Rotator Cuff Exam

Summary

This video script provides a detailed guide for assessing rotator cuff injuries in patients, focusing on the four key muscles: supraspinatus, infraspinatus, teres minor, and subscapularis. The examination includes inspection for deformities, muscle atrophy, and swelling, followed by palpation to check for tenderness and temperature changes. Range of motion tests assess flexibility and strength, both actively and passively. Special tests like the Supraspinatus, External Rotation, Hornblower's, Lift-off, and subacromial impingement tests help identify specific muscle injuries or impingements, ensuring a comprehensive evaluation for shoulder pain and dysfunction.

Takeaways

• 😀 The rotator cuff consists of four muscles: supraspinatus, infraspinatus, teres minor, and subscapularis, which surround the shoulder joint.
• 😀 Rotator cuff injuries are the most common cause of shoulder pain, particularly in patients over 40 years old.
• 😀 Common symptoms of rotator cuff injuries include shoulder pain, weakness, and limited range of motion.
• 😀 A physical examination is essential to assess the condition of the shoulder muscles and identify any abnormalities.
• 😀 The examination starts with inspection for signs of deformities, asymmetry, swelling, or skin abnormalities around the shoulder and scapula area.
• 😀 Palpation is used to detect tenderness, swelling, deformities, or temperature changes in the shoulder joint and surrounding areas.
• 😀 Range of motion testing is conducted both actively and passively, comparing the shoulder's movements on both sides to assess limitations.
• 😀 Specific tests like the MTK centers test, jobdesk test, and halo test help identify injuries in individual muscles of the rotator cuff.
• 😀 The external rotation test and hornblower test are designed to identify injuries in the infraspinatus and teres minor muscles, respectively.
• 😀 The liftoff test and club nyir sign test are used to assess injuries in the subscapularis muscle and identify possible subacromial impingement.
• 😀 The Hokkian Kennedy test helps identify subacromial impingement by testing for pain during internal rotation and flexion of the shoulder.

Q & A

What is the rotator cuff and what does it consist of?

The rotator cuff is a group of muscles and tendons that surround the shoulder joint, specifically composed of four muscles: supraspinatus, infraspinatus, teres minor, and subscapularis.

What is the most common cause of shoulder pain?

The most common cause of shoulder pain is rotator cuff injury, which usually occurs in individuals over the age of 40.

What symptoms do patients typically experience with rotator cuff injuries?

Patients often experience shoulder pain, weakness, and limited range of motion in the shoulder joint.

What is the first step in a physical examination for shoulder pain?

The physical examination begins with inspecting the area around the scapula to check for signs of deformity, asymmetry, lumps, swelling, or wounds.

What should be checked during palpation in a shoulder examination?

During palpation, the examiner checks for tenderness, swelling, deformities, and skin temperature changes around the shoulder joint, sternoclavicular joint, clavicle, acromioclavicular joint, and other key structures.

What is the purpose of testing range of motion in a shoulder exam?

Range of motion testing helps assess the mobility of the shoulder joint, both actively (by the patient) and passively (by the examiner), and compares the movement on both sides.

How is the supraspinatus muscle tested?

To test the supraspinatus, the examiner asks the patient to abduct the arm 90° and move it 30° forward in the scapular plane, then applies downward pressure on the arm while the patient resists. A positive test is when the patient is unable to resist or experiences pain.

What is the purpose of the external rotation test?

The external rotation test is used to identify injuries to the infraspinatus muscle. The patient’s arm is flexed at 90° and the examiner applies resistance during external rotation of the arm.

How does the hornblower’s test help diagnose shoulder injuries?

The hornblower's test is used to identify injuries to the teres minor muscle. The patient abducts the arm 90° and flexes the elbow 90°, then tries to externally rotate the shoulder against the examiner's resistance. A positive test indicates an injury.

What does the liftoff test assess?

The liftoff test is used to assess injuries to the subscapularis muscle. The patient is asked to place the back of their hand on their lower back and lift it away, with the examiner checking for abnormal scapula movement or pain.