7/31/2019 Tears of the Rotator Cuff

1/17

Tears of the Rotator Cuff

7/31/2019 Tears of the Rotator Cuff

2/17

Introduction

Shoulder pain : 3rd most common MS painafter LBP and neck pain

Cause of significant occupational disability

cadaver studies:

After 40 yo incidence of full thickness tears 18-26% and incidence of partial thickness tears 32-37%.

Before 40, tears rarely are observed.

MRI studies: tears in 34% of asymptomatic individuals of all

ages

After 60 years, 26% of patients have partial

thickness tears, and 28% demonstrate fullthickness tears.

7/31/2019 Tears of the Rotator Cuff

3/17

Introduction

Predisposing occupations: tree pruning,fruit picking, nursing, grocery clerking,longshoring, warehousing, carpentry, andpainting

Sports activity: throwing, tennis, skiing, andswimming

Athletes also show some signs of cuff

involvement Male = Female

7/31/2019 Tears of the Rotator Cuff

4/17

Rotator Cuff

A group of muscles and their tendonswhich inserts on the proximal humerusand function to stabilize shoulder joint

7/31/2019 Tears of the Rotator Cuff

5/17

Rotator Cuff

hold the head of the humerus in thesmall and shallow glenoid fossa of thescapula

Supraspinatus

Infraspinatus

Teres minor

Subscapularis

7/31/2019 Tears of the Rotator Cuff

6/17

Rotator Cuff Tears

Partial vs Full Thickness

Acute vs Chronic

Traumatic vs degenerative

7/31/2019 Tears of the Rotator Cuff

7/17

Etiology of Tears

Extrinsic mechanism

Intrinsic mechanism

Trauma

7/31/2019 Tears of the Rotator Cuff

8/17

Traumatic Tears

Result when a sudden force applied tothe rotator cuff resulting in failure ofthe tendon.

Under the age of 40 extreme forcesare involved

Over 40 years old can occur with

smaller forces

7/31/2019 Tears of the Rotator Cuff

9/17

7/31/2019 Tears of the Rotator Cuff

10/17

Symptoms

Sudden tearing sensation followed bysevere pain shooting through the arm

Pain in the shoulder or arm ,especially with arm movement(reaching overhead, reaching behindyour back, lifting, pulling )

Radiation of the pain to the upper,lateral arm

Pain at night Weakness Loss of shoulder range of motion

7/31/2019 Tears of the Rotator Cuff

11/17

Examination

Inspect for muscle wasting in chronictears

Palpation of the defect

Movement of the cuff : Weakness

Limitations

Pain

7/31/2019 Tears of the Rotator Cuff

12/17

Adjunct Examination

Radiographs

7/31/2019 Tears of the Rotator Cuff

13/17

MRI

Sensitive and Specific for RC Tears

Expensive and not always available

7/31/2019 Tears of the Rotator Cuff

14/17

USG

Gaining Popularity

Rapid and accurate

More readily

available Operator

dependent

7/31/2019 Tears of the Rotator Cuff

15/17

Treatment

Conservative vs Surgery

Partial thickness

Non surgical possible

Surgery if no improvement

Full Thickness, surgery if

nonsurgical treatment has failed

acute tears

tears associated with a sudden loss ofstrength and function

7/31/2019 Tears of the Rotator Cuff

16/17

Outcome

Tear size was the most importantdeterminant of outcome with regard toactive motion, strength,, patient

satisfaction, and need for anotheroperation

7/31/2019 Tears of the Rotator Cuff

17/17

Thank You