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77-416: T46 may refer to: T46 (classification) , a disability sport classification T-46 (tank) a Soviet tank Fairchild T-46 , an American jet trainer aircraft SJ T46 , a Swedish locomotive Slingsby T.46 , a British glider [REDACTED] Topics referred to by the same term This disambiguation page lists articles associated with the same title formed as

154-588: A pinched nerve , osteoarthritis , or rheumatoid arthritis . Neer promoted the concept of three stages of rotator cuff disease. Stage I, according to Neer, occurred in those younger than 25 years and involved edema and hemorrhage of the tendon and bursa . Stage II involved tendinitis and fibrosis of the rotator cuff in 25- to 40-year-olds. Stage III involved tearing of the rotator cuff (partial or full thickness) and occurred in those older than 40 years. For surgical purposes, tears are also described by location, size or area, and depth. Further subclasses include

231-469: A 2003 attempt to address "the overall objective to support and co-ordinate the ongoing development of accurate, reliable, consistent and credible sport focused classification systems and their implementation." There were changes made to the class in 2008, that made the category more selective by changing the minimum criteria to be eligible to compete in this classification. For the 2016 Summer Paralympics in Rio,

308-690: A 2008 study the frequency of such tears increased from 13% in the youngest group (aged 50–59 y) to 20% (aged 60–69 y), 31% (aged 70–79 y), and 51% in the oldest group (aged 80–89 y). Some risk factors, such as increased age and height, cannot be changed. Increased body mass index is also associated with tearing. Recurrent lifting and overhead motions are at risk for rotator cuff injury as well. This includes jobs that involve repetitive overhead work, such as carpenters, painters, custodians, and servers. People who play sports that involve overhead motions, such as swimming , water polo , volleyball , baseball , and tennis , and American football quarterbacks are at

385-471: A case-by-case basis. In case there was a need for classification or reclassification at the Games despite best efforts otherwise, athletics classification was scheduled for September 4 and September 5 at Olympic Stadium. For sportspeople with physical or intellectual disabilities going through classification or reclassification in Rio, their in competition observation event is their first appearance in competition at

462-429: A color similar to that of the track, and they must be placed entirely behind the starting line. Their location needs to be such that they do not interfere with the start of any other athlete. In field events for this class, athletes are not required to wear a prosthetic. In jumping events, athletes have 60 seconds during which they must complete their jump. During this time, they can adjust their prosthetic. If during

539-426: A combination of both. The cuff is responsible for stabilizing the glenohumeral joint to allow abduction and rotation of the humerus . When trauma occurs, these functions can be compromised. Because individuals are dependent on the shoulder for many activities, overuse can lead to tears, with the vast majority being in the supraspinatus tendon. The role of the supraspinatus is to resist downward motion, both while

616-538: A complete repair. Other options are a partial repair, and reconstruction involving a bridge of biologic or synthetic substances. Partial repairs are typically performed on retracted cuff tears. Tendon transfers are prescribed for young, active cuff-tear individuals who experience weakness and decreased range of motion, but little pain. The technique is not considered appropriate for older people or those with pre-operative stiffness or nerve injuries. People diagnosed with glenohumeral arthritis and rotator cuff anthropathy have

693-458: A daily basis. They have reduced upper limb functionality. Medically, this class includes people with contracture/ankylosis in joints of one limb and limited function in another limb. It means they have limited function in two limbs but to a lesser extent than LAF3. In terms of functional classification, this means the sportsperson is ambulatory with or without crutches and braces, has balance problems and reduced function in their throwing arm. For

770-404: A depressed position. Localized pain on the anterior shoulder suggests subacromial impingement, whereas posterior shoulder pain suggests internal impingement. For the diagnosis of full-thickness rotator cuff tear, the best combination appears to include once more the painful arc and weakness in external rotation, and in addition, the drop arm sign . This test is also known as Codman's test. The arm

847-526: A greater risk of experiencing a rotator cuff tear. Striking-based combat sports , such as boxing , also account for severe rotator cuff injuries in competitors, typically when their punches miss the target, or overusing the shoulder by throwing an excessively large number of punches. Certain track-and-field activities, such as shot put and javelin throw are also of considerable risk, especially when athletes perform outdoors under cold weather conditions or neglect warming-up procedures; proper warm-up of

