[41] Rotator Cuff Tear Flashcards
What is the rotator cuff?
A group of 4 muscles that support and rotate the glenohumeral joint
Are rotator cuff tears common?
Yes - prevalence in gen pop is around 20%
What muscles is the rotator cuff composed of?
- Supraspinatus
- Infraspinatus
- Teres minor
- Subscapularis
What movement does the supraspinatus do?
Abduction
What movement does the infraspinatus do?
External rotation
What movement does teres minor do?
External rotation
What movement does subscapularis do?
Internal rotation
What can rotator cuff tears be classified as
- Acute or chronic
- Partial or full thickness
What is considered to be an acute rotator cuff tear?
Lasting <3 months
What can full thickness rotator cuff tears be further classified into?
- Small (<1cm)
- Medium (1-3cm)
- Large (3-5cm)
- Massive (>5cm or involves multiple tendons)
How much force is required for an acute rotator cuff tear?
Depends - often occur in tendons with pre-existing degeneration, which requires minimal force, however can occur in young individuals when force required to cause tear can be large
Who do chronic rotator cuff tears occur in?
Individuals with degenerative microtears to the tendon
What causes degenerative microtears to the tendons of the rotator cuff?
- Overuse
- Increasing age
What are the main risk factors for rotator cuff tears?
- Age
- Trauma
- Overuse
- Repetitive overhead shoulder motions
What are the other risk factors for rotator cuff tears?
- BMI 25
- Smoking
- Diabetes mellitus
How will patients with rotator cuff tears present?
Pain over lateral aspect of shoulder and inability to abduct arm above 90 degrees
What is found on examination in rotator tuff tears?
- Tenderness over greater tuberosity and subacromial bursa regions
- Supraspinatus and infraspinatus atrophy can be seen in massive years
What specific tests can be done to assess for the presence of rotator cuff tears?
- Empty can test
- Gerbers lift off test
- Posterior cuff test
What does the ‘empty can test’ test?
Supraspinatus
How is the ‘empty can test’ done?
Place the shoulder in 90° abduction and 30° of forward flexion and internally rotate fully (as if you’re ‘emptying a can’). Gently push downwards on the arm.
What is a positive empty can test?
Weakness on resistance
What does Gerbers lift off test test?
Subscapularis
How is Gerbers lift off test done?
Internally rotate the arm so the dorsal surface of hand rests on lower back. Ask the patient to lift hand away from back against examiner resistance.
What is a positive Gerbers lift off test?
Weakness in actively lifting the hand away from back (compare to the contralateral side)
What does the posterior cuff test test?
Infraspinatus and tees minor
How is the posterior cuff test done?
The arm positioned at patient’s side, with the elbow flexed to 90°. The patient is instructed to externally rotate their arm against resistance
What is a positive posterior cuff test?
Weakness on resistance
What are the main differentials for rotator cuff tears?
- Fracture
- Persistent glenohumeral subluxation
- Brachial plexus injury
- Radiculopathy
What investigation should be done urgently in patients presenting with clinical features of a rotator cuff tear?
X-ray (to exclude fractures)
What may be found on x-ray in rotator cuff tears?
Most will be unremarkable.
In chronic tears, there may be evidence of reduced acromiohumeral distance, or sclerosis and cyst formation the rotator cuff insertion on the greater tuberosity of the humerus.
What further imaging can be done in rotator cuff tears once fractures have been excluded?
- Ultrasound
- MRI
Why is ultrasound used in rotator cuff tears?
Establish presence and size
Why is MRI imaging used in rotator cuff tears?
Detect size, characteristics, and location of eyear
What is the management of rotator cuff tears dependant on?
- Type of tear
- Functional status of patient
Who is conservative management of rotator cuff tears preferred in?
- Not limited by pain or loss of function
- Significant co-morbidities and unsuitable for surgery
How should patients presenting within 2 weeks of the injury be managed?
Should be advised on conservative management approach, but if this fails can be referred for surgical intervention
What is involved in the conservative management of rotator cuff tears?
- Analgesia
- Physiotherapy
- Corticosteroid infections into the subacromial space can be trialled
Who should get surgical management for rotator cuff tears?
- Not responding to conservative
- Large or massive tears
Who has worse outcomes for surgical repair of rotator cuff tears?
- Large or massive tears
- Age >65
- Poor compliance with rehab
- Current smokers
What is the main complication of rotator cuff tears?
Adhesive capsulitis
