7/31/2019 Shoulder Clinical Presentation-2

1/29

Clinical

7/31/2019 Shoulder Clinical Presentation-2

2/29

7/31/2019 Shoulder Clinical Presentation-2

3/29

7/31/2019 Shoulder Clinical Presentation-2

4/29

7/31/2019 Shoulder Clinical Presentation-2

5/29

7/31/2019 Shoulder Clinical Presentation-2

6/29

7/31/2019 Shoulder Clinical Presentation-2

7/29

7/31/2019 Shoulder Clinical Presentation-2

8/29

7/31/2019 Shoulder Clinical Presentation-2

9/29

7/31/2019 Shoulder Clinical Presentation-2

10/29

7/31/2019 Shoulder Clinical Presentation-2

11/29

7/31/2019 Shoulder Clinical Presentation-2

12/29

7/31/2019 Shoulder Clinical Presentation-2

13/29

7/31/2019 Shoulder Clinical Presentation-2

14/29

Rotator Cuff Disease/ImpingementSyndrome

Frequently Asked Questions

7/31/2019 Shoulder Clinical Presentation-2

15/29

What is the rotator cuff in the shoulder?

Rotator cuff is a group of flat tendons whichfuse together and surround the front, backand top of the shoulder joint.

The tendons are connected individually toshort, but very important muscles thatoriginate from the scapula.

When muscles contract they pull on the

rotator cuff tendon causing shoulder torotate upward, inward or outward hence thename rotator cuff

7/31/2019 Shoulder Clinical Presentation-2

16/29

What is impingement syndrome?

Uppermost tendon of the rotator cuff, thesupraspinatus tendon passes beneath thebone on top of the shoulder, called acromion.

If the space between undersurface ofacromion and top of humerus head is quitenarrow the rotator cuff tendon and adherent

bursa can therefore be pinched when the armis raised into a forward position.

7/31/2019 Shoulder Clinical Presentation-2

17/29

How does impingement syndrome relate torotator cuff disease?

When rotator cuff tendon and its overlyingbursa become inflamed and swollen withimpingement syndrome, the tendon may

being to break down near its attachment onthe humerus bone.

With continued impingement, the tendon isprogressively damaged, and finally may tearcompletely away from the bone.

7/31/2019 Shoulder Clinical Presentation-2

18/29

Why do some people develop impingement and rotatorcuff disease when others do not?

Many factors may predispose one person toimpingement and rotator cuff problems. Mostcommon is shape and thickness of the acromion.

If the acromion has a bone spur on the front edge itis more likely to impinge on the rotator cuff when thearm is elevated forward.

Sometimes muscles of the shoulder may becomeimbalanced by injury or atrophy and imbalance cancause the shoulder to move forward with certainactivities which may cause impingement.

7/31/2019 Shoulder Clinical Presentation-2

19/29

Other then impingement, what else can cause rotatorcuff damage?

In young, athletic individuals, injury to the rotatorcuff can occur with repetitive throwing, overheadracquet sports or swimming.

This type of injury results from repetitive stretchingof the rotator cuff during the follow through phaseof the activity.

The tear that occurs is not caused by impingementbut more by a joint imbalance. This may beassociated with looseness in the front of theshoulder caused by a weakness in the supportingligaments.

7/31/2019 Shoulder Clinical Presentation-2

20/29

What kind of symptoms does a patient havewhen the rotator cuff is injured?

Most common complaint is aching located inthe top and front of the shoulder, or on theouter side of the upper arm (deltoid area)

Pain is usually increased when the arm islifted to the overhead position.

With some complete rotator cuff tears, thearm cannot be lifted in the forward oroutward direction at all.

7/31/2019 Shoulder Clinical Presentation-2

21/29

How is the diagnosis of rotator cuff diseaseproven?

Diagnosis of rotator cuff disease includes acareful history taken and reviewed by thephysician, an x-ray to visualize the anatomy

of the bones of the shoulder and a physicalexamination.

An MRI (magnetic resonance imaging) canfrequently gives the final proof of the statusof the rotator tendon.

7/31/2019 Shoulder Clinical Presentation-2

22/29

What is the Initial treatment for Rotator cuff Disease andImpingement?

If minor impingement or rotator cuff tendonitis isdiagnosed a period of rest coupled with medicinestaken by mouth and physical therapy will frequentlydecrease the inflammation and restore the tone to the

atrophied muscles.

Activities causing the pain should be slowly resumedonly when the pain is gone.

Application of ice to the tender area three or fourtimes a day for 15 minutes is also helpful.

7/31/2019 Shoulder Clinical Presentation-2

23/29

What is the second line of treatment if therotator cuff pain and weakness persist?

If there is a thickened acromion or acromialbone spur causing impingement, it can beremoved with a burr using arthroscopic

visualization.

Often this will completely cure theimpingement and prevent progressive rotatorcuff injury

7/31/2019 Shoulder Clinical Presentation-2

24/29

If the Rotator cuff is already torn, what are theoptions?

When tendon of the rotator cuff has acomplete tear, the tendon must be repairedusing surgical techniques

In young working individuals repair of thetendon is most often suggested.

In some older individuals who not requiresignificant overhead lifting ability surgicalrepair may not be as important.

7/31/2019 Shoulder Clinical Presentation-2

25/29

What will happen if the rotator cuff is not

repaired?

In some situations, the bursa overlying the

rotator cuff may form a patch to close the

defect in the tendon

If the tendon edges become fragmented and

severely worn, and the muscle contracts andatrophies, repairs, repair at that point may

not be possible.

7/31/2019 Shoulder Clinical Presentation-2

26/29

How is a major injury to the rotator cuff tendon repairedsurgically?

The arthroscope is extremely helpful when repairingrotator cuff tendons

If it is necessary to suture a rotator cuff tear which

has pulled off the bone, a two inch incision can bemade directly over the tear that has been visualizedand localized using the arthroscope

The deltoid muscle fibers can be spread apart sothat strong stitches can attach the rotator cufftendon back to the bone

7/31/2019 Shoulder Clinical Presentation-2

27/29

How is my shoulder Treated after surgery?

In a minor operation for impingement, the

shoulder is placed in a simple sling

If full thickness tear of the rotator cuff waspresent and repaired, then the shoulder will

be supported by an UltraSling or a SCOI

postoperative brace

7/31/2019 Shoulder Clinical Presentation-2

28/29

What is the rehabilitation program afterrotator cuff surgery?

Depending on type of surgeryperformed, the program will allow a

period of time for healing of the softtissues followed by time to regainrange of motion and thenstrengthening the shoulder muscles,

particularly rotator cuff.

7/31/2019 Shoulder Clinical Presentation-2

29/29

How Successful is Rotator cuff surgery?

Every case is unique. In the young, healthy person

with a minor rotator cuff impingement, surgery ispredictably successful

Since it is necessary to trim back the unhealthy

tendon before reattaching it to the bone, adecreased range of motion of the shoulder willoften result.

The final outcome often depends on the willingnessand ability of an individual patient to work on theirpostoperative physical therapy program