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924-424: A high-riding humeral head and the acromion above it may lead to X-ray findings of wear on the humeral head and acromion; secondary degenerative arthritis of the glenohumeral joint (the ball and socket joint of the shoulder), called cuff arthropathy, may follow. Incidental X-ray findings of bone spurs at the adjacent acromioclavicular joint may show a bone spur growing from the outer edge of the clavicle downward toward

1001-506: A jump, the athlete's prosthesis falls off, the jump length start should start from where the takeoff board and the distance is where the prosthesis fell off. If prosthesis falls off outside the landing zone nearer the board than where athlete landed, the jump counts as a foul. In throwing events, implement weights are as follows: The classification was created by the International Paralympic Committee and has roots in

1078-503: A letter–number combination. If an internal link led you here, you may wish to change the link to point directly to the intended article. Retrieved from " https://en.wikipedia.org/w/index.php?title=T46&oldid=1153898055 " Category : Letter–number combination disambiguation pages Hidden categories: Short description is different from Wikidata All article disambiguation pages All disambiguation pages T46 (classification) This classification

1155-406: A positive response cannot rule out a partial rotator-cuff tear. However, with demonstration of good, pain-free function, the treatment will not change, so the test is useful in helping to avoid overtesting or performing unnecessary surgery. Tears of the rotator cuff tendon are described as partial or full thickness, and full thickness with complete detachment of the tendons from bone. Shoulder pain

1232-472: A relationship between age and cuff tear prevalence, with the most common cause being age-related degeneration and, less frequently, sports injuries or trauma . Those most prone to failed rotator cuff syndrome are people 65 years of age or older; and those with large, sustained tears. Smokers, people with diabetes, individuals with muscle atrophy or fatty infiltration, and those who do not follow postoperative-care recommendations also are at greater risk. In

1309-460: A side effect. A sling may be offered for short-term comfort, with the understanding that undesirable shoulder stiffness can develop with prolonged immobilization. Early physical therapy may afford pain relief with modalities (e.g. iontophoresis) and help to maintain motion. Ultrasound treatment is not efficacious. As pain decreases, strength deficiencies and biomechanical errors can be corrected. Shock wave therapy has seen widespread use since

1386-775: A significant risk for the development of irreparable rotator cuff damage, or the patient is very active and/or uses their arms for overhead work or sports. Rotator-cuff surgery appears to result in similar benefits as nonoperative management. As a conservative approach has less complications and is less expensive it is recommended as initial treatment. Those with pain but reasonably maintained function are suitable for nonoperative management. This includes medications that provide pain relief such as anti-inflammatory agents, topical pain relievers such as cold packs, and if warranted, subacromial corticosteroid or local anesthetic injection. Topical glyceryl trinitrate appears effective at relieving acute symptoms however, headaches were reported as

1463-399: A starting block. They have an option to start from a standing position, a crouch or a 3-point stance. In relay events involving T40s classes, no baton is used. Instead, a handoff takes place via touch in the exchange zone. People with arm amputations in this class can have elevated padded blocks to place their stumps on for the start of the race. These blocks need to be in a neutral color or

1540-559: A study which measured tendon length against the size of the injured rotator cuff, researchers learned that as rotator cuff tendons decrease in length, the average rotator cuff tear severity is proportionally decreased, as well. This shows that larger individuals are more likely to develop a severe rotator cuff tear if they do not "tighten the shoulder muscles around the joint". Another study observed 12 different positions of movements and their relative correlation with injuries occurred during those movements. The evidence shows that putting

1617-441: A thorough history and physical examination. Over-reliance on imaging may lead to overtreatment or distract from the true dysfunction causing symptoms. Symptoms may occur immediately after trauma (acute) or develop over time (chronic). Acute injury is less frequent than chronic disease, but may follow bouts of forcefully raising the arm against resistance, as occurs in weightlifting, for example. In addition, falling forcefully on

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1694-505: Is an ambulant class for people with minimal issues with trunk and lower limb functionality. People in this class have impairments in one upper limb. Medically, this class includes people with arthritis and osteoporosis, or ankylosis of the knee. In practice, this means minimal disability. In terms of functional classification, this means the sportsperson is ambulatory with good upper limb functionality, and minimal trunk or lower limb functionality. People in this class are not required to use

