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Rotator Cuff Tendinopathy Cheat Sheet (DRAFT) by

Rotator Cuff tendinopathy Rx, PE, Hx

This is a draft cheat sheet. It is a work in progress and is not finished yet.

Rotator Cuff

- Made up of supras­pin­atous, infras­pin­atous, teres minor and subsca­pularis
- Stabilises shoulder during movement - helps stop superior transl­ation during abduction by compre­ssing the humeral head

Causes

- Injury (falling, pushing, pulling, throwing, lifting)
- Repetitive injury (overhead movements)
- Age (decrease of vascul­arity, increase of degene­rative spurring)
- Hyperc­hol­est­ero­lemia
- Genetics
- DM
- Hx of cortic­ost­eroid injections
- impingment and hyperp­erf­usion
- Hypova­scu­larity during overhead activity -compr­esses zone of injury
- Supras­pin­atous undergoes tensile and compre­ssive overload during arm elevation = Tendon matrix degrad­ation
- More common in dominant arm
- People with UCS and scapula dyskinesis

Hx

- Acute = fallls, throws
- Tearin­g/s­napping feeling + severe pain and weakness in shoulder abduction
- Chronic - silently over time - gradual pain and weakness + crepitus
- Located to antero­lateral shoulder and radiates down arm
- Diffic­ultly raising arm overhead
- Worse at night
DASH

PE

- Atrophy of deltoid, infras­pin­atous, supras­pin­atous
- Crepitus on palpation on acromion
- Limited PROM int rot decreased elevat­ion­/ab­duction
- +ve apley's scratch
- May have diminished ROM in dominant shoulder
- consider Adhesive capsulitis if limited PROM in flexion and abduction
- Strength test of rotator cuffs - pain/w­eakness
- +ve Jobes
- +ve MHK and imping­ement arch sign
- +ve drop arm test
- +ve Neers
- Bicep tears should be assessed as they can occur with rotator cuffs
- Look for UCS and scapula dyskinesis
At least three of the following to diagnosis a full thickness rotator cuff tear (98% accuracy):
Age >60
Supras­pin­atous weaknesss
Weakness in external rotation
+ve imping­ement signs

DDx

- Scapula dyskinesis
- Shoulder anterior imping­ement syndrome
- Cx radicu­lopathy
- Biceps tendinitis
- Calcific tendinitis
- A/C joint injury
- Labral tear
- OA
- Instab­ility
- Fibrom­yalgia
- Adhesive capsulitis
- Bursitis
- MFPS
- TOS
- F#
- Infection
- Neoplasm
- Somato­vis­ceral referral -Cardiac

Imaging

- Usually not needed unless acute injury in young patient with suspected rupture, signif­icant loss of strength, signif­icant disruption
- MRIa most sensitive

Management

- Activity modifi­cation (avoid carrying heavy objects, overhead activity)
- Sleep on unaffected side with pillow between arm and trunk on affected side
- Overweight = diet and exercise
- Stretc­hin­g/STW of pecs, infras­pin­atous, teres minor, subsca­pul­aris, traps, LS and posterior capsule
- Cross friction massage over area
- Scapul­oth­oracic, GH joint, Cx Tx spine mobili­sat­ion­/ma­nip­ulation
- Slow loading - moderate effort, low reps
- Assess night pain
- Exercise - Codman pedulum, towel
- Stretching - restor­ation of adduction internal rot and ext rot (cross body, sleeper stretch)
- Resistance exercises for rotator cuff, perisc­apular, ext rot, serratus, lower traps
- Address scapula dyskin­esi­s/UCS
- Sx if failure of conser­vative therapy
Poor prognosis:
1. Full thickness tear >1cm (Sx option is usually considered first)
2. Symptoms lasting more than 1 year
3. Functional impair­men­t/w­eakness