ a better choice

A

less; better; MRI

77
Q

Recovery from rotator cuff surgery is dependent on several factors including _____________________

A

age of the patient, size of the tear, health of the patient, & type of surgery

78
Q

Overall goals of RC rehabilitation

A

decrease pain and inflammation, increasing ROM and strength, and restore function

79
Q

Following RC surgery, PROM increases:

A

shoulder range of motion and limits development of adhesions without disrupting repair site

80
Q

Factors to consider

A

patient age, tear size, fatty atrophy grade pre-op and comorbidities such as: tobacco use, diabetes, and workers comp

81
Q

What contributes to delayed motion

A

larger tear size, older age, and comorbidities that increase likelihood of re-tear/poor outcomes

Clinical Interventions 2 (3 decks)

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