- Discussion: 
-
rotator cuff anatomy:
-
frequency of tear:
-
diff dx of cuff tears;: (
partial rotator cuff tear)
-
etilogy of tear:
-
how do RTC tears heal?
- 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)
-
arthroscopic rotator cuff repair
-
partial rotator cuff tear:
-
open rotator cuff repair and
open acromioplasty
- assessment of cuff tear /
mobilization of cuff /
restoration of the foot print
- note intervening bare area between the articular
margin and the infraspinatus and teres minor
-
references
-
management of massive rotator cuff tear
- concomitant procedures:
-
biceps tenodesis;
-
distal clavicle excision (w/ concomitant arthrosis)
- reference:
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;
-
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
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.
- 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.
-
Superior Humeral Dislocation: A Complication Following Decompression and Debridement for Rotator Cuff Tears.
-
Operative Treatment of failed repairs of the rotator cuff.
-
Captured Shoulder: a complication of rotator cuff surgery.
- References
