- See:
partial rotator cuff tear:
- 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, Fujimoto Y, Nakagawa Y, et al:
J Bone Joint Surg 1988;70A:1224-1230.
- 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:
- in the study by BA. Goldberg et al. (Clin Orthop 2001), the authors documented the functional outcome in a consecutive
series of 46 patients;
- following inclusion criteria:
- full-thickness rotator cuff tear seen by ultrasonography, arthrogram, or magnetic resonance imaging;
- absence of a Workers’ Compensation claim or previous surgery;
- followup of at least 1 year;
- election of nonoperative management by the patient;
- 26 of the tears involved only the supraspinatus, two involved the supraspinatus and infraspinatus, and two involved
the supraspinatus, infraspinatus, and subscapularis (16 reports did not specify the size of the tear).
- treatment consisted only of patient education and a home program of gentle stretching and strengthening;
- at average followup of 2.5 ± 1.6 years, 27 (59%) patients experienced improvement with nonoperative treatment,
14 (30%) patients experienced worsening, and five (11%) patients remained unchanged;
- references:
-
Nonoperative treatment of rotator cuff tears.
-
Conservative treatment of rotator cuff tears.
-
Results of nonoperative management of full-thickness tears of the rotator cuff.
- Nonoperative management of full-thickness tears of the rotator cuff.
Wirth MA.
Basamania C.
Rockwood CA Jr. Orthopedic Clinics of North America.
28(1):59-67, 1997 Jan.
- Outcome of Nonoperative Management of Full-Thickness Rotator Cuff Tears.
BA. Goldberg et al.
Clin Orthop 2001 January;2001(382):99-107
- References
