I-Rotator Cuff Impingement vs Rotator Cuff Tear.ppt Flipbook PDF

What is Rotator Cuff Impingement? Highly occupied space between the roof and the floor. Supraspinatus and sub-acromial b

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Rotator Cuff Impingement vs Rotator Cuff Tears

What is Rotator Cuff Impingement?  Highly occupied space between the roof and the floor.  Supraspinatus and sub-acromial bursa.  Repetitive pinching of these structures cause swelling and inflammation

Causes of Impingement  Repetitive overhead or cross body motion  Type 2 or 3 morphologic acromion  Cuff weakness  Degenerative changes  Kyphotic posture

Causes of Impingement Roof can come down  Supraspinatus outlet narrowing  AC Joint O/A  Spurs

 Acromial morphology  Type II or III

Morphologic Acromion

Causes of Impingement Floor can go up  Subacromial Soft Tissue swelling  R.C. tendonitis  Bursal swelling  Calcific Tendonitis  Greater Tuberosity Fx  Weak cuff

Tendonitis vs Tendinopathy  Acute inflammation with little tendon thickening  Structures affected: Cuff tendon Sub-acromial bursa biceps tendon

 Chronic pain with thickening and disorganization of tendon fibers  No acute inflammatory process

Management of Tendinitis  Rest from impingement activities  NSAIDs  Iontophoresis  Ice for pain (acutely)  Heat for perfusion  Sub-acromial injection

Management of Tendinopathy  Re-establish perfusion to the cuff tendon with heat modalities  Re-align tendon fibers  Develop high rep. low wt. exercise program in limited range  Humeral head depression (Hammock Effect)  Kyphosis reduction  Be patient!

Signs of Tendinitis/opathy       

Pain with palpation sub-acromial space + Neer impingement test. + Hawkins-Kennedy test. Painful arc. P.M. pain when rolling onto shoulder. MMT- Flexion, Abd, ER painful. Relief with injection.

Proximal Biceps Tendonitis  R.C. Inhibition and lack of dynamic stability causes humeral head to migrate superiorly.  This places excessive strain on proximal bicep tendon within bicipital groove  = Bicep Tendonitis

stal Bicep Tendon Rupture 

Classic Presentation  Excessive load towards extension placed on forearm against forced flexion of elbow.  Pt hears and feels “pop”  Immediate pain, swelling,  Ecchymosis.  Exam  Palpable defect in distal bicep tendon  Popeye Deformity of bicep  Weakness into flexion

 Weakness with supination

Biceps ruptures Fix it or forget it?

Rotator Cuff Tears         

Traumatic > degen. Male > female. > 45y/o P.M. pain all positions Overcompensation Massive=min. pain Partial = mod-severe Weak ER, abd, flex. + Supraspinatus test

Rotator Cuff Tears (cont.)  + Lift-off test  + Drop arm test  FOOSH, cranking things (outboard motor), awkward lift

Do all rotator cuff tears eed to be repaired???

Management of RCTs      

Decrease pain and inflammation Immobilize- but not too long Diagnostic testing (x-rays, MRI) Modify activities (work/sports) Refer to orthopedics Prevent adhesive capsulitis

Things to remember about otator cuff tears  Tears can retract  Inappropriate G-H motion leads to more impingement and early arthritis  Develop cervical spine pain  Scarred up tears decrease post-op healing time