Rotator cuff tears

what is the etiology for a R/C tear

-compression

-tensile overload

-macro trauma

compression

-decreased subacromial space OR

-decreased GH joint stability resulting in humeral head migration

tensile overload

-overuse/repetitive activities overload the tendon

-athletics that overload/overuse the R/C (especially supraspinatus)

macro trauma

-forces exceed the strength of the tendon resulting in a tear (FOOSH, sudden ECCENTRIC load)

-often occurs in older people who already have compression of subacromial space

FOOSH is

-often the MOI for a R/C tear

-R/C tries to prevent adduction (eccentric overload)

Classification of rotator cuff tears

-full vs partial thickness

-bursal or articular

-size of tear

-tendons involved

-shape of tear

-retraction

-tissue quality

full thickness rotator cuff tear

-tear extends completely through the tendon

-can range from small (1cm) to massive (5cm)

Where can rotator cuff tears occur

-bursa

-articular surface of humeral head

What constitutes a small tear

- < 1 cm

What constitutes a medium tear

-1-3 cm

what constitutes a massive tear

- > 5cm

shape of the tear is important to

-the surgeon

what is retraction

-how retracted the muscle is from the attachment point

tissue quality is

-very important

-decreased quality tissue is not as strong and repair is fragile

what tendons may be involved in R/C tears

-supraspinatus

-infraspinatus

-teres minor

-subscapularis

What muscle/tendon is always involved

-supraspinatus

what clinical findings will you see with a R/C tear

-insidious (degenerative), acute (injury or overuse) sxs

-pain

-weakness

-loss of shoulder ROM

-painful arc (60-120)

-pain w/ specific resisted tests of involved R/C muscle

-atrophy of muscles

-pain to palpation

-palpable defect

Where would a pt experience pain to palpation w/ a R/C tear

-pain at insertion

How would you palpate a defect (rent sign)

-palpate R/C tendons anterior to the margin of the acromion

-IR and ER the humerus

-observe and palpate for a defect of more than one finger width

What special tests can you do for R/C tear

-drop arm (supraspinatus)

-external rotation lag sign (infraspinatus)

-empty can test (supraspinatus)

-full can test (supraspinatus)

-specific R/C MMTs

-Hawkins Kennedy (painful w/ tear and impingement)

Who are candidates for surgical repair

-full thickness tears

-partial thickness tears that are unresponsive to conservative tx

surgery can be delayed up to _______________ with no significant change in outcomes

-3 mos

-any longer could be detrimental

full thickness tears and surgery

-symptomatic large, full thickness tears, esp in younger pts

-older pts w/ significant disability

-symptomatic small full thickness tears depend on pain and response to conservative tx

surgical techniques

-open RC repair

-arthroscopic surgical repair

Open RC repair

-more complex tears

-tears obstructed by delt

- > 5cm incision in anterior shoulder, remove delt from humerus to gain access

-longer recovery time

arthroscopic repair

-camera and cutting instrument

-2 small incisions to locate and repair tear

-smaller tears and tears w/ unobstructed view

Post surgical rehab is based on

-extent of tear (minimal or massive_

-strength and extent of repair

General precautions for post surgical rehab

-no active GH motion for 4-6 wks (can do passive)

-no elevation past 70 degrees for 4-6 wks

-avoid wb thru UE (will push humeral head into acromion)

-avoid carrying wt w/ UE (no more than 15 lbs 1st year)

-limit activities w/ fall risk

-BRODY AND HALL pg 778-779

non-operative rehab is

-very similar to post op rehab

In general in non-op rehab early mobilization

-is encouraged as opposed to sling and iimmobilization

In non-op rehab the pt will follow the ___________ phases but may progress more quickly

-same

pts long term precautions will

-depend on extent of the tear

a delay of surgery up to 3 mos has

-no effect on outcome

age influences outcomes

-negatively

number of tendons injured affects outcome of

-pts undergoing conservative tx but

-not surgery

subacromial decompression at the time of surgery influences the outcome

-positively