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This is Brent of the Brookbush Institute, and
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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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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.