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Quick Recertification Series

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Several of the muscles also have rotational and abduction functions at this joint. * Tendon disease in this group occurs on a spectrum from impingement/ tendinosis to partial rupture of the tendon( s), to full rupture of the tendon(s). * Most commonly, rotator cuff tears occur in the dominant arm as a degenerative process caused by blood supply issues and bone spur growth in older adults and less commonly as an acute injury in younger adults. * There is some evidence that rotator cuff tears may occur more commonly in smokers and that smokers have a more prolonged recovery from rotator cuff surgery. *CLINICAL ASSESSMENT * History - Patients generally complain of shoulder pain that radiates to the anterolateral portion of the arm and is worse with overhead reaching and rotational activities at the glenohumeral joint. -

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                           Quick Recertification Series
                              D AW N C O L O M B - L I P PA , PA- C ; A M Y M E R C A N T I N I K L I N G L E R , M S , PA- C



      ROTATOR CUFF DISEASE                                • Physical examination                           ment syndrome. Findings suggestive
                                                            – Decrease in active range of motion           of impingement syndrome include
      ›GENERAL FEATURES                                       at the shoulder, especially in rota-         narrowed subacromial space, rotator
      • The rotator cuff is a group of four                   tion and flexion, is common in               cuff tendinosis, and fluid in the bursa.
        muscles (supraspinatus, infraspinatus,                both impingement/tendinosis and              Partial and full-thickness tendon tears
        subscapularis, and teres minor) situat-               rotator cuff tear.                           are generally evident on MRI.
        ed in the periscapular region whose                 – Weakness in external rotation may          • MRI arthrography may be per-
        tendons run intra-articularly through                 suggest an infraspinatus tear (and,          formed in patients with possible gle-
        the glenohumeral joint and attach at                  although less common, a teres                noid labrum tears or who have previ-
        the proximal humerus.                                 minor tear).                                 ously had intra-articular surgery.
      • The major function of this muscle                   – The lift-off test (patient places
        group is to enhance the support of the                hand, palm up, on back and lifts           ›TREATMENT
        humeral head in the glenoid. Several                  off back) is helpful when examin-          • Impingement syndrome
        of the muscles also have rotational                   ing subscapularis function.                  – May be treated conservatively with
        and abduction functions at this joint.              – The drop arm test is performed by              cryotherapy and NSAIDs during
      • Tendon disease in this group occurs                   the examiner passively positioning             symptomatic flares. Patients may
        on a spectrum from impingement/                       the patient’s arm in abduction and
        tendinosis to partial rupture of the ten-             then the patient attempts to slowly         >>QUESTIONS & ANSWERS<<
        don(s), to full rupture of the tendon(s).             lower the arm. An abrupt drop of
      • Most commonly, rotator cuff tears                     the arm is positive and may indi-           1. The integrity of the subscapularis tendon
        occur in the dominant arm as a                        cate damage to the rotator cuff.            can be tested by
        degenerative process caused by blood                – Provocative tests for presence of           a. The lift-off test
        supply issues and bone spur growth                    impingement include the Hawkins             b. The Neer impingement test
        in older adults and less commonly as                  test and Neer impingement test.             c. The Hawkins test
        an acute injury in younger adults.                    ■ In the Hawkins test, the patient
                                                                                                          d. Resisted external rotation
      • There is some evidence that rotator                     holds the arm in 90˚ of glenohu-
        cuff tears may occur more commonly                      meral flexion and flexes elbow;           Answer: a
        in smokers and that smokers have a                      tester internally rotates the gleno-      Explanation: The Neer impingement test
        more prolonged recovery from rota-                      humeral joint. Finding is positive if     and Hawkins tests both test for nonspecific
        tor cuff surgery.                                       this maneuver induces pain.               impingement. Resisted external rotation
                                                              ■ In the Neer impingement test the          would give you information about the
                                                                                                          integrity of the infraspinatous muscle.
      ›CLINICAL ASSESSMENT                                      patient holds the forearm in prona-
      • History                                                 tion as the examiner forcibly flexes
                                                                                                          2. The presence of unilateral periscapular
        – Patients generally complain of                        at the glenohumeral joint while sta-      muscle atrophy and weakness on physical
          shoulder pain that radiates to the                    bilizing the scapula. Finding is posi-    examination
          anterolateral portion of the arm                     
								
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