Chapter 72 - Rotator Cuff Tear and Cuff Tear Arthropathy Flashcards
large tears vs small tears
large tears progress faster than small tears
risk factors for a rotator cuff tear
age
smoking
female sex
family history
diabetes
high cholesterol
Pathophysiology of age related degeneration in rotator cuff tears
changes in collagen, proteoglycan, water content
usually involves the supraspinatus and infraspinatus, and starts on the articular side
pathophysiology of impingement related tears
chronic impingement on coracoacromial arch, tears start on bursal side, associated with hook shaped acromion
Describe the supraspinatus and infraspinatus footprints
supraspinatus:
13mm medial to lateral
20mm AP
infraspinatus:
14mm medial to lateral
20mm superoinferior
what is the rotator cable?
thick band of tissue running perpendicular to the supraspinatus tendon, connecting supra and infra tendons
describe the hypovascular critical zone
ARTICULAR side of the cuff, closes to the insertion on the GT
what presenting symptom is correlated to poor outcomes after non-op management?
night pain
what imaging modality is best for detecting partial thickness RCTs
intra-articular contrast enhanced MRI (MR arthogram)
indications for operating on rotator cuff tears
- failed non-op management (>6mo)
- traumatic RCT in active patients
- acute, full thickness tears
- old people with RCTs with good mm on mri
- partial articular sided lesions >50% ( if<50% can be treated with SAD alone)
outcomes of rotator cuff repair technique
essentially equivalent results with single row, double row, or transosseous techniques
what will overresection anterior to the anterolateral tip of the acromion cause?
anterosuperior humeral head escape - caused by overresection of the coracoacromial ligament
what tendon transfer to do for subscap failure?
pectoralis major transfer
what tendon transfer to do for infraspinatus/supraspinatus
latissimus dorsi transfer
- best restores ER
- forward flexion is a secondary function and not as well restored
*** MUST have an intact subscap
what tendon transfer is promising for restoring forward elevation?
lower trapezius transfer
downside is you need allograft
what is the most common causative organism in infections post rotator cuff repair
c. acnes
rotator cuff arthropathy - findings intraarticular
non-inflammatory joint effusion containing calcium hydroxyapatite crystals, synovial hyperplasia, multiple loose bodies
radiographic findings unique to RCA
- acetabularization of the acromion
- eccentric superior glenoid wear
- absence of typical peripheral osteophytes around the humeral head that are usually seen in GH OA
contraindications to rTSA
deficient deltoid function
non-compliant patients
chronic infection
poor glenoid bone stock
outcomes of ream-and-run hemiarthropalsty
increased rehab, need very compliant patient
avoids the potential limitations associated with a prosthetic glenoid component
provides patient with the opportunity for a level of activity beyond that recommended for a total shoulder arthroplasty
Center of Rotation changes in rTSA
- COR moved medial and distally
- assists deltoid fulcrum
- improves active abduction
outcome of aTSA in RCA
- absolutely contraindicated
- leads to the rocking horse phenomenon and glenoid loosening
number one complication post rTSA
instability (dislocation)
number one complication post aTSA
glenoid component loosening