1771-432: Is an important component of effective clinical practice. Clinical judgement, rather than over-reliance on MRI or any other modality, is strongly advised in determining the cause of shoulder pain, or planning its treatment, since rotator cuff tears are also found in some without pain or symptoms. The role of X-ray, MRI, and ultrasound is adjunctive to clinical assessment and serves to confirm a diagnosis provisionally made by

1848-475: Is associated with pain over the front and side (anterolateral) of the shoulder pain that radiates towards the elbow. The pain may occur with shoulder movement above the horizontal position, shoulder flexion and abduction . Pain is often described as weakness. Actual muscle weakness does not correlate with symptoms of weakness. Symptom severity does not correlate with rotator cuff defect size and associated muscle quality. Epidemiological studies strongly support

1925-764: Is comparable to the activity limitations in running and jumps roughly comparable to that found in an athlete with a unilateral above elbow amputation. Athletes who have impairments of both arms, affecting elbow and wrist and roughly comparable to the activity limitations experienced by an athlete with bilateral through wrist / below elbow amputations of both arms, or an athlete with one above elbow amputation and one below elbow amputation, will also be placed in this class". The International Paralympic Committee defined this classification on their website in July 2016 as, "Upper limb/s affected by limb deficiency, impaired muscle power or impaired range of movement". This class includes people from

2002-425: Is currently considered the gold standard, ultrasound may be most cost-effective. Usually, a tear will be undetected by X-ray, although bone spurs, which can impinge upon the rotator cuff tendons, may be visible. Such spurs suggest chronic severe rotator cuff disease. Double-contrast arthrography involves injecting contrast dye into the shoulder joint to detect leakage out of the injured rotator cuff, and its value

2079-594: Is for disability athletics . T46 is for track events and F46 is for field events. This classification is one of several classifications for athletes with ambulant related disabilities. Similar classifications are T40 , T42 , T43 , T44 , T45 and T47 . Jane Buckley, writing for the Sporting Wheelies , describes the athletes in this classification as: "Single above elbow/Single below elbow amputation or similar disability." The Australian Paralympic Committee defines this classification as being for athletes who have

2156-436: Is influenced by the experience of the operator. The most common diagnostic tool is magnetic resonance imaging (MRI), which can sometimes indicate the size of the tear, as well as its location within the tendon. Furthermore, MRI enables the detection or exclusion of complete rotator cuff tears with reasonable accuracy and is also suitable for diagnosing other pathologies of the shoulder joint. The logical use of diagnostic tests

2233-463: Is mucoid degeneration. Most people develop rotator cuff tendinopathy within their lifetime. As part of rotator cuff tendinopathy, the tendon can thin and develop a defect. This defect is often referred to as a rotator cuff tear . Acute, traumatic rupture of the rotator cuff tendons can also occur, but is less common. Traumatic rupture of the rotator cuff usually involves the tendons of more than one muscle . Rotator cuff tendinopathy is, by far,

2310-565: Is often done on site at a sports training facility or competition. The second stage is observation in practice, the third stage is observation in competition and the last stage is assigning the sportsperson to a relevant class. Sometimes the health examination may not be done on site because the nature of the amputation could cause not physically visible alterations to the body. During the training portion of classification, observation may include being asked to demonstrate their skills in athletics, such as running, jumping or throwing. A determination

2387-590: Is raised to the side to 90° by the examiner. The injured individual then attempts to lower the arm back to neutral with palm down. If the arm drops suddenly or pain is experienced, the test is considered positive. Magnetic resonance imaging ( MRI ) and ultrasound are comparable in efficacy and helpful in diagnosis, although both have a false positive rate of 15–20%. MRI can reliably detect most full-thickness tears, although very small pinpoint tears may be missed. In such situations, an MRI combined with an injection of contrast material, an MR-arthrogram, may help to confirm

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2464-551: Is recommended that people who are unable to raise their arm above 90 degrees after two weeks should be further assessed. Surgery may be offered for acute ruptures and large attritional defects with good quality muscle. The benefits of surgery for smaller defects are unclear as of 2019. Rotator cuff tendinopathy is often asymptomatic even when there is thinning or a full thickness defect. Rotator cuff defects are common on post mortem and MRI studies in those without any history of shoulder pain or symptoms. Rotator cuff tendinopathy

2541-400: Is reliable in the detection of partial-thickness rotator cuff tears. However, its routine use is not advised, since it involves entering the joint with a needle, with the potential risk of infection. Consequently, the test is reserved for cases in which the diagnosis remains unclear. Musculoskeletal ultrasound has been advocated by experienced practitioners, avoiding the radiation of X-ray and

