Chapter 72 - Rotator Cuff Tear and Cuff Tear Arthropathy

Question 1

large tears vs small tears

Answer 1

large tears progress faster than small tears

Question 2

risk factors for a rotator cuff tear

Answer 2

age
smoking
female sex
family history
diabetes
high cholesterol

Question 3

Pathophysiology of age related degeneration in rotator cuff tears

Answer 3

changes in collagen, proteoglycan, water content

usually involves the supraspinatus and infraspinatus, and starts on the articular side

Question 4

pathophysiology of impingement related tears

Answer 4

chronic impingement on coracoacromial arch, tears start on bursal side, associated with hook shaped acromion

Question 5

Describe the supraspinatus and infraspinatus footprints

Answer 5

supraspinatus:
13mm medial to lateral
20mm AP

infraspinatus:
14mm medial to lateral
20mm superoinferior

Question 6

what is the rotator cable?

Answer 6

thick band of tissue running perpendicular to the supraspinatus tendon, connecting supra and infra tendons

Question 7

describe the hypovascular critical zone

Answer 7

ARTICULAR side of the cuff, closes to the insertion on the GT

Question 8

what presenting symptom is correlated to poor outcomes after non-op management?

Answer 8

night pain

Question 9

what imaging modality is best for detecting partial thickness RCTs

Answer 9

intra-articular contrast enhanced MRI (MR arthogram)

Question 10

indications for operating on rotator cuff tears

Answer 10

• 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)

Question 11

outcomes of rotator cuff repair technique

Answer 11

essentially equivalent results with single row, double row, or transosseous techniques

Question 12

what will overresection anterior to the anterolateral tip of the acromion cause?

Answer 12

anterosuperior humeral head escape - caused by overresection of the coracoacromial ligament

Question 13

what tendon transfer to do for subscap failure?

Answer 13

pectoralis major transfer

Question 14

what tendon transfer to do for infraspinatus/supraspinatus

Answer 14

latissimus dorsi transfer
- best restores ER
- forward flexion is a secondary function and not as well restored

*** MUST have an intact subscap

Question 15

what tendon transfer is promising for restoring forward elevation?

Answer 15

lower trapezius transfer
downside is you need allograft

Question 16

what is the most common causative organism in infections post rotator cuff repair

Answer 16

c. acnes

Question 17

rotator cuff arthropathy - findings intraarticular

Answer 17

non-inflammatory joint effusion containing calcium hydroxyapatite crystals, synovial hyperplasia, multiple loose bodies

Question 18

radiographic findings unique to RCA

Answer 18

• acetabularization of the acromion
• eccentric superior glenoid wear
• absence of typical peripheral osteophytes around the humeral head that are usually seen in GH OA

Question 19

contraindications to rTSA

Answer 19

deficient deltoid function
non-compliant patients
chronic infection
poor glenoid bone stock

Question 20

outcomes of ream-and-run hemiarthropalsty

Answer 20

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

Question 21

Center of Rotation changes in rTSA

Answer 21

• COR moved medial and distally
• assists deltoid fulcrum
• improves active abduction

Question 22

outcome of aTSA in RCA

Answer 22

• absolutely contraindicated
• leads to the rocking horse phenomenon and glenoid loosening

Question 23

number one complication post rTSA

Answer 23

instability (dislocation)

Question 24

number one complication post aTSA

Answer 24

glenoid component loosening