Shoulder rotator cuff pathology Flashcards Preview

Z My Ortho Upper Limb > Shoulder rotator cuff pathology > Flashcards

Flashcards in Shoulder rotator cuff pathology Deck (17):
1

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

2

look

nil of note

3

feel

tenderness over ant aspect glenohumeral joint [site of insertion of rotator cuff tendons]

4

active movement

painful full ROM [arc of pain on abduction]

5

passive movement

less pain on passive ROM
normal end feel
no crepitus

6

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

7

special tests

scarf test for AC joint
empty can test = painful
apprehension test for instability in ligamnets

8

DDx

rotator cuff tear
adhesive capsulitis
glenohumeral arthritis
cervical radiculopathy

9

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

10

why is adhesive capsulitis and glenohumeral arthritis unlikely?

no restriction to active or passive ROM

11

why is cervical radiculopathy unlikely?

no pain going from neck down to below elbow
no sensory disturbances
no motor weakness
no reflex loss

12

investigations if dx in doubt

Xray
MRI
U/S

13

Xray

RARELY DONE
CALCIFIC TENDONITIS
CALCIFICATION IN CORACOHUMERAL LIGAMENT
PROXIMAL MIGRATION OF HUMERUS IF CHRONIC ROTATOR CUFF TEAR

14

MRI

evaluates muscle quality
size
shape
degree of retraction of tear

15

U/S

most effectent and cost-effective dx

16

no-op tx

analgesia
physio
ortho referral

17

op tx

arthroscopic subacromial decompression
rotator cuff repair
arthroscopic or open tendon transfers