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Duke Orthopaedics
Wheeless' Textbook of Orthopaedics

Rotator Cuff Tears   

 - 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 cuffrestoration 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


Original Text by Clifford R. Wheeless, III, MD.

Last updated by Data Trace Staff on Thursday, January 3, 2013 4:37 pm