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Tears of the Rotator Cuff
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Introduction
Shoulder pain : 3rd most common MS painafter LBP and neck pain
Cause of significant occupational disability
cadaver studies:
After 40 yo incidence of full thickness tears 18-26% and incidence of partial thickness tears 32-37%.
Before 40, tears rarely are observed.
MRI studies: tears in 34% of asymptomatic individuals of all
ages
After 60 years, 26% of patients have partial
thickness tears, and 28% demonstrate fullthickness tears.
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Introduction
Predisposing occupations: tree pruning,fruit picking, nursing, grocery clerking,longshoring, warehousing, carpentry, andpainting
Sports activity: throwing, tennis, skiing, andswimming
Athletes also show some signs of cuff
involvement Male = Female
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Rotator Cuff
A group of muscles and their tendonswhich inserts on the proximal humerusand function to stabilize shoulder joint
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Rotator Cuff
hold the head of the humerus in thesmall and shallow glenoid fossa of thescapula
Supraspinatus
Infraspinatus
Teres minor
Subscapularis
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Rotator Cuff Tears
Partial vs Full Thickness
Acute vs Chronic
Traumatic vs degenerative
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Etiology of Tears
Extrinsic mechanism
Intrinsic mechanism
Trauma
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Traumatic Tears
Result when a sudden force applied tothe rotator cuff resulting in failure ofthe tendon.
Under the age of 40 extreme forcesare involved
Over 40 years old can occur with
smaller forces
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Symptoms
Sudden tearing sensation followed bysevere pain shooting through the arm
Pain in the shoulder or arm ,especially with arm movement(reaching overhead, reaching behindyour back, lifting, pulling )
Radiation of the pain to the upper,lateral arm
Pain at night Weakness Loss of shoulder range of motion
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Examination
Inspect for muscle wasting in chronictears
Palpation of the defect
Movement of the cuff : Weakness
Limitations
Pain
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Adjunct Examination
Radiographs
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MRI
Sensitive and Specific for RC Tears
Expensive and not always available
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USG
Gaining Popularity
Rapid and accurate
More readily
available Operator
dependent
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Treatment
Conservative vs Surgery
Partial thickness
Non surgical possible
Surgery if no improvement
Full Thickness, surgery if
nonsurgical treatment has failed
acute tears
tears associated with a sudden loss ofstrength and function
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Outcome
Tear size was the most importantdeterminant of outcome with regard toactive motion, strength,, patient
satisfaction, and need for anotheroperation
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Thank You