Rotator Cuff Seizure: A Case Study

Walch et al first described the internal impingement as an intraarticular impingement of the rotator cuff in the abducted and externally rotated shoulder. With 90 degrees of both abduction and external rotation, the articular surface of the posterior superior rotator cuff becomes pinched between the labrum and the greater tuberosity.5 The authors separated the labral lesions from SLAP lesions which extended anteriorly to the biceps anchor at the supraglenoid tubercle, concluding that internal impingement may be responsible for a subset of patients with isolated posterior SLAP tears.5

Russell Carrington is a 25 year old right handed relief pitcher for the MLB team the Baltimore Orioles. Carrington has been playing baseball since he was seven years old and this was his third season in the Major Leagues. Carrington was at the mound and in the motion of throwing a fastball, when he felt a “pop” in his overhand motion. He dropped to his knees and clinched his right shoulder in pain. Athletic trainers came onto the field an upon examination Carrington stated his arm felt like it was “dead” and felt like it was “catching”. Carrington was seen by the team physician. She performed ROM exercises, strength, and stability tests on his shoulder and examined his neck and head to ensure pain wasn’t coming from a pinched nerve. She concluded that further testing and imaging was necessary. Carrington had an X-ray and MRI done on his shoulder and he was diagnosed with a type II SLAP (Superior Labrum Anterior and Posterior) lesion. He didn’t want surgery done because he would miss the remainder of the season and possibly the next, so doctors prescribed non-steroid anti-inflammatory medication and five months physical therapy to strengthen the shoulder capsule. After completion of physical therapy, the pain didn’t improve and arthroscopy surgery was recommended.

Patient is a 57-year-old male fuel tank driver who sustained cumulative trauma on 2/7/2004 due to repetitive movement caused by delivering fuel. As per QME dated 1/25/14, the patient has numbness in the fingers and the patient is diagnoses that he has carpal tunnel syndrome. The left wrist had undergone carpal tunnel surgery; however, he gets numbness from the wrist up into his forearm and numbness in the fingertips. It was also noted that on 12/5/13, the patient complains of shoulder pain bilaterally at 7/10. It is constant and goes into noth arms, along with weakness with numbness in the hands, decreased ability to perform activities of daily living, and impared grip. The pain in the bilateral shoulders is constant and aching with intermittent

This paper is going to be over rotator cuff injuries and what to do if this occurs to an athlete. The rotator cuff consists of four muscles which are the Subscapularis, infraspinatus, teres minor, and the supraspinatus and their associated tendons that insert into the Humerus. These groups of muscles are responsible for rotating the arm internally and externally as well as abducting the shoulder. The acronym for the four muscles of the rotator cuff is known as SITS. The best treatment for symptomatic, nontraumatic rotator cuff tears is unknown. The purpose of this trial was to compare the effectiveness of physiotherapy, acromioplasty, and rotator cuff repair for this injury. The way this trial worked was that 180 shoulders with the symptomatic,

RCT is a common disease. According to general population surveys, the prevalence of rotator cuff tear is 25 % in those older than 50 years of age and 20 % in those older than 20 years of age (1). The rotator cuff is a group of 4 muscles and their tendons supraspinatus, infraspinatus, teres minor, and subscapularis (2). These muscles connect the upper-arm bone, or humerus, to the shoulder blade. The important job of the rotator cuff is to keep the shoulder joint stable. RCT can be caused by degenerative changes, repetitive micro-traumas, severe traumatic injuries, and secondary dysfunctions. Falling on an outstretched hand, unexpected force when pushing or pulling or during shoulder dislocation can cause traumatic injury to the rotator cuff.

Millions of people across the United States suffer from either Bursitis or a rotator cuff injury every year. Although sometimes the two can be misconceived, they are very different in all actuality. Bursitis is the inflammation or irritation of the bursa. A bursa is a fluid-filled sac used as a bumper near the joints to reduce friction. There are many bursae located in your body, some of which being in the hip, shoulder, wrist, and elbow. However, a rotator cuff injury only affects the shoulder area of the body. The “rotator cuff” is composed of the supraspinatus, infraspinatus, subscapularis, and teres minor muscles. There is only one main way to be diagnosed with Bursitis and it happens when you overuse a joint in sports or on the job. You can put the bursa under pressure for a long time, thus causing the bursa to become inflamed.

