8/6/2019 Clinical Pattern: Rotator cuff pathology

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ClinicalPatterns.com: Rotator cuff pathology

Symptom description -Shoulder region pain, may refer down lateral arm to elbow

-May report pain around medial scapular border and/or upperthoracic region-In more acute, severe cases, pain may extend into forearm.Inflammation may cause neural compression and associatedsymptoms-Weakness and/or stiffness with shoulder movement

Behavior (Aggravating factors) -Overhead, across body, and behind back shoulder AROM-Sleeping, especially on involved side

Behavior (Easing factors) -Rest-NSAID or steroid use

Special questions & Red flags -Clarify any possible cervical-related signs and symptoms-Rule out visceral sources if risk factors identified

History -Age: Higher incidence in 4th and 5th decade for tendinopathy and

tears with increasing frequency of tears in succeeding decades-May follow trauma: falling on shoulder, elbow, or outstretched hand,MVA, throwing or overhead injury (or prior hx. of repetitive use)

-Insidious onsetObjective signs & Special tests -Shoulder A/PROM pain and/or restriction: Especially overhead and

behind back, may demonstrate painful arc during abduction orflexion or shrug sign during abduction.-(+) tenderness at involved site (supraspinatus most common)-MMT: Pain and/or weakness with specific muscle testing-Tests for RC tears (high specificity): Drop arm test (supraspinatustear), ERLS (non-specific/infraspinatus tear), Lift off, Bear hug or

Belly press tests (subscapularis tear)

-The Hawkins-Kennedy test may serve as a screen and either

the Empty can or Infraspinatus test may serve as a confirmatory testfor subacromial impingement (SAI)

Treatment options -Address shoulder ROM limitations if stiffness present. Considerjoint mobilization, STM, and stretching (typically flexion and ER first,then abduction and behind back later). IF PATIENT AT RISK FORFROZEN SHOULDER, BE MORE AGGRESSIVE-DFM to involved tendon-Address any cerivical-thoracic stiffness with joint

mobilization/manipulation, stretching (foam roll), and scapulothoracicstrengthening.-Progressive strengthening to glenohumeral and scapulothoracicmusculature. Early and mid program strengthening up to 90degrees elevation.-Modality use may be helpful in certain cases. US to compliment MTand exercise, iontophoresis if non-responsive to other treatments.