Rotator Cuff

Question 1

The STAR–Shoulder model primarily classifies patients based on:
A. Imaging findings
B. Pathoanatomic diagnosis
C. Tissue irritability and impairments
D. Surgical candidacy

Answer 1

C. Tissue irritability and impairments

Question 2

Rotator cuff related pain syndrome is best described as:
A. Isolated bursitis
B. Single tissue pathology
C. Multiple potential pain generators
D. Pure external impingement

Answer 2

C. Multiple potential pain generators

Question 3

Which pain location is most common in subacromial pain syndrome?
A. Medial scapular border
B. Anterolateral shoulder
C. Posterior elbow
D. Neck only

Answer 3

B. Anterolateral shoulder

Question 4

Intrinsic mechanisms of rotator cuff degeneration primarily involve:
A. Posture
B. Tendon vascularity and biology
C. Scapular kinematics
D. Ergonomics

Answer 4

B. Tendon vascularity and biology

Question 5

Extrinsic mechanisms of rotator cuff pathology involve:
A. Genetics
B. Direct compression or shear
C. Aging only
D. Muscle fatigue only

Answer 5

B. Direct compression or shear

Question 6

Internal impingement refers to contact between the rotator cuff and the:
A. Coracoacromial ligament
B. Glenoid rim
C. AC joint
D. Clavicle

Answer 6

B. Glenoid rim

Question 7

MRI sensitivity for full-thickness rotator cuff tears is approximately:
A. 40–50%
B. 60–70%
C. 90–100%
D. 100% for all tears

Answer 7

C. 90–100%

Question 8

Which patient factor is most strongly related to rotator cuff tendon status?
A. Sex
B. Height
C. Age
D. Hand dominance

Answer 8

C. Age

Question 9

High irritability shoulder symptoms typically present with:
A. AROM = PROM
B. Pain only at end range
C. AROM < PROM
D. No night pain

Answer 9

C. AROM < PROM

Question 10

Which special tests are considered pain provocation tests rather than tissue-specific tests?
A. Neer and Hawkins
B. Lachman and Pivot Shift
C. Phalen and Tinel
D. Slump and SLR

Answer 10

A. Neer and Hawkins

Question 11

Which outcome measures are associated with irritability classification in STAR-Shoulder?
A. Oswestry
B. FOTO, PSS, ASES
C. Berg Balance
D. LEFS

Answer 11

B. FOTO, PSS, ASES

Question 12

Matched care in the STAR-Shoulder model has been shown to:
A. Be equivalent to unmatched care
B. Underperform unmatched care
C. Outperform unmatched care
D. Increase surgery rates

Answer 12

C. Outperform unmatched care

Question 13

A patient reports anterolateral shoulder pain reproduced with Neer and Hawkins. Imaging shows partial supraspinatus tear, but strength is good. Best classification?
A. Adhesive capsulitis
B. Subacromial pain syndrome
C. Glenohumeral instability
D. Cervical radiculopathy

Answer 13

B. Subacromial pain syndrome

Question 14

A 65-year-old with atraumatic full-thickness cuff tear prefers conservative care. Best initial recommendation?
A. Immediate surgery
B. 3-month trial of PT
C. Injection only
D. Immobilization

Answer 14

B. 3-month trial of PT

Question 15

Which finding best indicates internal impingement rather than subacromial impingement?
A. Pain below 70° elevation
B. Glenoid contact above 120° elevation
C. AC joint tenderness
D. Hooked acromion

Answer 15

B. Glenoid contact above 120° elevation

Question 16

A patient demonstrates scapular winging and pain with elevation. Which test helps determine if symptoms change with scapular assistance?
A. Spurling
B. SAT
C. Lachman
D. Drop arm

Answer 16

B. SAT

Question 17

Which scapular motion pattern is normal during arm elevation?
A. Downward rotation
B. Anterior tilt
C. Upward rotation, posterior tilt, external rotation
D. Pure retraction

