Rotator Cuff Tear & Frozen Shoulder - Exam 3

Question 1

what type of activities cause a gradual or degenerative rotator cuff tear?

Answer 1

repetitive overhead activities

Question 2

what type of activities cause an acute rotator cuff tear?

Answer 2

high UE velocity (throwing)
heavy lifting
impact (fall with outstretched hand FOOSH)

Question 3

what are the two most common structures involved in a rotator cuff tear?

Answer 3

supraspinatus
infraspinatus

Question 4

rotator cuff tears are graded by:

Answer 4

size (S, M, L)
partial/full thickness tear

Question 5

when the labrum and biceps are involved with a traumatic RC tear, what occurs?

Answer 5

superior labral ant/post (SLAP) tear:
– long head of biceps excessively contracts and tears labrum
AND/OR
compression onto labrum from FOOSH

Question 6

when the labrum and biceps are involved with a gradual RC tear, what occurs?

Answer 6

repetitive stresses without/with abnormal mechanics

Question 7

what are symptoms of a rotator cuff tear?

Answer 7

worse impingement plus lose mobility and contraction
increased pain with repetitive overhead activities

Question 8

what would the PT see with a rotator cuff tear?

– painful arc around:
– resisted testing:
– stress tests:
– special tests:

Answer 8

–painful arc around 90 deg. elevation
– weak and painful in flex, abd/ER, possibly IR
– possibly (+)
– (+) for cuff and possibly labrum and biceps

Question 9

what are test parameters to determine all RC tears?

Answer 9

> 65 years of age
weak ER
night P!

Question 10

what are test parameters to determine full thickness RC tears?

Answer 10

> /= 60 years
+ painful arc, drop arm (high spec. for supraspinatus tear), infraspinatus test

Question 11

what 3 tests have high specificity for subscapularis tears?

Answer 11

lift off
belly press
bear hug

Question 12

how do you treat a RC tear?

Answer 12

treat as the worse cases on hypermobility with tissue damage that has occurred
early ROM with degenerative tears
– accelerated recovery in most
– limited tendon healing with large tears

Question 13

what are the ultimate purposes of MET for RC tear? (2)

Answer 13

stabilization
tissue proliferation of muscle, tendon, and/or labrum

Question 14

what is the biggest predictor of a tear going to surgery? irrespective of?

Answer 14

patient’s negative perception
irrespective of:
- size of tear
- retraction
- fatty infiltration
- age
- pain

Question 15

what are MD prescriptions for RC tear?

Answer 15

corticosteroid injections (short term relief)
primarily arthroscopic procedures with arthroplasty – sewing fibers back together and reattaching to bone

Question 16

true or false. surgeon makes sure patient has full ROM under anesthesia

Answer 16

true

Question 17

what are 3 Rx options for degenerative tears?

Answer 17

1. PT - successful outcomes, esp w small or partial tears
2. surgery - good outcome w P!, ROM, strength, quality of life, sleep
3. radiological - not as good outcomes because structures doesn’t always have to change to be functionally better or improve symptoms

Question 18

what are 2 Rx options for acute small to medium tears?

Answer 18

1. PT - proceed w caution. if not progressing well, delays associated with poor surgical outcomes
2. surgery - no difference from PT or slightly more beneficial. more critical in younger patients who need to use their arm for higher activity levels

Question 19

what are 2 Rx options for multi-tendon and/or massive full thickness tears?

Answer 19

1. PT - may help, mostly in low demand patients or those unfit for surgery but increased tear progression/arthropathy
   2- surgery - challenging but ~80% satisfaction rate

Question 20

when would joint replacements be used for RC tear?

Answer 20

irreparable tears

Question 21

reverse total shoulder arthroplasty (RTSA):
– superior to hemiarthroplasty in terms of:
– joint relationship?
– outcomes?

Answer 21

– pain relief, function, active elevation
– convex/concave reversed (concave on convex)
– good! 90% able to participate in sports without significant restriction if activity performed preoperatively

Question 22

what are rehab protocol highlights for RC tear?
– best if:
– bracing in:
– P! management:
– early vs delayed mobilization?
– early isometric loading:

Answer 22

– criterion and time based
– 15 deg ER
– TENS
– move them early!
– improved outcomes

Question 23

what are some favorable parameters for better prognosis after RC surgery?

