Transcript Signs and Symptoms

Rotator Cuff Tear
Algorithm
Chelsea Kufahl
Kayla Lingenfelter
Amanda Livingston
Brandon Smith
End point diagnosis:
*Rotator Cuff Tear
It could be this:
*Tendonitis
*Labral Tear
*Impingement
*Adhesive Capsulitis
*Referred shoulder pain from other source
End point diagnosis
Rotator Cuff Anatomy
Supraspinatus
Origin: Supraspinatus scapular fossa
Insertion: Superior facet on greater tubercle of humerus
Action: Initiates abduction at shoulder and externally rotates humerus
Infraspinatus
Origin: Infraspinatus scapular fossa
Insertion: Middle facet on greater tubercle of humerus
Action: Externally rotates the humerus
Teres Minor
Origin: Lateral border of scapula
Insertion: Inferior facet on greater tubercle of humerus
Action: Externally rotates humerus and weakly adducts the arm at shoulder
Subscapularis
Origin: Subscapular fossa and from lower 2/3 of lateral border of scapula
Insertion: Lesser tubercle of humerus and anterior portion of shoulder joint capsule
Action: Internally rotates and adducts the humerus at shoulder
***All four muscles draw the humerus toward the glenoid fossa , strengthening the shoulder joint
Anatomy
Acute Tear:
If you fall down on your outstretched arm or lift something too heavy with a jerking
motion, you can tear your rotator cuff. This type of tear can occur with other shoulder
injuries, such as a broken collarbone or dislocated shoulder.
Degenerative Tear:
Most tears are the result of a wearing down of the tendon that occurs slowly over
time. This degeneration naturally occurs as we age.
Several factors contribute to degenerative, or chronic, rotator cuff tears.
• Repetitive stress. Repeating the same shoulder motions again and again especially
overhead motions can stress your rotator cuff muscles and tendons. Overhead sports
and many jobs and routine chores can cause overuse tears, as well.
• Lack of blood supply. As we get older, the blood supply in our rotator cuff tendons
lessens. Without a good blood supply, the body's natural ability to repair tendon
damage is impaired. This can ultimately lead to a tendon tear.
• Bone spurs. As we age, bone spurs (bone overgrowth) often develop on the
underside of the acromion bone. When we lift our arms, the spurs rub on the rotator
cuff tendon. This condition is called shoulder impingement, and over time will
weaken the tendon and make it more likely to tear.
Mechanism of Injury
Partial Tear:
This type of tear damages the soft tissue, but does not
completely sever it.
Full-Thickness Tear:
This type of tear is also called a complete tear. It splits the
soft tissue into two pieces. In many cases, tendons tear off
where they attach to the head of the humerus.
Rotator Cuff Tear
Risk Factors
Age
• As you get older, your risk of a rotator cuff
injury increases.
• Rotator cuff tears are most common in people
> 40.
Poor Posture
• Forward-Shoulder Posture
o Can cause a muscle or tendon to become irritated
and inflamed when you throw or perform
overhead activities
Weak Shoulder Muscles
•
Abductors and External Rotators
o This risk factor can be decreased or
eliminated with shoulder-strengthening
exercises, especially for the less commonly
strengthened muscles on the back of the
shoulder and around the shoulder blades.
Repetitive Overhead Lifting
• Athletes
o tennis players
o baseball pitchers
• Occupation
o painters
o carpenters
o others who do overhead work
Traumatic Injury
•
•
History of falls
History of any other shoulder injury
• MOI
• FOOSH with arm abducted or extended
• Sudden jarring/sharp loading
• Lifting from floor
• O-linemen strike
• Gradual onset d/t impingement and fraying
• Location of Pain
• Supraspinatus: outer aspect of shoulder to deltoid insertion,
may radiate to elbow
• Infraspinatus: posterior aspect of shoulder, may radiate
down posterior arm
• Subscapularis: local discomfort
Signs and Symptoms
• Description of Pain
• Intermittent
• At rest: superficial, local, anterior
• After activity: deep ache, may radiate to elbow
• AM/PM
• Night pain
• Can’t sleep on affected shoulder
• Feeling of weakness
• Can’t comb hair, reach into cabinet, lift light-mod weight items
• Supraspinatus and ER specifically
Signs and Symptoms
• Observation
• Atrophy of Muscle: Hollowed supraspinatus/infraspinatus
fossa
• Shoulder Hike: upper trap/deltoid compensation during
movement
• Limited AROM
• Full PROM
Signs and Symptoms
•
•
•
•
Empty Can Test
Drop Sign
Hand Behind Back – Lift Off Test
Hornblower Sign
Primary Tests for Rotator Cuff Tear
• Patient elevates shoulder to 90° of
scaption with thumb pointed down.
