- Discussion:
-
rotator cuff anatomy:
-
frequency of tear:
-
diff dx of cuff tears;:
- 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;
- by definition, partial tears involve 50% or more of the tendon;
- in the study by SC Weber (Arthroscopy 1999), 32 patients with significant partial-thickness rotator cuff tears were treated with debridement and
acromioplasty versus 33 patients who were with mini-open repair;
- 88% of tears were on the articular sidee;
- acromiplasty and debridement group:
- significant number of the arthroscopic group had fair results by UCLA score criteria;
- 3 patients reruptured the remaining cuff later despite adequate acromioplasty;
- healing of the partial tear was never observed at second-look arthroscopy;
- acromioplasty alone did not prophylactically prevent rotator cuff tear progression;
- the good results of arthroscopic treatment of significant partial-thickness tears deteriorated with time;
- open repair group:
- although postoperative pain was significantly greater and recovery slower with open repair, no patient was reoperated on and rerupture of the repair did not occur;
- 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:
- Surgical Treatment:
-
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);
-
rotator cuff repair
- 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.
Arthroscopic Debridement and Acromioplasty Versus Mini-Open Repair in the Treatment of Significant Partial-Thickness Rotator Cuff Tears.
Stephen C. Weber, M.D. Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 15, No 2 (March), 1999: pp 126-131
Transtendon arthroscopic repair of partial-thickness, articular surface tears of the rotator cuff
