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CC May 2016 Testing for Rotator Cuff Disorders

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echoecho's version from 2016-07-24 18:28

Section

Question Answer
List the 4 muscles that make up the rotator cuff?1) teres major 2) subscapularis 3) supraspinatus 4) infraspinatus
Define rotator cuff disease?1) full or partial thickness tears of the tendons of these muscles 2) tendinopathy of these tendons 3) subacromial bursitis
Shoulder pain is the ____ most common musculoskeletal reason to seek medical care and has a significant impact on quality of life and need for sick leave?third
Rotator cuff disease is the most common cause of ____ ______ seen by physicians?shoulder pain
Rotator cuff disease is more common with increasing ______?age
Do most patients require surgical repair of their injury (including some patients with full thickness tear)?no
List the symptoms or signs of rotator cuff disease? What may be noticed on physical exam?1)shoulder and arm pain particularly during overhead activities. Pain is dull or sharp and often occurs in the region of the deltoid. There is night pain, weakness and stiffness 2) crepitus
If a full thickness tear is present, what may be present?painless loss of active motion
List the 3 testing of the rotator cuff available?1) pain provocation tests 2) strength tests 3) composite tests (strength and pain)
List the 3 pain provocation tests?1) Neer test 2) painful arc test 3) Hawkins test
Describe the Neer test?with the elbow in extension and the shoulder in internal rotation, the examiner passively moves the arm through forward flexion; the test is positive if pain occurs with this motion
Describe the painful arc test?the patient moves the arm actively through full abdution; the test is positive if pain is elicited between 60 degree and 120 degree of abdution
Describe the Hawkins test?with the arm in 90 degree of forward flexion and the elbow flexed 90 degrees, the examiner stabilizes the elbow and internally rotates the shoulder; the test is positive if pain occurs during internal rotation
List the 3 strength tests?1) drop arm test 2) external rotation lag 3) internal rotation lag
Describe the drop arm test?starting with the arm in 90 degere of abduction, the patient slowly lowers the arm; the test is positive if the arm drops immediately and pain occurs
Describe the external rotation lag test ?with the elbow in 90 degrees flexion and the arm in 20 degree of abduction, the examiner passively rotates the arm and the patient is asked to maintain the position; the test is positive if the patient isunable to maintain the arm in external rotation
Describe the internal rotation lag test?with the dorsum of the hand of the affected arm resting on the back and the elbow in 90 degree flexion, the examiner lifts the hand off the back adn the patient is asked to maintain the position; the test is positive if the patient cannot maintain the position of their hand
List the 3 composite tests?1) empty can test 2) resisted abduction test 3) external rotation resistance
Describe the empty can test? with the arm in 90 degree of abduction, 30 degrees horizontal adduction and 90 degrees internal rotation, elbow extended and thumb pointed towards the flor the patient resists downward pressure; the test is positive if there is pain or weakness during resistance
Describe the resisted abduction test?arm is abducted to 90 degrees and the examiner applies downward pressure; the test is positive if there is pain or weakness during the downward pressure
Describe the external rotation resistance test?with the elbow in 90 degress of flexion, the examiner applies pressure proximal to the wrist against external rotation; the test is positive if there is pain or weakness during the application of the pressure
In 2013, a meta-analysis was performed to identify the most accurate clinical exams for the dx of rotator cuff disease. Out of 28 studies, only ____ were of sufficient quality to be included in the review?5
*** Among the pain provocation tests, only a positive _______ test had a positive likelihood ratio of greater than 2; a normal test also had the lowest negative likelihood ratio?painful arc test
The other pain provocation tests had lower postiive likelihood ratio, including which 2 tests?1) Neer test 2) Hawkins test
*** The most accurate strength tests for a full thickness rotator cuff tear were positive _____ test and a positive ______ test?external rotation lag test; internal rotation lag test
The most accurate strength test for any rotator cuff disease was the _______ test?drop arm test
The most accurate compositve test for rotator cuff disease ie the _______ test? What 2 composite tests were less accurate?1) external rotation resistence 2) empty can test and resisted abduction test
Define bicep tendinopathy?diagnosed when a patient experiences pain when trying to elevate the arm against resistance when the arm is fully extended in supination and the shoulder is flexed
Bicep tendon rupture will result in what deformity in the mid upper arm?"popeye deformity"
What test is done to detect acromioclavicular joint disorders? Describe the test?1) cross body adduction test (straight arm lifted to 90 degree flexion and then passively adducted across the body)
Cervical spine stenosis presents with what symptoms?neck and NOT shoulder pain
*** SUMMARY = Patients with rotator cuff disease most commonly presents with what?shoulder and arm pain (particularly during overhead activities)
*** SUMMARY = the most accurate strength test for any rotator cuff disease is the _____ test?drop arm test
*** SUMMARY = the most accurate strength test for a full thickness rotator cuff teear are a positive ______ test adn a postiive _____ test?1) external rotation lag test 2) internal rotation lag test
*** SUMMARY = of the pain provaocation tests, a postiive _____ test has a postiive likelihoood ratio of 3.7; an normal ____ test has the lowest negative likelihood ratio of 0.36?1) painful arc test 2) painful arc test
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