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Park et al. Rotator Cuff Tear Testing Cluster
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The Park et al. Rotator Cuff Tear Testing Cluster is a comprehensive diagnostic tool that objectively evaluates the degree of tear severity in rotator cuff tears. This tool consists of several physical tests, namely: shoulder strength, range of motion, ultrasound, magnetic resonance imaging (MRI), and electromyography (EMG). This cluster of tests can provide an accurate diagnosis of the severity of rotator cuff tears and determine the most appropriate treatment plan. The use of the Park et al.
Transcript
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This is Brent of the Brookbush Institute, and
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...blank
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in this video we're going to go over the
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Park et al. rotator cuff tear testing
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cluster. I'm excited to bring you guys
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this video because it finally brings
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together all of the special test videos
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we've done, into the clusters we actually
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use in clinic. I'm gonna have my friend
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Alyssa come out she's going to help me
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demonstrate this testing cluster. Now
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this cluster is three tests, we're going
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to do the external rotators strength
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test the infraspinatus test. We're
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going to do the drop arm test, and we're
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going to do the painful arc test. If she
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gets a positive and all three of those
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tests,. chances are we have rotator cuff
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tear. Now if we were talking to somebody
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other than Alyssa, her being over 60
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years of age, would also be another
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positive sign that we could add to our
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diagnostic criteria. So I'm
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going to go through these three tests
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real quick here. First we're going to
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start off with that infraspinatus test
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or the external rotators strength test.
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Once again I would demonstrate this, make
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sure you're turning out you're not
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pushing out with your shoulder alright
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so I'll brace your elbow, go ahead and
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brace your wrist like this, go ahead and
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push out. How's that feel? Feels
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pretty strong, she has no pain.
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We're going to go ahead and have her
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stand up. Now the drop arm test normally
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you would be in front of your patient,
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you're going to go ahead and passively
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take them to 90 degrees of shoulder
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abduction. I'm going to go ahead and have
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her hold this for me, can you hold up
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here. Now if I let go, and let's say this
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is her symptomatic side, and all of a
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sudden she dropped, she couldn't even
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hold it up here, that would be a positive
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sign, The other thing you guys will see
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is if I let her go and she slowly brings
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her arms back down, and we saw one side
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fall faster than the other, despite the
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fact that she was trying to bring them
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down equally, that would also be a
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positive sign on this test. Now the last
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one we've done a few times both in the
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clusters and as an end of
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video here, we have the painful arc test,
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this one again patient communication is
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very important. You want to make sure
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they tell you when the pain starts, when
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it's at its worst, and then when it goes
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away as they take their shoulder through
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its entire range of motion of abduction.
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So she's going to come out in this big sweeping
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motion as high as she can, and in
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Alyssa's case, anything? No pain.
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Alright so go ahead and have a seat. She
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obviously was negatived all that these
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three tests, so we're going to say
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rotator cuff probably not torn, your
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rotator cuff is probably fine. now let's
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test your acting skills. We're going to
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say Alyssa's a swimmer, except instead of
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the impingement video we did where we
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talked about a chronic onset, we're going to
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say this time she's coming in three
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weeks after having a spill at the pool.
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She was trying to walk around the pool,
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hit a wet spot, feet went out from under her.
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You guys know what that's like
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especially if you live here in New York
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in a winter. You hit a piece of snow,
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something, feet fly out. She put her arm
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back to block herself, and as she did her
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shoulder gave out. That caused instant pain,
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she hasn't swam since, the pain has been
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getting progressively worse and she's
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known as she's gotten a lot weaker and
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has pain during some functional
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activities, maybe just raising up her arm
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to take a glass out of the top shelf of
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a cupboard. So that would be a
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kind of a standard subjective exam that
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we would get back for somebody who's
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indicative of rotator cuff tear. Now
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we're going to do these tests again,
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we're gonna get a little acting from you,
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you ready? So we maybe go ahead and
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do that infraspinatus test, I brace her
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elbow, I say go ahead and try to push out,
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and all I see is like marked weakness
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right off the bat, and I wouldn't be
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surprised does that hurt. It does. Alright so
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that hurts, that's not good that's
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one positive. Go ahead and stand up for
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me.
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If I take her to 90 degrees here and I
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go ahead and ask her to hold this for me,
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and then slowly let her arms back down
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to her side, and we noticed we already
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have a problem or she's having a hard
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time holding this side up. Did that hurt
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just to try to keep it up? Okay, and if I
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ask you to try to pull your arm up this
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way, can you do it? You can, notice she's
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kind of focused on this side here, how did
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that feel is that painful, yeah, okay.
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So let's do this one more time
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we'll just do this arm okay, and let me
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have you try to go up, where does the
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pain start? Right about there, okay, so she
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has pain right about there, probably
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worse right up here. Yeah, and it wouldn't
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be surprising to me guys if you ask
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somebody to do this painful arc test, and
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they can barely do it because of pain if
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we had a rotator cuff tear. Good, go ahead
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and take a seat for me. Alright, so she
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has positive to all three of those tests
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we have a pretty good indication that we
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have a rotator cuff tear, and unlike our
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impingement syndrome where that gives us
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poor prognosis, poor diagnostic info; in
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this case rotator cuff tears are
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something human movement professionals
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whether we're athletic therapists, we're
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physical therapists, we're chiropractors
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we have to be a little careful with. If
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we see really really marked weakness on
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all of these exams, a whole lot of pain,
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we might want to go ahead and refer out
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to a physician, get some imaging done.
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Because we know that those significant
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tears, those significant rotator cuff
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tears, don't often do very well with
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physical therapy. We don't want to waste
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our clients time, wasted our clients
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resources and money trying to apply
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physical therapy modalities that in the
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long run are probably not going to work
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anyway. This is also one of those
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diagnostic criteria's where we have
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to be very careful with the
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interventions we
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select, because we don't want to select
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interventions that could make that tear
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worse. So whereas I might give somebody
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let's say external rotation activation
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to start with, and I might grab let's say
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a blue band which is the second or third
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strength up, maybe for her I'm just going
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to go okay, can we get a little external
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rotation done. If we can i'm going to
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start off with a really light band to
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start strengthening and maybe i don't
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even want to start with those
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strengthening activation techniques, I
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start with some mobility techniques. See
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if increasing mobility, reducing some of
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the hyperactivity that comes with a
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rupture or comes with in acute injury
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like that, helps to improve symptoms. If
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it does then we continue on with our
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therapy and see if we can do this
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conservatively rather than
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surgically. So there you guys have it the
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Park et al rotator cuff testing cluster.
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That was the external rotation strength
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or infraspinatus test, the drop arm test,
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and the painful arc test. Definitely one
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of the testing clusters we use here,
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along with that Park et al. impingement
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test when we have individuals who come
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in with shoulder pain.
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