Rotator Cuff Tear

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! Rotator Cuff Tears Description: radiate down the arm towards A rotator cuff tear is a the elbow and up towards the Arthroscopic Repair common cause of shoulder pain neck. Surgery is recommended and disability among adults. Diagnosis: when non-surgical treatments Normally there are 4 rotator cuff Your doctor will perform a have been tried. This tendons that form a covering comprehensive physical technique uses multiple small over the top of the shoulder. examination. Additional tests incisions (portals) and These tendons allow the shoulder may be performed to rule our arthroscopic technology to to move and rotate. Most tears other possible injuries. These visualize and repair the occur in the tests may include x-rays, bone rotator cuff. All-arthroscopic supraspinatus scanning, ultrasound, and repair is usually an outpatient tendon, but magnetic resonance imaging procedure. Suture anchors are other parts of (MRI). placed into the bone and used the rotator to re-attach the tendons to cuff may be Treatment: the bone. The results are involved. Your doctor may recommend comparable if not better than Overuse is the a brief period of anti- to those for mini-open repair most common inflammatory medication and and open repair. cause of tears, however a fall or activity modification. A course of Rehabilitation after surgery is sudden injury can also cause a rehabilitation may also be important. tear. helpful. Injection of a corticosteroid with a local Symptoms: anesthetic may alleviate the Pain often develops slowly symptoms. Anti-inflammatory over a period of time and may be medication should be used worse at night time or with cautiously as these medications overhead activities. An injury may have harmful side-effects. may cause acute pain. Pain may NATURAL HISTORY OF ROTATOR CUFF TEAR Forty percent of patient treated without surgery develop enlargement of the rotator cuff tear over a 5-year period of time. However, 20% of those will have no symptoms. Therefore, less than half of patients with tears with have enlargement but 80% of patients whose tears enlarge will develop symptoms. Small partial thickness tears may heal without surgery. OUTCOMES OF ROTATOR CUFF TEAR REPAIR Satisfaction rates are over 80-95% with improved range of motion and strength. Approximately 6-30% will have a re-tear of the repair, however many of these remain asymptomatic. Outcomes are improved with earlier repair, smaller tears, patient age, and patient compliance after surgery. TEL: 306-520-5625 FAX: 305-520-5628 WWW.HOMMENORTHOPEDICS.COM .

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Rotator Cuff and Subacromial Impingement Syndrome: Anatomy, Etiology, Screening, and Treatment
Rotator Cuff and Subacromial Impingement Syndrome: Anatomy, Etiology, Screening, and Treatment The glenohumeral joint is the most mobile joint in the human body, but this same characteristic also makes it the least stable joint.1-3 The rotator cuff is a group of muscles that are important in supporting the glenohumeral joint, essential in almost every type of shoulder movement.4 These muscles maintain dynamic joint stability which not only avoids mechanical obstruction but also increases the functional range of motion at the joint.1,2 However, dysfunction of these stabilizers often leads to a complex pattern of degeneration, rotator cuff tear arthropathy that often involves subacromial impingement.2,22 Rotator cuff tear arthropathy is strikingly prevalent and is the most common cause of shoulder pain and dysfunction.3,4 It appears to be age-dependent, affecting 9.7% of patients aged 20 years and younger and increasing to 62% of patients of 80 years and older ( P < .001); odds ratio, 15; 95% CI, 9.6-24; P < .001.4 Etiology for rotator cuff pathology varies but rotator cuff tears and tendinopathy are most common in athletes and the elderly.12 It can be the result of a traumatic event or activity-based deterioration such as from excessive use of arms overhead, but some argue that deterioration of these stabilizers is part of the natural aging process given the trend of increased deterioration even in individuals who do not regularly perform overhead activities.2,4 The factors affecting the rotator cuff and subsequent treatment are wide-ranging. The major objectives of this exposition are to describe rotator cuff anatomy, biomechanics, and subacromial impingement; expound upon diagnosis and assessment; and discuss surgical and conservative interventions.
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(Ii) Rotator Cuff Arthropathy
ARTICLE IN PRESS Current Orthopaedics (2007) 21, 415–421 Available at www.sciencedirect.com journal homepage: www.elsevier.com/locate/cuor MINI-SYMPOSIUM: SHOULDER RECONSTRUCTION (ii) Rotator cuff arthropathy Lennard FunkÃ, John Haines, Ian Trail Wrightington Upper Limb Unit, Wrightington Hospital, Hall Lane, Apley Bridge, Wigan, UK KEYWORDS Summary Rotator cuff Rotator cuff arthropathy is a specific and uncommon disease entity. It affects mainly arthropathy; elderly, but often active people. The exact causes are not known, but there is evidence of Shoulder; genetic predisposition, crystal disease and mechanical factors. There are numerous Deltoid rehabilitation; treatment options for both the pain and dysfunction. Generally, non-operative measures Hyaluronan are successful, if used appropriately and timely. Arthroscopic debridement and washout injections; alone has only short-term benefit, but arthroscopic biceps tenotomy or tenodesis is Arthroscopic shoulder effective in eliminating pain caused by long head of biceps tendon pathology. Anatomical surgery; hemi-arthroplasty, whether stemmed or surface replacement, primarily improves pain. Biceps tenotomy; However, modern designs specifically for cuff tear arthropathy have shown improved Biceps tenodesis; functional results. Surface replacement implants also confer the benefits of being less Surface replacement; invasive and of preserving bone. Reverse total shoulder arthroplasty is a powerful tool for Reverse geometry the elderly patient with unresponsive painful pseudoparalysis. However, it has a high arthroplasty complication rate and should be used with care. & 2007 Elsevier Ltd. All rights reserved. Introduction Charles Neer coined the term ‘‘cuff tear arthropathy’’ in 1977 and published his classic article in 1983.2 Neer Rotator cuff arthropathy is characterised by rotator cuff described the pathoanatomical changes associated with insufficiency, diminished acromiohumeral distance and massive, chronic full-thickness rotator cuff tears, which arthritic changes of the glenohumeral joint.
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