Background:
Mode of Injury (MOI) = Trauma, Repetitive activity, Degenerative
Pain mechanism = Nociceptive local / Nociceptive referred.
Pathomechanics = Myogenic.
Usually caused by trauma similarly to ASD, with a fall on an outstretched arm.
It can also be caused by repetitive overuse which can fatigue the stabilising shoulder muscles (the rotator cuffs), which can be graded in 3 ways:
Small tear = less than 1cm (2/3 of the time it can be asymptotic due to the small size)
Medium tear = 1-3cm
Larger tear = 3-5cm
Can heal in 4-6 months healing time.
Symptoms:
Pain
Weakness
+ pain arc
Stiffness
Loss of rhythm
Loss of function
Aggravating factors:
Movement
Sleeping
Lifting heavy objects
Dressing
Easing factors:
Heat
Ice
Medication
Epidemiology:
60+.
Common in sports particularly baseball.
Most tears occur in the supraspinatus tendon.
Healing time = 4-6 months.
Prognostic factors:
Age.
Occupation.
Gender.
Co-morbidities.
Assessment:
Observation =
Dressing
Decreased ROM
Increased pain
Weakness
Compensating
Postural changes
Decrease strength
Clearance examination =
Shoulder
Thoracic spine
Cervical spine
Movement / Palpation =
Active / Active assisted / Passive / Resisted.
Decreased active ROM.
Active assisted may be better than active movement.
Passive may be reduced.
Decreased quality of movement.
Shoulder control may be reduced.
Instability may be present.
End feel = Stiff.
Neurogenic =
Dermatomes
Myotomes
Reflexes
Neurodynamic =
Median nerve test
Ulnar nerve test
Axillary nerve test
Special Test =
Drop arm test
Empty can test
Full can test
External lag test
Lift off sign test
Pain arc
Bicep load ll test
Apprehension test
Functional Test =
Arm at the back of head
Arm behind lower back
Arm across opposite shoulder
Differential Diagnosis:
Shoulder impingement
SLAP lesions
Thoracic outlet syndrome
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