The clinician applies resistance.
• Positive response is if there is
weakness or pain in the supraspinatus
region.
• Test is indicative of supraspinatus
tendonitis or a supraspinatus tear.
Empty Can Test
• The PT will passively move the
patients arm to 90° of
abduction with the elbow bent
at 90°.
• A positive sign is if the patient
is unable to hold their arm in
that position due to weakness
and pain the rotator cuff area.
• Test is indicative of
infraspinatus tear.
Drop Sign
• The PT will put help the
patient get into a position
where they put the arm fully
extended and internally
rotated where they touch their
lower back with the back of
their hand.
• A positive sign is if the
patient is unable to lift the
back of the hand off their
back.
• This is indicative of
subscapularis weakness or
tear.
Hand Behind Back – Lift Off Test
• The PT will put patient’s arm in 90°
of abduction in scapular plan. The
elbow is flexed at 90°. The patient
will try to ER forearm against the
resistance of the PT.
• A positive sign is if the patient
cannot externally rotate their arm,
and they assume a position of a
positive hornblower sign.
• This test is indicative of teres minor
tear.
Hornblower Sign
• Subacromial Impingement Tests
• Hawkins-Kennedy Impingement Test
• Supraspinatus tendon impingement
• Can be positive if have a rotator cuff tear.
• Neer’s Test
• Supraspinatus tendon impingement
• Labral Tear Tests
• Crank Test
• SLAP lesions
• Speed’s Test
• Superior labral tear / Bicipital tendonitis
• O Brien’s Test
• Labral tear
Other Tests to Perform
• Shoulder Stability Tests
• Sulcus Sign
• Multidirectional instability/inferior stability
• Load and Shift Test
• Anterior and posterior instability of glenohumeral joint
• Apprehension Test
• Anterior instability
• Relocation Test
• Anterior instability
Other Tests to Perform
Algorithm
This algorithm can assist physical therapists
by giving them a set of steps to follow if
their patient is displaying the signs and
symptoms associated with a rotator cuff tear.
The physical therapist can then follow the
steps in the algorithm to come to a diagnosis
for their patient and treat them accordingly.
TAKE HOME MESSAGE
• Burbank, K. M., J. H. Stevenson, G. R. Czarnecki, and J. Dorfman.
"Chronic Shoulder Pain: Part I. Evaluation and Diagnosis." American
Family Physician 77.4 (2008): 453-60. Print.
• Loudon, J, Swift, M. & Bell, S. (2008) The Clinical Orthopedic Assessment
Guide (2nd ed). Champaign, IL: Human Kinetics.
• Murrell, G. A., & Walton, J. R. (2001). Diagnosis of rotator cuff tears.
Lancet, 357(9258), 769–70. doi:10.1016/S0140-6736(00)04161-1
• OrthoInfo. (2011). Rotator Cuff Tears. Retrieved from
http://orthoinfo.aaos.org/topic.cfm?topic=a00064.
• Jain, N. B., Wilcox, R. B., Katz, J. N., & Higgins, L. D. (2013). Clinical
examination of the rotator cuff. PM & R : the journal of injury, function,
and rehabilitation, 5(1), 45–56. doi:10.1016/j.pmrj.2012.08.019
• Yamamoto, A. (n.d.). Prevalence and risk factors of a rotator cuff tear in the
general population. (2010). Journal of Shoulder and Elbow Surgery, 19(1),
116-120. Retrieved from
http://www.sciencedirect.com/science/article/pii/S1058274609002043
References