Rotator Cuff Tear Flashcards
What joint do the rotator cuff muscles work on?
Glenohumeral joint
How can rotator cuff tears be classified?
Either acute = less than 3 months or chronic = more than 3 months
Can be partial thickness or full thickness.
Full thickness can be classified into small, medium, large or massive.
What are the rotator cuff muscles and what are their individual functions?
Supraspinatus - abduction
Infraspinatus - external rotation
Teres minor - external rotation
Subscapularis - internal rotation
They also provide stability to the glenohumeral joint
What is the pathophysiology of rotator cuff tears?
Acute tears in tendons with pre existing degeneration common,y
Trauma can cause a large acute tear
Chronic tears occours in degenerative microtears to the tendon, commonly from overuse and seen in greater incidence with increased age
What are the risk factors for tears?
Age Trauma Overuse Repetitive overhead shoulder motions Obesity Smoking Diabetic
What are the clinical features of rotator cuff tears?
- Pain over lateral aspect of shoulder
- Inability to abduct arm over 90 degrees
- Tenderness over greater tuberosity
- Atrophy of supraspinatus and infraspinatus can be seen in massive tears
What specific tests can be done for the rotator cuff muscles?
1) Jobe’s test - the ‘empty can test’; tests supraspinatus. Gently push downwards on the arm. A positive test is present if there is weakness on resistance.
2) Gerber’s lift-off test - tests subscapularis. internally rotate the arm so the dorsal surface of hand rests on lower back. Ask the patient to lift hand away from back against examiner resistance. A positive test is weakness in actively lifting the hand away from back (compare to the contralateral side).
3) Posterior cuff test (tests infraspinatus and teres minor) – the arm positioned at patient’s side, with the elbow flexed to 90°. The patient is instructed to externally rotate their arm against resistance.A positive test is present if there is weakness on resistance.
What investigations can be done for rotator cuff tears?
Urgent plain film radiograph to exclude fracture
USS can establish size of year and MRI can be used to locate size, characteristics and location.
How are rotator cuff tears conservatively managed?
Depends on type of tear and functional status
Conservative management is preferred if not limited by pain or loss of function, or those with significant co morbidities making them unsuitable for surgery.
If presenting 2 weeks since injury, conservative management includes analgesia and physiotherapy, with potentially corticosteroid injections into subacromial space.
How are rotator cuff tears surgically managed?
2 weeks since the injury or remaining symptomatic despite conservative management should be referred for surgical intervention. Large and massive tears should also be considered for surgical repair.
Repairs can be done arthroscopically (allowing for earlier recovery) or via open approach (preferred in large or complex tears)
What is the main complication of tears?
Adhesive capsulitis
