Rotator cuff injury most often involves what muscle?
Rotator cuff tears can either be?
Supraspinatus
Traumatic or degenerative?
When thinking clinically you must think about why the supraspinatus tendon is doing this, i.e. reasoning behind it so you can target treatment here. Eg weak rhomboids, hooked acromion etc
Supraspinatus functions?
Active when?
Whats its secondary functions?
functions in both flexion and abduction like the deltoid
-activity is fairly constant and greater than deltoid through first 60 degrees of abduction
Sceondary functions: 1) Compression of the GH joint 2) Acts as a vertical 'steerer' for the humeral head 3) maintains stability of the arm view slide 5
What kind of people will you see Rotator cuff tears in mostly?
-late to middle age and has problems with shoulder for some time - this patient then lifts a load or suffers an injury that tears the tendon
-RCT also occurs in young people- generally overuse injury or trauma
The area is poorly vascularised so has poor capacity to heal. So tendinitis always seems to occur in the same place.
How does acromion type affect the likelihood of getting an impingement syndrome or rotator cuff tear?
slide 9
Type 1 to 3
3 is hooked shaped so it reduces the subacromial space making damage or inflammation to the underlying structures more likely.
Which way will your humerus migrate if you tear the supraspinatus tendon?
Superior migration coz supraspinatus normally helps keep it in place and the deltoid tends to lift it up so that its mechanical advantage is better.
slide 10
Biceps - what are the things that can go wrong with the biceps and what is often the causes?
- bicipital tendinopathy (long head)
- biceps tear (rupture of the long head)
- dislocation of the bicep tendon (long head)
- most cases are secondary to a rotator cuff injury esp Impingement and instability
What is the characteristics you would see in biceps tendinopathy?
12
Bicep tendon injuries most often seen in patients with?
- pain in anterior shoulder located over biceptital groove, sometime radiating down elbow
- pain aggravated by activities that require shoulder flexion, forearm supination and or elbow flexion
- pain worse with initiate of activity
- some patients describe fatigue with shoulder movements
- symptoms made better with rest, ice and massage, stretching and sometimes heat
- night pain isn’t uncommon (i.e. laying on side with arm curled up.
-often see in young patients who have done lay back bicep curl or something, or traumatic fall, sports
-older patients 40-60 with history of shoulder problems, secondary to chronic wear and tear of the tenon
View slide 14
Describe how dislocation of bicep tendon would occur and what structures are involved?
What are the signs and symptoms?
- tear to trasnverse humeral ligament allows bicep tendon to dislocate out of bicepital groove.
- also often associated in people with shallow bicepital groove.
Signs?
- anterior shoulder pain with popping, cracking and occasional locking
- shoulder pain present when arm is abducted 90 degrees and rotates intern and out
the stability of the shoulder relies on what?
who are the static stabilisers?
Who are the dynamic stabilisers?
- joint- glenoid labrum deepening the GH “socket”
- ligaments and joint capsules- limited though coz they need to be quite flexible for large ROM
- shoulder is primary stabilisation.
Instability is usually due to 2 or more of the above.
Static:
joint shape including labrum (creates a -‘ve intra-articular pressure (a-suction)
-capsule and ligaments
Dynamic stabilisers:
- rotator cuff muscles
- LH of biceps
- scapular stabilisers (rhomboids, serratus anterior)
- deltoid (adds to -‘ve intracapsular pressure!)
GH Instability.
What are the directions of instability that can happen in the shoulder?
The instability can be classified from either?
Whats the most common form of instability?
Anterior
posterior
multidirectional
Also classified as traumatic or non-traumatic
Anterior traumatic instability most common esp in young active patients
-non traumatic instability associated with connective tissue disorders or generalised laxity.
Recurrent post-Traumatic Instability.
Most common in who?
May be associated with?
- common in males <20 yrs
- May be assoisated with detachment of antero-inferior glenoid labrum (Bankart tear/ lesion)
Whats a SLAP lesion?
classification system?
Superior Labrum anterior posterior
-classified into types I-IV depending on tear position and integrity of bicep tendon
Slide 24
GH dislocation:
Normally what type?
-complications?
-Often requires what?
Traumatic anterior
May be associated with neuromuscular compromise
-high chance it will occur again
-often requires surgery and significant rehabiliation
-Dont pop it back in coz you could get sued!- lay them flat on belly with arm hanging in front of them of table.
-if pulse has disappeared give a little traction until it re-appears then hold it there until medical assistance arrives.
GH Dislocation
What are the 2 major types of classifications?
TUBS:
- Traumatic
- Unidirectional
- Bankart labral lesion present
- Surgery often required
AMBRI
- Atraumatic
- Multidirectional
- Bilateral
- Rehabilitation best course of care.
What 2 most likely things that will cause an impingement?
Its the most common type of shoulder pain.
Pain is usually seen were?
What patterns will be seen?
Acute bursitis- patient will be very reluctant to move their shoulder at all
Acute tendonitis- hurts to move but they will move it through some motions.
Pain usually over lateral, superior shoulder
Typical pattern is painful arc- i.e. starts at 30 degrees-150- why it stops hurting is there is no movement at glenohumeral joint after this. Patients with AC pain will experience it after the 150 degrees.
What is the anatomy of the Coracoacromial Arch
i.e. formed by?
Forms a subacromial space/ outlet through which these pass:
Formed by the:
- acromion
- coracoacromial ligament
- inferior surface of the AC joint
Forms a subacromial space/ outlet through which these pass:
Supraspinatus
-subacromial (subdeltoid) bursa
Bursitis
happens why
can be distinguished how?
responds well to what?
Due to limited subacromial space
-distinction can be made as it presents with localised warmth and erythema due to inflammation of quite superficial bursa.
responds well to NSAIDS, Ice and rest
