Rotator Cuff Tear Flashcards by Siva Pye

Risk factors/etiology for RC tears:

_______ or __________ (tendinosis) tears including with repetitive overhead activities

gradual; degenerative

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What are the 3 ways acute RC tears happen?

High UE velocity (throwing)
heavy lifting
impact on fall with outstretched hand

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What is the order of most common RC tears?

Supraspinatus>Infra pinatus>Subscapularis> Teres Minor

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The ______ and _______ are 40-73% involved with RC tears

labrum; biceps

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What is a SLAP tear? How do you fix it?

Superior Labral Anterior/Post

surgically fixate Bicep’s tendon (aka tenodesis)

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RC symptoms are _________

acute

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With RC tear, the pt. will have history of what….? This is high speculation of what?

popping, clicking, catching

Labral tear

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With RC tear, your pt. will have increased P! with what kind of activities?

overhead

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Are RC tears hyper or hypomobile?

hypermobile

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What are hypermobile signs in a SCAN?

A/PROM?
Combined Motion?
Resisted/MMT?
-Stress test?

PROM> AROM

Inconsistent block with combined motion

Resisted/MMT will be weak and P!ful
- FLX
-RC (ABD/ER, possibly IR)

Stress test +

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With hypermobility and RC tear, there will be a P!ful arc around ___° of elevation

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All tears special test (cluster) consist of:

> 65 years of age

Weak ER

Night P!

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Full thickness tear consist of:

≥ 60 years of age

+ P!ful arc, drop arm, and Infra. test

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What special test would you perform for speculation of a Supra/Infraspinatus?

ER Lag Sign

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If your pt. has drop arm, what is the concern?

There could be a supraspinatus tear

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2 non-specific tear test?

Empty Can

Jobe Test

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3 Test for Subscapularis?

Lift Off

Bear Hug

Belly Press

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What is the appropriate PT Rx for RC tear?

MET!

Specifically:
- STABILIZATION
- tissue proliferation
- address any joint hypomobility

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What is the biggest predictor of a tear going to sx?

patient’s negative perception

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What is the evidence of effectiveness for corticosteroid injections?

No evidence of effectiveness within 4 weeks of shot

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____________ is when the surgeon sews the fibers back together and reattaching to bone

reconstruction

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________ tears have a good clinical outcome with P!, ROM, strength, quality of life, and sleep after surgery

degenerative

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What kind of tear has successful outcomes with PT, like surgery, and especially for those with small or partial tears or those unfit for sx

degenerative

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RC tear: What is the outcome for PT with acute small to medium tears?

it may help, if no good progress, delays can be associated with poor surgical outcomes

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RC tear: What is the outcome for surgery with acute small to medium tears?

no difference from PT, more critical in younger patient

With Multi-tendon and/or Massive Full Thickness Tears, PT may help, but in what kind of patients?

low-demand or ppl unfit for sx

Name a few probable factors for prognosis after sx

young age no diabetes small tear higher bone density

Shoulder joint replacements are MOSTly used with ________ tears and less with ___-_____ changes

irreplaceable; age-related

What is the joint relationship with Total Shoulder Arthroplasty?

concave/convex

With total shoulder arthroplasty, what motion should you avoid?

HYPEREXT

The first 6 weeks after rTSA should include what kind of PT Rx?

POLICED including immobilization with sling no pushing, pulling, or lifting

What are some AAROM activities for 0-6 weeks after tRSA?

Pendulums Standing pulley or supine flx Supine IR/ER Stretch into ER Scapular PREs

After 6-8 weeks with rTSA should include what kind of PT Rx?

DC sling add... sitting pulley, standing AROM into flex

With tRSA: ____-_____ weeks you should do progressive isotonic shoulder PREs

8-12

What are the results of tRSA?

Good to excellent outcomes

Frozen Shoulder Contraction Syndrome is also called what?

adhesive capsulitis frozen shoulder

________ _________ is frequently misdiagnosed with any multi-directional limitation in ROM

Frozen Shoulder

What is the primary etiology of FSCS?

autoimmune conditions

What are risk factors for FSCS?

hypothyroidism diabetes 40-65 years old biological female previous adhesive capsulitis family Hx

What is the secondary etiology of FSCS?

concomitant injury, i.e., humeral fx, and period of extended inflammation and immobilization

With FSCS, it is more often ___________ of _____ capsule and ligaments

inflammation; GH

What structures are involved with FSCS?

GH capsule and ligaments joint space

With FSCS, the symptoms are typically _______ and _________P! with loss of motion

gradual; progressive

What are hypomobile signs in a SCAN with FSCS?

Combined motion- consistent block Resisted/MMT- possibly weak and or P!ful (depends on stage) Stress test- distx probably + depends on stage Accessory motion- hypomobile Special test+ for impingement

4 stages of Frozen Shoulder

I- Initial II- Freezing III- Frozen IV- Thawed

What stage of Frozen Shoulder is.... - Gradual onset Achy at rest Sharp with use Night P! common Unable to lie on involved side - high irritability - Losing ROM - End feel: Empty and P!ful

Stage I

What stage of Frozen Shoulder is.... - Worsening and constant P!, particularly at night - high irritability - Moderate to severe limitations - Empty and P!ful

Stage II

What stage of Frozen Shoulder is.... - Stiffness > Intermittent - moderate irritability - Moderate to severe limitations with P! at end range, AROM like PROM - Firm

Stage III

What stage of Frozen Shoulder is.... - Minimal to no P! - low irritability - ROM gradually improves - Firm end feel

Stage IV

What is the PT Tx for FSCS?

POLICED Pt. education: describe 4 stages, promote p! free functional activity, and match intensity of stretching JM's with S&S always

Which modality for FSCS is an additional benefit to JM and modalities for P!/ROM/Function?

cryotherapy

Which modality for FSCS has evidence for short term and long term functional changes?

LASER

What is the weakest modality for frozen shoulder?

E-stim

What level of JM has moderate evidence for short and long term benefits with FSCS?

Grade III-V

_______ have an inconsistent benefit for ROM when added to exercise in shoulders with gradual onset

STM for ROM/flexibility has what kind of evidence for FSCS?

moderate

What is the primary MET focus with FSCS?

elasticity and mobility ; but also to offset disuse

With MD Rx: ________ steroids have moderate evidence for short term

oral

Cortisone injection with FSCS has a ______ and ______-_______ benefit

short and mid-term

How long does Stage I of Frozen Shd. last?

1-2 months

How long may the P! and mobility deficits last with frozen shd?

12-18 months

What is the capsular pattern?

ER> ABD> FLX> IR

With tRSA: ____-_____ weeks: add in gym type exercises

12-16

Rotator Cuff Tear Flashcards

(65 cards)