2618-588: Is then made as to what classification an athlete should compete in. Classifications may be Confirmed or Review status. For athletes who do not have access to a full classification panel, Provisional classification is available; this is a temporary Review classification, considered an indication of class only, and generally used only in lower levels of competition. Notable athletes in this class include T46 world record holders Dinesh Priyantha (SRI), Heath Francis (AUS), Gunther Matzinger (AUT) and Yunidis Castillo (CUB). Ajibola Adeoye 's T46 100m world record, set at

2695-403: Is usually eccentric , such as when two people are carrying a load and one lets go, forcing the other to maintain force while the muscle elongates. Chronic tears are indicative of extended use in conjunction with other factors such as poor biomechanics or muscular imbalance. Ultimately, most are the result of wear that occurs slowly over time as a natural part of aging. They are more common in

2772-431: Is usually found only through examination. With longer-standing pain, the shoulder is favored and gradually loss of motion and weakness may develop, which, due to pain and guarding, are often unrecognized and only brought to attention during the physical exam. Primary shoulder problems may cause pain over the deltoid muscle intensified by abduction against resistance – the impingement sign. This signifies pain arising from

2849-424: Is variable and may not be proportional to the size of the tear. Tears are also sometimes classified based on the trauma that caused the injury: Long-term overuse/abuse of the shoulder joint is generally thought to limit range of motion and productivity due to daily wear and tear of the muscles, and many public web sites offer preventive advice. (See external links) The recommendations usually include: According to

2926-445: The 1992 Summer Paralympics , has not yet been beaten. Simon Patmore (AUS) and South African sprinter Zivan Smith also run in this class. Madeleine Hogan (AUS) is a field competitor in this class, winner of the F46 javelin event at the 2011 IPC Athletics World Championships . Rotator cuff tear Rotator cuff tendinopathy is a process of senescence . The pathophysiology

3003-415: The International Paralympic Committee had a zero classification at the Games policy. This policy was put into place in 2014, with the goal of avoiding last minute changes in classes that would negatively impact athlete training preparations. All competitors needed to be internationally classified with their classification status confirmed prior to the Games, with exceptions to this policy being dealt with on

3080-406: The muscles ; noticeable pain during rest; crackling sensations ( crepitus ) when moving the shoulder; and inability to move or lift the arm sufficiently, especially during abduction and flexion motions. Pain in the anterolateral aspect of the shoulder is not specific to the shoulder, and may arise from, and be referred from, the neck, heart, or gut. Symptoms will often include pain or ache over

3157-445: The "Single arm, above or below elbow amputation. Normal function in both lower limbs. Other impairments in trunk. Upper limb function in throwing." After the introduction of the T47 classification in 2013, the International Paralympic Committee redefined T46 as being for athletes who: "...have a unilateral upper limb impairment that affects the shoulder and/or elbow joint of one arm and which

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3234-456: The 1,500 meter race. People who are Les Autres compete in this class. This includes LAF4 and LAF6 classified athletes. In general, Les Autres classes cover sportspeople with locomotor disabilities regardless of their diagnosis. LAF4 sportspeople in this class may compete in T46. This is a standing class for people with an upper limb deficiency impacting their joints in one or both arms. At

3311-655: The 100 meter race, men in the A3, A4, A5, A6, A7, A8 and A9 in the discus, men in A6, A7 and A8 in the discus, men in A1, A2, A3, A4, A5, A6, A7, A8 and A9 in the javelin, men in A6, A7 and A8 in the javelin, men in A8 and A9 in the shot put, men in A6, A7 and A8 in the high jump, men in A6, A7 and A8 in the long jump, men in A6, A7 and A8 in the 100 meter race, men in A7 and A8 in the 400 meter race, and men in A7 and A8 in

3388-448: The 1984 Summer Paralympics, LAF4 sportspeople were described by the Games organizers as "ambulant, with or without crutches and/or braces. They had weakness in the dominant arm, causing reduced function." LAF6 competitors can be classified into several athletics classes including F46. While athletes in this class have minimal functionality problems with their throwing arm, they have an impairment that impacts their non-throwing arm. At

