- Discussion:
-
rotator cuff anatomy:
-
frequency of tear:
-
diff dx of cuff tears;: (
partial rotator cuff tear)
- etilogy of tear:
-
impingement syndrome: (75%)
- shoulder instability (
anterior or
multi-directional) (15%) (should be considered in any young active patient);
- trauma:
- occurs in 10% of patients;
- note that a displaced
greater tuberosity frx is a RTC tear equivolent;
- references:
- Tears of the rotator cuff of the shoulder associated with pathological changes in the acromion: A study in cadavera. Ozaki J. JBJS 1988;70A:1224-1230.
-
Position of the humeral head and rotator cuff tear: an anatomical observation in cadavers.
- Shoulder Exam:
-
impingement sign and test:
- it is essential to document ROM deficits, since rotator cuff repair would not be expected
to yield a good outcome in the face of fixed shoulder contractures;
- Radiographic Findings:
-
scapular outlet view:
-
30 deg caudal tilt view AP view:
-
arthrography:
-
MRI of Shoulder:
Coronal Oblique View of Shoulder:
- Non Operative Management:
- Surgical Management:
-
tears due to impingement and trauma: (see:
impingement syndrome)
-
open rotator cuff repair and
open acromioplasty -
references
-
arthroscopic rotator cuff repair
-
concomitant procedures:
-
biceps tenodesis;
-
distal clavicle excision (w/ concomitant arthrosis)
- references:
The influence of distal clavicle resection and rotator cuff repair on the effectiveness of anterior acromioplasty.
-
arthroscopy (
arthroscopic acromioplasty) followed by
rotator cuff repair
- allows accurate assesment of rotator cuff tear;
- look for hypervascularity at the base of the biceps tendon as well as fraying of the cuff just lateral to the biceps tendon;
- does not require elevation of the deltoid off the acromioplasty;
- allows a more lateral incision, directly over the rotator cuff tear, (avoid deltoid detachment);
- w/ restricted motion, consider arthroscopic capsular release prior to rotator cuff tear;
-
partial rotator cuff tear:
-
precautions:
- rotator cuff repair should not be performed in the face of a fixed contracture;
- consider aggressive PT to restore motion or arthroscopic release of the rotator interval (for loss of external rotation in adduction) or
release of the posterior capsule (for loss of internal rotation);
-
tears due to instability:
- requires
anterior reconstruction in addition to
rotator cuff repair;
- ref: Occult anterior subluxations of the shoulder in noncontact sports. Garth WP, Allman FL, Armstrong WS: Am J Sports Med 1987;15:579-580.
-
management of massive rotator cuff tear:
- Complications:
-
Failed Acromioplasty / Rotator Cuff Surgery:
- Captured Shoulder:
- refers to restrictive subdeltoid adhesions which develop following surgery and which limit ROM;
- may occur in about 5% of patients;
- treatment relies arthroscopic lysis of adhesions;
- references:
- Failed Repair of the Rotator Cuff. Evaluation and Treatment of Complications. E.H. Karas MD and J.P. Iannotti MD PH.D. JBJS. Vol 79-A, No 5, May 1997. p. 784-793.
-
Superior Humeral Dislocation: A Complication Following Decompression and Debridement for Rotator Cuff Tears.
- Operative Treatment of failed repairs of the rotator cuff. LU Bigliani et al. JBJS Vol 74-A. 1992. p 1505-1515.
- Captured Shoulder: A complication of rotator cuff surgery. MA Mormino MD et al. Arthroscopy. Vol 12. No 4. Aug. 1996. p 457.
- References
