rotator cuff injuries

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Mr Lee Van Rensburg

May 2014

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J Bone Joint Surg Am. 2014;96:265

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Farmer Falls from tractor

Pain and weakness in shoulder

.

.

Diffuse pain in upper arm, following fall X rays show some arthritis Weakness and pain

No firm diagnosis

.

Rheumatology 2006;45:215–221

.

See’s physio - 2 weeks later Pain slightly better Affecting sleep Still struggling with elevation 90°

? Rotator cuff tear

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Why ? tear Jobe’s

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- Apley's Scratch Test - Jobes Supraspinatus test - Dawburn's sign- Sherry Party sign- Codman's Sign (Drop Arm Sign)- Rent Test- Zero Degree Abduction Test - Burkhead's Thumbs down & Burkhead's Thumbs up

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J Shoulder Elbow Surg. 2009 Jul-Aug;18(4):529-34

175175

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Send back to GP ? Tear Refer on Image Inject

Start rehab?

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? Tear in tendon Special scan Stop using it tear get worse……

Keep it moving !

.

Full thickness tear Supraspinatus Infraspinatus

.

60-69 =30% FTRCT

70-79 = 50% FTRCT

80-89 = 80% FTRCT

Age-related prevalence of rotator cuff tears in asymptomatic shoulders; Tempelhof et al; JSES July 1999 (Vol. 8, Issue 4, Pg 296-299

1953 - 61

1930 - 84

1936 - 78

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Surgery Rehabilitation

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Agency for healthcare research and qualityUSA July 2010

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1 study

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J BJS - Br January 2010 vol. 92-B no. 1 83-91

Age 59 (44-75) Age 61 (46-75)

Symptoms 10 - 12 months

+- 50:50 traumatic and atraumatic

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J BJS - Br January 2010 vol. 92-B no. 1 83-91

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J BJS - Br January 2010 vol. 92-B no. 1 83-91

Constant score

SatisfactionPhysiotherapy 7.2 (1-10)Surgery 9 (1-10)

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J BJS - Br January 2010 vol. 92-B no. 1 83-91

Secondary surgery group

Delay in surgery 5 monthsFinal outcome 7.5 points less constant score

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J BJS - Br January 2010 vol. 92-B no. 1 83-91

42 Happy not surgery

9 no surgery constant score 7.5 less

Surgery did better

BUT

.

.

Clin Orthop 1983;175:18-24.

N = 37 Group 1 – Operated within 3 weeks (n=12) Group 2 – Operated within 3 to 6 weeks (n=6) Group 3 – Operated within 6-12 weeks (n=19)

F/U ave. 7.0 years (range, 1 - 21 years) Abduction

Group 1 = 168° Group 2 = 126° Group 3 = 129°

Pain relief good for all Repair best within 3 weeks

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J Shoulder Elbow Surg (2011) 20, 62-68

N= 36 3 groups

Group 1 - 0-8 weeks Group 2 - 8-16 weeks Group 3 - > 16 weeks

All improved Pain 7 down to 1Elevation 55 to 133

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Surgery Rehabilitation

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Anaesthetic Infection Stiffness Incomplete resolution Recurrence Re tear Rehab

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Day case overnight stay 60-80% better Sling

3 weeks 6 weeks social protection

Nothing heavier cup of tea 6 weeks Drive 6-8 weeks (2 weeks)

Desk top 4-6 weeks Manual work 3 months

Healed 6 weeks 60% 3 months 80%

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Non operative Relative rest NSAID Physio Steroid injection (controversial) Supra scapular nerve block

Operative

JSES - 2008;17:863-870

3 months

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Non operative Operative

Arthroscopic Debridement Reverse decompression Biceps tenotomy Suprascapular nerve ablation

Open Reverse shoulder replacement

JSES - 2008;17:863-870

3 months

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.

.

.

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Many different types of procedures

Standard anaesthetic Wound closure Initial recovery

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Sling till arm awake Stay out of kitchen Most wear off 8 Hours

Pre emptive analgesia

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Subcuticular prolene suture

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Steristrips

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Mepore Dressings

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Pad

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Sling (Rotator Cuff Repair)

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J Shoulder Elbow Surg (2011) 20, 326-332

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J Shoulder Elbow Surg (2012) 21, 61-65