3465-481: The 1984 Summer Paralympics, LAF4, LAF5 and LAF6 track athletes had the 100 meters and 1,500 meters on their program. In field events, they had shot put, discus, javelin and club throws. No jumping events were on the program for these classes. There was a large range of sportspeople with different disabilities in this class at the 1984 Summer Paralympics. LAF4 is an ambulant class for people who have difficulty moving or severe balance problems. They may use crutches on

3542-413: The 1984 Summer Paralympics, LAF4, LAF5 and LAF6 track athletes had the 100 meters and 1,500 meters on their program. In field events, they had shot put, discus, javelin and club throws. No jumping events were on the program for these classes. There was a large range of sportspeople with different disabilities in this class at the 1984 Summer Paralympics. LAF6 is an Les Autres sports classification. It

3619-671: The 1990s to treat various musculoskeletal disorders including rotator cuff disease, but evidence of its efficacy remains dubious. In a review of 2020, the benefits and harms of shock wave therapy for rotator cuff disease, with or without calcificationcurrently, were investigated. They found low to moderate certainty evidence, that there were very few clinically important benefits of shock wave therapy, and uncertainty regarding its safety. A conservative physical therapy program begins with preliminary rest and restriction from engaging in activities which gave rise to symptoms. Normally, inflammation can usually be controlled within one to two weeks, using

3696-431: The Games. Classification is often based on the anatomical nature of the amputation. The classification system takes several things into account when putting people into this class. These include which limbs are effected, how many limbs are affected, and how much of a limb is missing. For this class, classification generally has four phase. The first stage of classification is a health examination. For amputees, this

3773-702: The ISOD A6 and A8 classes . People who are amputees compete in this class, including and A8. In general, track athletes with amputations in should be considerate of the surface they are running on, and avoid asphalt and cinder tracks. The nature of an A6 or A8 athletes's amputations in this class can effect their physiology and sports performance. Because they are missing a limb, amputees are more prone to overuse injuries in their remaining limbs. Common problems for intact upper limbs for people in this class include rotator cuffs tearing, shoulder impingement , epicondylitis and peripheral nerve entrapment. A study of

3850-537: The acromiohumeral distance, acromial shape, fatty infiltration or degeneration of muscles , muscle atrophy , tendon retraction, vascular proliferation, chondroid metaplasia, and calcification . Again, in surgical planning, age-related degeneration of thinning and disorientation of the collagen fibers, myxoid degeneration, and hyaline degeneration are considered. Diagnostic modalities, dependent on circumstances, include X-ray, MRI, MR arthrography , double-contrast arthrography, and ultrasound . Although MR arthrography

3927-455: The acromion. Cricket bowling , swimming , tennis , baseball , and kayaking are often implicated. Progression to a hooked acromion could be an adaptation to an already damaged, poorly balanced rotator cuff with resultant stress on the coracoacromial arch . Other anatomical factors include an os acromiale and acromial spurs. Environmental factors include age, shoulder overuse, smoking, and medical conditions that affect circulation or impair

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4004-440: The alternative of total shoulder arthroplasty, if the cuff is largely intact or repairable. If the cuff is incompetent, a reverse shoulder arthroplasty is available and, although not as robust a prosthesis, does not require an intact cuff to maintain a stable joint. Diagnosis is based upon physical assessment and history, including description of previous activities and acute or chronic symptoms. A systematic physical examination of

4081-401: The arm in a neutral position relieves tension on all ligaments and tendons. One article observed the influence of stretching techniques on preventive methods of shoulder injuries. Increased velocity of exercise increases injury, but beginning a fast-movement exercise with a slow stretch may cause muscle/tendon attachment to become more resistant to tearing. When exercising, exercising

4158-442: The arm is raised in a forward or upward position. Repetitive impingement can inflame the tendons and bursa, resulting in the syndrome. Well-documented anatomic factors include the morphologic characteristics of the acromion , a bony projection from the scapula that curves over the shoulder joint. Hooked, curved, and laterally sloping acromia are strongly associated with cuff tears and may cause damage through direct traction on

4235-501: The arm straight out from the body with the palm up, the person then needs to hold it there for 10 seconds) and the external rotation lag sign (with the arm by the side and the elbow bent to 90 degrees the person tries to rotate outwards against resistance). A combination of tests seems to provide the most accurate diagnosis. For impingement, these tests include the Hawkins-Kennedy impingement sign, in which an examiner medially rotates