Rotator Cuff Tendonitis usually occurs in people 30-80 years of age, and the weakness in the shoulder is only mild to moderate. Rotator cuff tendonitis, also knows as " shoulder bursitis" or "impingement syndrome" occurs

The patient was an active participant in both contact as well as non-contact athletic activities. The patient reported occurrence of different symptoms that included; pain, weakness, instability, paresthesia, crepitus, as well as instability of the shoulder during sleep. Sulculus sign was conducted to assess the rotator interval and load and shift test for determination of the patient’s posterior stability. The doctor diagnosed positive for multidirectional instability. The patient’s multidirectional instability was not caused by a traumatic event. The patient had not exercised the joint over a long period of time, hence he had a weak shoulder joint, particularly the rotator cuff. The doctor recommended that the patient should be treated for the pain and inflammation of the shoulder caused by the multidirectional instability and then placed on physical therapy aimed for one year aimed at helping in the strengthening of the muscles of the patient that support the scapula (shoulder blade) and the rotator cuff (shoulder joint) so as to help the patient in returning to normal physical activity and also prevent an injury at the same place

Treatment depends on the damage done to the tendon. By having an accurate diagnosis, a careful physical examination of the shoulder and x-ray examination of the shoulder can help

A rotator cuff tear is an injury that plagues much of the elderly population as well as a variety of athletes. The etiology of a rotator cuff tear is primarily due to the degeneration of the tendons or more specifically the thinning and disorientation of collagen fibers and degradation of various cells and tissues. 1 Rotator cuff tears are more likely to occur with age. Rotator cuff tears may occur due to direct trauma such as falling or shearing linked to a simple throwing or rotation of the arm and shoulder.2

^8,5 ASI occurs when the arm is in adduction with the shoulder internally rotated. The biceps complex pulley, also known as a capsuloligamentous complex, adjoins the anterior glenoid causing injury when in extreme motions. With the PSI, the pulley is put into risk with abduction and external rotation on the posterosuperior glenoid. ^8 PSI is also associated with partial-thickness tears on the deep side of the articular surface of the rotator cuff. ^5 This can be a common cause for a peel-back mechanism associated with a SLAP lesion. ^8 Peel-back mechanisms can be produced many different ways, but are mostly seen with a SLAP lesion or internal impingement. These can occur when the shoulder is placed into abduction and extreme external rotation with a torsional force added to the labro-bicipital complex that is at the base of the biceps on the posterior superior labrum. ^1,5 This causes fatigue and failure of the humeral head that rotates medially over the upper rim of the glenoid fossa creating a shearing force. ^1,5 Increased superior labral strain in overhead athletes occurs during the late-cocking phase of throwing when arm is externally rotated. ^1

*insert article *attachedBesides being able to see the inside of a shoulder, doctors use different physical tests to evaluate the shoulder in order to determine what type of injury and how severe an injury may be. One such test was recently developed by Dr. Carl J. Basamania at the Womack Army Medical center in Fort Bragg, N.C. The test was developed to evaluate shoulder instability in a patient. During the test the Dr. or examiner stands next to the patient who is to lay flat on his/her back. The hand of the examined should is held firmly by the examiner. The examiner then pushes against the clavicle to stabilize th scapula, while they also gently hold the pectoral muscle with their thumb in order to be able to assess relaxation. The examiner then rotates the arm form neutral to full external rotation. If the patient has AIGHL incompetence there is a lack of tightening as the arm reaches full external rotation. The test has appeared to be highly accurate and may be of value to Dr.'s and surgeons alike. After doctors have determined what type and what degree of injury a patient has sustained using various tests it is on to the next step, rehabilitation.

Rotator cuff tendons are prone to degeneration leading to swelling with sub-luxation due to continuous active and passive forces. Rotator cuff pathology includes tendinopathy, tendinosis and bursitis, as well as rotator cuff tears. Most common indication for rotator cuff tears include increasing age and traumatic shoulder injury. Clinical symptoms for rotator cuff injuries include shoulder pain, weakness and loss of range of motion. However, these symptoms are common in various diseases; differential diagnosis includes labral tears, glenohumeral ligament tears or sprains, coracoacromial and arcomioclavicular ligament tears and sprains, osteoarthritis, adhesive capsulitis, proximal peripheral neuropathies and cervical radiculopathy. Hence,

On 3/15/17 due to a schedule conflict Laurie Wawrzyniak met Mr. Rife at the office of Dr. Wines. Mr. Rife has made positive gain in range of motion with physical therapy. He still reports pain when raising the left arm. A cortisone injection was recommended along with a MRI. The injection was done under ultra sound in the office. While performing the injection under ultra sound Dr. Wines noted the rotator cuff was thinning and he was concerned there was a tear. Dr. Wines recommended a MRI of the shoulder. Physical therapy will continue and treatment options will be. The MRI will be done on 3/15/17. I have advised Mr. Rife to obtain a copy of the MRI CD to bring to the appointment on 3/23/17 with Dr. Wines.

The conduction of the Apley’s Scratch Test and Gerber’s Lift off Test along with the MRI scans was to identify Rotator Cuff Tendonitis. These tests trial the movement of the rotator cuff to see how the limitations of movement correspond with the receptance of pain. With Rotator Cuff Tendonitis, the individual will experience uncomfortable pain during movement and at night. Occurrence will happen if the individual holds the arm at a certain position for long periods of time, such as working on the computer for continuous hours, branching with poor posture. Another contribution to the occurrence is the individual’s participation in activities that needs the arm to actively and continuously maneuver