Shoulder Rotator Cuff Tears

Learning Objectives What is?Why people get?Who gets?How does manifest ?How do we investigate ?How do we treat? Definition / Anatomy Etiology / Mech of injury Incidence Hystory / Physical exam Investigation Treatment

What is ? Anatomy Dynamic stabiliser of gleno-humeral joint

- Supra spinatus- Infraspinatus - Subscapularis- Teres minor Single tendon unit Greater tuberosity of humerusFront & Back viewLateral view

What is ? Anatomy Shoulder Bursa - between the rotator cuff and acromion- protective fluid-filed sack - to reduce friction Lateral view Anterior view Cross section view

What is ? Definition Rotator cuff dysfunction

continuum pathology ranging from Tendonitis Partial Tear Complete tear

Why people get ? Etiology Mechanism of injury Mechanism of rupture theories

Intrinsic factors - poor vascular supply ( at tendon insertion ) - ageing of the tendons ( collagen / fibroblasts )

Extrinsic factors - excessive tensile force- direct trauma - overuse injuries

Who gets it ? IncidenceCould happen at any age

Young age- traumatic ( sports / accidents )

- mainly acute tears

Middle & Old age - overuse ( ex painters, builders ) - mainly chronic tears precipitated by an acute event ( strain / trauma )

How does it manifest? History

Onset of symptoms - acute / insidious

Pain at work / in sleep Pain with elevation / abduction Weakness Inability to raise the arm

Could be asymptomatic ( chronic tear )

How does it manifest ? Physical Exam Inspection - muscle atrophy ( deltoid ) / deformities

- check for any asymmetryPalpation - systematic / orderly soft tissue & bony structures

- tenderness greater tuberosity ( insertion of rotator cuff ) Range of movement- record active and passive range of movements of shoulder

- any difference between passive active ROM suggestive of rotator cuff insufficiency

How does manifest ? Physical Exam Supraspinatus test

How do we investigate ? Investigation Radiography - acromial anatomy - presence of acromial spurs - note any other abnormality Ultrasound - preferable requires experienceShoulder Arthrogram - mainly for Rotator Cuff tears MRI - most useful and promising tool

How do we investigate ? Investigation MRI Shoulder

How do we treat? Treatment Non operative treatment Most small / medium sized chronic tears

Anti-inflamatory medication ( NSAIDs )

Strengthening exercises

Physiotherapy

How do we treat ? Treatment Surgical Treatment Rotator cuff repair