4312-530: The diagnosis. It should be realized that a normal MRI cannot fully rule out a small tear (a false negative) while partial-thickness tears are not as reliably detected. While MRI is sensitive in identifying tendon degeneration (tendinopathy), it may not reliably distinguish between a degenerative tendon and a partially torn tendon. Again, magnetic resonance arthrography can improve the differentiation. An overall sensitivity of 91% (9% false negative rate) has been reported, indicating that magnetic resonance arthrography

4389-565: The dominant arm, but a tear in one shoulder signals an increased risk of a tear in the opposing shoulder. Several factors contribute to degenerative, or chronic, rotator cuff tears of which repetitive stress is the most significant. This stress consists of repeating the same shoulder motions frequently, such as overhead throwing, rowing, and weightlifting. Many jobs that require frequent shoulder movement such as lifting and overhead movements also contribute. In older populations impairment of blood supply can also be an issue. With age, circulation to

4466-487: The expense of MRI while demonstrating comparable accuracy to MRI for identifying and measuring the size of full-thickness and partial-thickness rotator cuff tears. This modality can also reveal the presence of other conditions that may mimic rotator cuff tear at clinical examination, including tendinosis, calcific tendinitis, subacromial subdeltoid bursitis, greater tuberosity fracture, and adhesive capsulitis. However, MRI provides more information about adjacent structures in

4543-419: The front and outer aspect of the shoulder, pain aggravated by leaning on the elbow and pushing upward on the shoulder (such as leaning on the armrest of a reclining chair), intolerance of overhead activity, pain at night when lying directly on the affected shoulder, and pain when reaching forward (e.g., unable to lift a gallon of milk from the refrigerator). Weakness may be reported, but is often masked by pain and

4620-411: The inflammatory and healing response, such as diabetes mellitus . Intrinsic factors refer to injury mechanisms that occur within the rotator cuff itself. The principal is a degenerative-microtrauma model, which supposes that age-related tendon damage compounded by chronic microtrauma results in partial tendon tears that then develop into full rotator cuff tears. As a result of repetitive microtrauma in

4697-400: The injured individual's flexed arm, forcing the supraspinatus tendon against the coracoacromial ligament and so producing pain if the test is positive, a positive painful arc sign, and weakness in external rotation with the arm at the side. Another common impingement test is the neer test. The neer test is performed by the examiner maximally forward flexing the patient's arm with the scapula in

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4774-421: The most common reason people seek care for shoulder pain . Pain related to rotator cuff tendinopathy is typically on the front side of the shoulder, down to the elbow, and worse reaching up or back. Diagnosis is based on symptoms and examination . Medical imaging is used mostly to plan surgery and is not needed for diagnosis. Treatment may include pain medication such as NSAIDs and specific exercises. It

4851-418: The rotator cuff tendons decreases, impairing natural ability to repair, increasing risk for tear. Another potential contributing cause is impingement syndrome , the most common non-sports related injury and which occurs when the tendons of the rotator cuff muscles become irritated and inflamed while passing through the subacromial space beneath the acromion . This relatively small space becomes even smaller when

4928-430: The rotator cuff, but cannot distinguish among inflammation, strain, or tear. Individuals may report that they are unable to reach upward to brush their hair or to lift a can of food from an overhead shelf. No single physical examination test distinguishes reliably between bursitis, partial-thickness, and full-thickness tears. The most useful single test for infraspinatous tendon tears is the drop sign (the examiner lifts

5005-435: The rotator cuff. Spurs may also be seen on the underside of the acromion, once thought to cause direct fraying of the rotator cuff from contact friction, a concept currently regarded as controversial. As part of clinical decision-making, a simple, minimally invasive, in-office procedure, the rotator cuff impingement test, may be performed. A small amount of a local anesthetic and an injectable corticosteroid are injected into

5082-683: The setting of a degenerative rotator cuff tendon, inflammatory mediators alter the local environment and oxidative stress induces tenocyte apoptosis , causing further rotator cuff tendon degeneration. A neural theory also exists that suggests neural overstimulation leads to the recruitment of inflammatory cells and may also contribute to tendon degeneration. Depending upon the diagnosis, several treatment alternatives are available. They include revision repair, non-anatomic repair, tendon transfer, and arthroplasty. When possible, surgeons make tension-free repairs in which they use grafted tissues rather than stitching to reconnect tendon segments. This can result in