Answer 17

C. Upward rotation, posterior tilt, external rotation

Question 18

Posterior shoulder tightness is MOST associated with:
A. Increased GH internal rotation
B. Superior humeral translation
C. Increased subacromial space
D. Reduced pain

Answer 18

B. Superior humeral translation

Question 19

Which stretch has evidence for improving posterior shoulder tightness?
A. Sleeper stretch
B. Hamstring stretch
C. Calf stretch
D. Upper trap stretch

Answer 19

A. Sleeper stretch

Question 20

A patient with short pectoralis minor is likely to demonstrate:
A. Increased posterior tilt
B. Increased scapular anterior tilt
C. Increased upward rotation
D. No kinematic change

Answer 20

B. Increased scapular anterior tilt

Question 21

Which intervention has best evidence for improving shoulder pain in SAPS?
A. Passive modalities only
B. Exercise and manual therapy
C. Bed rest
D. Bracing

Answer 21

B. Exercise and manual therapy

Question 22

Thoracic thrust manipulation may reduce shoulder pain primarily through:
A. Mechanical decompression
B. Neurophysiologic mechanisms
C. Muscle hypertrophy
D. Tendon healing

Answer 22

B. Neurophysiologic mechanisms

Question 23

Which finding is most consistent with low irritability?
A. Night pain
B. Pain before end range
C. AROM = PROM
D. High disability

Answer 23

C. AROM = PROM

Question 24

A patient demonstrates weakness of rotator cuff and scapular muscles. Primary treatment focus?
A. Surgery
B. Strengthening and endurance training
C. Immobilization
D. Traction

Answer 24

B. Strengthening and endurance training

Question 25

Which ergonomic factor increases subacromial load? A. Load close to body B. Work below 90° C. High moment arm D. Divided loads

Answer 25

C. High moment arm

Question 26

Which imaging finding on X-ray suggests chronic rotator cuff tear? A. Increased joint space B. Acromiohumeral distance <7–10 mm C. Labral calcification D. Normal acromion

Answer 26

B. Acromiohumeral distance <7–10 mm

Question 27

Which patient is most appropriate for early surgical consult? A. 70-year-old sedentary with chronic pain B. Young patient with acute traumatic tear C. Mild tendinopathy D. Intermittent pain only

Answer 27

B. Young patient with acute traumatic tear

Question 28

Which scapular dyskinesis pattern is most common? A. Excessive downward rotation B. Early/excessive scapular elevation (shrug) C. Retraction only D. Depression

Answer 28

B. Early/excessive scapular elevation (shrug)

Question 29

If scapular dyskinesis is corrected with verbal cueing, this MOST suggests: A. True muscle rupture B. Motor control deficit C. Complete tear D. Fracture

Answer 29

B. Motor control deficit

Question 30

Which mechanism is LEAST modifiable with rehab? A. Posterior capsule tightness B. Weakness C. Acromial shape D. Scapular control

Answer 30

C. Acromial shape

Question 31

A patient has pain with isometric ER and elevation. This finding is consistent with: A. Labral tear only B. Rotator cuff tendinopathy C. Cervical radiculopathy D. AC joint sprain

Answer 31

B. Rotator cuff tendinopathy

Question 32

Which factor contributes to superior humeral migration? A. Strong rotator cuff B. Cuff weakness C. Increased posterior tilt D. Scapular stability

Answer 32

B. Cuff weakness

Question 33

Which treatment component addresses motion impairments? A. Strengthening B. Stretching/manual therapy C. Surgery D. Injection

Answer 33

B. Stretching/manual therapy

Question 34

Which plane is generally safest for overhead exercise? A. Sagittal B. Frontal C. Scapular plane D. Transverse

Answer 34

C. Scapular plane

Question 35

Which statement about special tests is MOST accurate? A. Identify specific tissue B. Determine surgery C. Indicate pain provocation only D. Replace imaging

Answer 35

C. Indicate pain provocation only

Question 36

A patient with SAPS and moderate irritability should initially receive: A. High-load plyometrics B. Moderate physical stress and impairment-based exercise C. Complete rest D. Surgery

Answer 36

B. Moderate physical stress and impairment-based exercise