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I-Rotator Cuff Impingement vs Rotator Cuff Tear.ppt · 2014-03-27 · Rotator Cuff Impingement vs...

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Rotator Cuff Impingement vs Rotator Cuff Tears
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Page 1: I-Rotator Cuff Impingement vs Rotator Cuff Tear.ppt · 2014-03-27 · Rotator Cuff Impingement vs Rotator Cuff Tears. What is Rotator Cuff Impingement? Highly occupied space between

Rotator Cuff Impingement vs

Rotator Cuff Tears

Page 2: I-Rotator Cuff Impingement vs Rotator Cuff Tear.ppt · 2014-03-27 · Rotator Cuff Impingement vs Rotator Cuff Tears. What is Rotator Cuff Impingement? Highly occupied space between

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

Page 3: I-Rotator Cuff Impingement vs Rotator Cuff Tear.ppt · 2014-03-27 · Rotator Cuff Impingement vs Rotator Cuff Tears. What is Rotator Cuff Impingement? Highly occupied space between

Causes of Impingement

Repetitive overhead or cross body motion

Type 2 or 3 morphologic acromion

Cuff weakness Degenerative

changes Kyphotic posture

Page 4: I-Rotator Cuff Impingement vs Rotator Cuff Tear.ppt · 2014-03-27 · Rotator Cuff Impingement vs Rotator Cuff Tears. What is Rotator Cuff Impingement? Highly occupied space between

Causes of Impingement

Roof can come down Supraspinatus

outlet narrowing AC Joint O/A Spurs

Acromial morphology Type II or III

Page 5: I-Rotator Cuff Impingement vs Rotator Cuff Tear.ppt · 2014-03-27 · Rotator Cuff Impingement vs Rotator Cuff Tears. What is Rotator Cuff Impingement? Highly occupied space between

Morphologic Acromion

Page 6: I-Rotator Cuff Impingement vs Rotator Cuff Tear.ppt · 2014-03-27 · Rotator Cuff Impingement vs Rotator Cuff Tears. What is Rotator Cuff Impingement? Highly occupied space between

Causes of Impingement

Floor can go up

Subacromial Soft Tissue swelling R.C. tendonitis Bursal swelling Calcific Tendonitis Greater Tuberosity Fx Weak cuff

Page 7: I-Rotator Cuff Impingement vs Rotator Cuff Tear.ppt · 2014-03-27 · Rotator Cuff Impingement vs Rotator Cuff Tears. What is Rotator Cuff Impingement? Highly occupied space between

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

Page 8: I-Rotator Cuff Impingement vs Rotator Cuff Tear.ppt · 2014-03-27 · Rotator Cuff Impingement vs Rotator Cuff Tears. What is Rotator Cuff Impingement? Highly occupied space between

Management of Tendinitis

Rest from impingement activities

NSAIDs Iontophoresis Ice for pain (acutely) Heat for perfusion Sub-acromial

injection

Page 9: I-Rotator Cuff Impingement vs Rotator Cuff Tear.ppt · 2014-03-27 · Rotator Cuff Impingement vs Rotator Cuff Tears. What is Rotator Cuff Impingement? Highly occupied space between

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!

Page 10: I-Rotator Cuff Impingement vs Rotator Cuff Tear.ppt · 2014-03-27 · Rotator Cuff Impingement vs Rotator Cuff Tears. What is Rotator Cuff Impingement? Highly occupied space between

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.

Page 11: I-Rotator Cuff Impingement vs Rotator Cuff Tear.ppt · 2014-03-27 · Rotator Cuff Impingement vs Rotator Cuff Tears. What is Rotator Cuff Impingement? Highly occupied space between

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

Page 12: I-Rotator Cuff Impingement vs Rotator Cuff Tear.ppt · 2014-03-27 · Rotator Cuff Impingement vs Rotator Cuff Tears. What is Rotator Cuff Impingement? Highly occupied space between

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

Page 13: I-Rotator Cuff Impingement vs Rotator Cuff Tear.ppt · 2014-03-27 · Rotator Cuff Impingement vs Rotator Cuff Tears. What is Rotator Cuff Impingement? Highly occupied space between

Biceps rupturesFix it or forget it?

Page 14: I-Rotator Cuff Impingement vs Rotator Cuff Tear.ppt · 2014-03-27 · Rotator Cuff Impingement vs Rotator Cuff Tears. What is Rotator Cuff Impingement? Highly occupied space between

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

Page 15: I-Rotator Cuff Impingement vs Rotator Cuff Tear.ppt · 2014-03-27 · Rotator Cuff Impingement vs Rotator Cuff Tears. What is Rotator Cuff Impingement? Highly occupied space between

Rotator Cuff Tears (cont.)

+ Lift-off test + Drop arm test FOOSH, cranking

things (outboard motor), awkward lift

Page 16: I-Rotator Cuff Impingement vs Rotator Cuff Tear.ppt · 2014-03-27 · Rotator Cuff Impingement vs Rotator Cuff Tears. What is Rotator Cuff Impingement? Highly occupied space between

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

Page 17: I-Rotator Cuff Impingement vs Rotator Cuff Tear.ppt · 2014-03-27 · Rotator Cuff Impingement vs Rotator Cuff Tears. What is Rotator Cuff Impingement? Highly occupied space between

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

Page 18: I-Rotator Cuff Impingement vs Rotator Cuff Tear.ppt · 2014-03-27 · Rotator Cuff Impingement vs Rotator Cuff Tears. What is Rotator Cuff Impingement? Highly occupied space between

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

Page 19: I-Rotator Cuff Impingement vs Rotator Cuff Tear.ppt · 2014-03-27 · Rotator Cuff Impingement vs Rotator Cuff Tears. What is Rotator Cuff Impingement? Highly occupied space between

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