5159-732: The shoulder as a whole and not one or two muscle groups is also found to be imperative. When the shoulder muscle is exercised in all directions, such as external rotation, flexion, and extension, or vertical abduction, it is less likely to develop a tear of the tendon. A rotator cuff tear can be treated operatively or non-operatively. No benefit is seen from early rather than delayed surgery, and many with partial tears and some with complete tears will respond to nonoperative management. Consequently, an individual may begin with nonsurgical management. However, early surgical treatment may be considered in significant (>1 cm – 1.5 cm) acute tears, in young individuals with full-thickness tears who have

5236-566: The shoulder can cause acute symptoms. These traumatic tears predominantly affect the supraspinatus tendon or the rotator interval and symptoms include severe pain that radiates through the arm, and limited range of motion, specifically during abduction of the shoulder. Chronic tears occur among individuals who constantly participate in overhead activities, such as pitching or swimming, but can also develop from shoulder tendinitis or rotator cuff disease. Symptoms arising from chronic tears include sporadic worsening of pain, debilitation, and atrophy of

5313-403: The shoulder comprises inspection, palpation, range of motion, provocative tests to reproduce the symptoms, neurological examination, and strength testing. The shoulder should also be examined for tenderness and deformity. Since pain arising from the neck is frequently 'referred' to the shoulder, the examination should include an assessment of the cervical spine looking for evidence suggestive of

5390-418: The shoulder is relaxed and carrying weight. Supraspinatus tears usually occurs at its insertion on the humeral head at the greater tubercle . Though the supraspinatus is the most commonly injured tendon in the rotator cuff, the other three can also be injured at the same time. The amount of stress needed to acutely tear a rotator cuff tendon will depend on the underlying condition of the tendon. If healthy,

5467-409: The shoulder, such as the capsule, glenoid labrum muscles, and bone, and these factors should be considered in each case when selecting the appropriate study. X-ray projectional radiography cannot directly reveal tears of the rotator cuff, a 'soft tissue', and consequently, normal X-rays cannot exclude a damaged cuff. However, indirect evidence of pathology may be seen in instances where one or more of

5544-433: The stress needed will be high, such as with a fall on the outstretched arm. This stress may occur coincidentally with other injuries such as a dislocation of the shoulder or separation of the acromioclavicular joint . In the case of a tendon with pre-existing degeneration, the force may be more modest, such as with a sudden lift, particularly with the arm above the horizontal position. The type of loading involved with injury

5621-506: The subacromial space to block pain and provide anti-inflammatory relief. If pain disappears and shoulder function remains good, no further testing is pursued. The test helps to confirm that the pain arises primarily from the shoulder, rather than being referred from the neck, heart, or gut. If pain is relieved, the test is considered positive for rotator-cuff impingement, of which tendinitis and bursitis are major causes. However, partial rotator-cuff tears may also demonstrate good pain relief, so

5698-437: The tendon. Conversely, flat acromia may have an insignificant involvement in cuff disease and consequently may be best treated conservatively. The development of these different acromial shapes is likely both genetic and acquired. In the latter case, there can be a progression from flat to curved or hooked with increasing age. Repetitive mechanical activities such as sports and exercise may contribute to flattening and hooking of

5775-441: The tendons has undergone degenerative calcification ( calcific tendinitis ). The humeral head may migrate upward (high-riding humeral head) secondary to tears of the infraspinatus, or combined tears of the supraspinatus and infraspinatus. The migration can be measured by the distance between: Normally, the former is positioned inferiorly to the latter, and a reversal therefore indicates a rotator cuff tear. Prolonged contact between

5852-459: The throwing and/or swinging arm can help reduce the stress on the musculature of the shoulder girdle. Corticosteroid injections around the tendons increase the risk of tendon tear and delay tendon healing. The shoulder is a complex mechanism involving bones, ligaments , joints , muscles , and tendons . The two main causes are acute injury or chronic and cumulative degeneration of the shoulder joint. Mechanisms can be extrinsic , intrinsic or

5929-557: Was done comparing the performance of athletics competitors at the 1984 Summer Paralympics when the ISOD classification system was in use. It found there was no significant difference in performance in times between women in A6 , A7 and A8 in the discus, women in A6, A7 and A8 in the shot put, women in the A6, A7 and A8 in the long jump, women in A6, A7 and A8 in the 100 meter race, women in A5 , A6, A7 and A8 in

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