Shoulder pain with muscle power deficits

what are the risk factors for a rotator cuff tear or tendinopathy?

• >40 years old

• participation in repetitive OH lifteing

• overhead athletes

• smoking

• obesity

• metabolic syndrome

• psychosocial/contextual factors

what are the causes of a rotator cuff tear/tendinopathy?

• traumatic: lifting something heavy, car accident, fall on outstretched hand, shoulder discloation

• degenerative: tendon regeneration, repetitive overuse, bone spurs, poor blood supply

what is the rotator cuff tendinopathy spectrum in determining if it is a tendinopathy or a full tear?

1. acute reactive presentations

2. chronic degernative presentations

3. tendon structural changes

4. load intolerance— tendons respond well to load so this would indicate a full tear

what are the types of RC tears?

• partial tear: incomplete tear; some portion of the RTC muscle or tendon is affected but does not extend all the way through

• full thickness tear: complete tear; extends from top to bottom of a RTC muscle or tendon

what are the objective examination findings for a RCT?

• limited shoulder AROM— scaption, flextion, abduction, ER, IR

• weakness or pain with resisted ER, IR, flexion, and abduction

• positive cluster special test findings: Drop arm test, infraspinatus test, and painful arc

• positive external rotation lag sign, lift off test, belly press test

what do we do if someone has positive signs and symptoms of a RCT?

try treatment but refer out if failure to perform

t/f many patients with rotator cuff tendinopathy or partial-thickness tears improve with nonsurgical management.

true

t/f many patients with rotator cuff tendinopathy or partial thickness tears do not improve with nonsurgical management.

false, they do improve

__________ is recommended as first line management for RC tendinopathy.

exercises based rehab

when should initial conservative treatment be used to treat the RTC?

• RC tendinopathy

• partial-thickness tears

• degenerative full thickness tears without marked functional loss

• older adults with lower functional demands

• patients with improving symptoms/function

when should early surgical repair be use to treat the RC?

• traumatic full thickness tears

• marked weakness or loss of function

• large acute tears younger or highly activie individuals

• failure to improve with irreperable pathology or significant tissue degernation

treatment of the RTC is based on?

irritability, severity, and impairment

what is the presentation and treatment focus for someone with high, moderate, and low irritability?

high: present w pain and limited tolerance. focus on control and protection

moderate: present w weakness and functional limits. focus on strength and load

low: present w movement dysfunction. focus on mobility and performance

what are the CPG takeways for treating the RTC?

• patient centered education and self managment are essential

• progressive exercise is first line care

• exercise may include motor control and/or resistance training with varied loads

• manual therapy may be used as an adjuct for short term relief

• imaging/referral is not routine initially unless red flags or concerning presentation are present

what are the graded assessment recommendations by the CPG?

grade A: objective measures (ROM and MMT). patient reported outcome measures (SPADI, DASH)

grade B: special tests— painful arch for diagnosis and hawkins kennedy for ruling out.

grade F: subjective history, physical assessment, red flags, imaging, referral

what are the graded treatment recommendations by the CPG?

grade A: exercise

grade B: manual

grade C: education, and modalities

grade D: taping

what tests can help rule in a supraspinatus tear?

Jobe test, full can test, and ER lag sign

what are the differential diagnoses for rotator cuff tear?

adhesive capsulitis, GH instability, OA, referred pain

what are the 5 best RTC exercises?

1. lateral raise

2. wall slides

3. push ups

4. overhead press

5. ball throws and catches— eccentric for throwing athletes