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Rotator cuff thinning or tear
List three next steps in your diagnostic workup. Press pause and list your answers. resume when you are ready to receive feedback. plain films of the shoulder in this patient symptoms and physical examination findings are diagnosed in plain films are of limited value in the absence of trauma and the high likelihood of an impingement syndrome. Impingement syndromes are amenable to conservative therapy. conservative therapy includes avoidance of trigger motions swath and sling support that allows shoulder movement but takes the weight of the arm off the shoulder non steroidal analgesics and if needed physical therapy in the setting of trauma Antero posterior and axillary radiographic views can demonstrate rotator cuff thinning or tear and narrowing of the subacromial space between the humerus and the inferior surface of the acromion which is normally less than seven millimeters ultrasound for patients to do not respond to conservative therapy ultrasonography of the shoulder by experienced operators has shown good diagnostic accuracy for rotator cuff syndromes and Bicipital tendon disorders. The accuracy of diagnostic ultrasonography is comparable to that of magnetic resonance imaging or MRI.
For full thickness tears sensitivity is approximately 92% and specificity is approximately 93% ultrasonography is less expensive than MRI, and often is preferred by patients MRI in patients with persisting symptoms, high suspicion of rotator cuff tear, uncertain diagnosis or the prospect of surgery MRIs, the preferred diagnostic study for full thickness tears. MRI has a reported sensitivity of 94% and specificity of 93%. If MRI is negative, a rotator cuff tear is highly unlikely. MRI also demonstrates pathologic processes such as a vascular necrosis, biceps tendinopathy, and degenerative and inflammatory conditions of the shoulder. In summary, this 52 year old housepainter has a two month history of progressing right shoulder pain with overhead movements. His shoulder causes pain at night when the patient’s sleeps on his right side. He hears an occasional grating sound. There is no history of trauma other than a minor shoulder injury from high school football. The patient denies any associated neck or back Pain and reports no arm or leg numbness. paraesthesia shows weakness or gate change. On physical examination. The patient has tenderness over the right lateral shoulder, some limitation of shoulder range of motion and positive findings on all five recommended tests for rotator cuff syndrome. These are the painful arc tests to provoke pain, the three strength tests internal rotation, external rotation, and drop arm test and the composite test.(Click here)