Clinical - Rotator Cuff

Question 1

What are the Muscles of the Rotator Cuff?

Answer 1

• Supraspinatus
• Infraspinatus
• Tere Minor
• Subscapularis

“SITS”

Question 2

What are the 4 characteristics of the Supraspinatus?

Answer 2

• Arises:
  
  • Supraspinatus fossa
• Inserts:
  
  • into greater tuberosity of the humerus
• Action:
  
  • Abducts arms
  • Draws humerus toward glenoid
• Innervation:
  
  • Suprascapular nerve

Question 3

What are the 4 characteristics of the Infraspinatus?

Answer 3

• Arises:
  
  • from infraspinatus fossa
• Inserts:
  
  • into greater tuberosity of the humerus
• Action:
  
  • Rotates the arm laterally
  • Draws the humerus toward the glenoid
• Innervation:
  
  • Suprascapular nerve

Question 4

What are the 4 characteristics of Teres Minor?

Answer 4

• Arises:
  
  • dorsal surface of the scapula
• Inserts:
  
  • post. portion of greater tuberposity of the humerus
• Action:
  
  • rotates the arm laterally
  • draws the humerus toward the glenoid fossa
• Innervation:
  
  • axillary nerve

Question 5

What are the 4 characteristics of the Subscapularis?

Answer 5

• Arises:
  
  • subscapular fossa
• Inserts:
  
  • lesser tuberosity of the humerus
• Action:
  
  • rotates the arm medially
  • draws the humerus toward the glenoid
• Innervation:
  
  • subscapular nerve

Question 6

What are the functions of the Rotator Cuff?

Answer 6

• Stabilize the proximal humerus in the glenoid fossa
• Rotation of the humerus
• Work in conjunction w/ the deltoid muscle

Question 7

What is the most common diagnosed disorder of the shoulder?

Answer 7

• Subacromial Impingement
  
  • outlet impingment = primary cause of most rotator cuff tears & chronic lesions of the long head of the bicep
• Classification of Outlet Impingment
  
  • Stage 1
    
    • edema/hemorrhage
  • Stage 2
    
    • fibrosis/thickening of subacromial bursa
  • Stage 3
    
    • partial/complete tear in the RTC
    • biceps tendon ruptures

Involves:

• Supraspinatus Outlet
  
  • Supraspinatus tendon
  • Bicep tendon
  • Subacromial bursa
• Boundaries of the outlet
  
  • Acromion
  • Coracoacromial ligment
  • Acromioclavicular joint
  • Inferior border of the humeral head

Question 8

What are common symptoms of Impingment?

Answer 8

• Pain
  
  • reported worse at night
  • increased w/ overhead activity
  • may be anterior or lateral
  • may radiate down toward deltoid muscle

Question 9

What would a physical exam tell us?

Answer 9

Physical Exam

• Painful arc
  
  • 70-120 degrees of elevation
• Supraspinatus or Infraspinatus wasting
• Rotator Cuff weakness
• (+) Need impingement sign
• (+) Hawkins’ sign

Radiographic Studies:

• AP view
• Axillary lateral view
• Supraspinatus view
• MRI

Question 10

What are the 2 types of Treatments?

Answer 10

Conservative Treatment

• Avoid symptom producing activities
• NSAIDs (anti-inflammatory meds)
• Physiotherapy
  
  • emphasis on ROM & scapular stabilizers
• Steroid injection

Surgical Treatment

• Neer
  
  • proposed anterior acromioplasty
    
    • removes prominant anterior undersurface of acromion
• Coracoacromial ligament release
• Resection of the distal clavicle