Answer 23

younger males
higher bone density
higher fitness level / no obesity
greater preoperative ROM
smaller and single tear
less fatty infiltration
no biceps/AC involvement

Question 24

what are two other names for frozen shoulder contraction syndrome?

Answer 24

frozen shoulder
adhesive capsulitis

Question 25

is frozen shoulder syndrome common? if not, what is it frequently misdiagnosed with?

Answer 25

no any multidirectional limitation in ROM

Question 26

what are risk factors for frozen shoulder?

Answer 26

female hypothyroidism 40-65 years previous adhesive capsulitis diabetes family history

Question 27

what is the primary cause of frozen shoulder? secondary?

Answer 27

primary: pathology, particularly autoimmune conditions secondary: concomitant injury and period of immobilization (ex: grandma falling - takes longer to heal)

Question 28

what is the pathogenesis of frozen shoulder?

Answer 28

inflammation of GH capsule and ligaments (persistent inflammation, fibrosis) reduced joint volume

Question 29

what structures are involved in frozen shoulder?

Answer 29

GH capsule and ligaments joint space

Question 30

what are symptoms of frozen shoulder?

Answer 30

gradual and progressive P!, loss of motion functional limitations w/ reaching, sleeping, other ADLs

Question 31

what would you find in a scan and biomechanical exam for frozen shoulder? ROM? combined motions? resisted/MMT? stress test? accessory motion? special tests?

Answer 31

- loss of ER > abd > Flex > IR = capsular pattern of restriction @ GH joint - consistent block - possibly weak and/or P!ful depending on stage - distraction possibly + depending on stage - hypomobile - (+) for impingement

Question 32

Frozen shoulder stage I: initial symptoms? irritability? ROM? end feel?

Answer 32

- gradual onset, achy at rest, sharp with use, night P!, unable to lie on involved side -high - AROM < PROM - empty and painful

Question 33

Frozen shoulder stage II: freezing symptoms? irritability? ROM? end feel?

Answer 33

-- constant p!, particularly at night -- high -- moderate-severe limitations AROM < PROM -- empty and painful

Question 34

Frozen shoulder stage III: frozen symptoms? irritability? ROM? end feel?

Answer 34

-- stiffness > P! , intermittent P! -- moderate -- moderate to severe limitations with pain at end range AROM like PROM -- firm

Question 35

Frozen shoulder stage IV: thawing symptoms? irritability? ROM? end feel?

Answer 35

-- minimal to no pain -- low -- gradually improves -- firm

Question 36

what is PT Rx for frozen shoulder? (2)

Answer 36

-- POLICED -- patient education

Question 37

when giving patient education for frozen shoulder what 3 things do you do?

Answer 37

1 - describe natural course of 4 stages 2 - promote P! free functional activity 3 - match intensity of stretching/JMs with S&S

Question 38

what modalities could be prescribed for frozen shoulder?

Answer 38

cryotherapy - additional benefit to JM LASER - evidence for short and long term functional changes E stim

Question 39

what kind of benefit does JM have for frozen shoulder?

Answer 39

mixed benefits for P! and ROM

Question 40

what kind of benefit does STM have for frozen shoulder?

Answer 40

ROM/flexibility - moderate evidence

Question 41

what does MET primarily focus on for frozen shoulder?

Answer 41

elasticity and mobility increases also offset disuse, particularly with inhibited muscles * multimodal approach is effective for most patients

Question 42

what would a MD prescribe for frozen shoulder?

Answer 42

oral steroids cortisone injection - gives PT windows to do more with decreased symptoms manipulation under anesthesia --> worst case

Question 43

how long does stage I last for frozen shoulder?

Answer 43

1-2 months (prolonged inflammatory phase)

Question 44

P! and mobility deficits for frozen shoulder may last?

Answer 44

12-18 months

Question 45

if frozen shoulder goes untreated, how long will it take to resolve itself?

Answer 45

12-42 months ~50% with P! out to 4.5-7 years