Rotator cuff injuries Flashcards
What are the 4 muscles of the rotator cuff and what do they do?
- Supraspinatus: abducts the arm before the deltoid
- Infraspinatus: external rotation
- Teres minor: adduction and external rotation
- Subscaprularis: Adduction and internal rotation
What are the causes of subacromial impingement (supraspinatus tendonitis)?
- Swollen supraspinatus tendon (supraspinatus tendinopathy or subacromial bursitis)
- Reduced space between acromion and humeral head (osteophytes)
- 30% of cases follow trauma
What are the symptoms of subacromial impingement (supraspinatus tendonitis)?
- Tenderness of over anterior acromion
- Painful arc between 60-120 degrees and 170-180 degrees (demonstrated by passive abduction then active adduction)
- Pain will radiate to upper arm
- May have painful spasms of trapezius
What are the examination findings of subacromial impingement (supraspinatus tendonitis)?
- Active movement more painful than passive movement (causes more impingement)
- Positive empty can (jobes) test
What are the investigations for subacromial impingement (supraspinatus tendonitis)?
- X-ray for bony involvement (may show degenerative changes)
- USS may show it
- MRI is definitive but only done in run up to surgery
What is the management of mild to moderate subacromial impingement (supraspinatus tendonitis)?
- Rest
- Analgesia with paracetamol and NSAIDs
- Physio
What is the treatment of severe subacromial impingement (supraspinatus tendonitis)?
- Corticosteroid injection in subacromial bursa
- Surgery (removal of osteophytes or acromioplasty)
What is a tendinopathy?
Degenerative change in the structure of a tendon from well structured bundles of collagen to disarrayed fibrils with a larger ECM volume
What are the common sites of tendinopathy?
- Supraspinatus (most common)
- Achilles
- Common flexor/extensor insertion of forearm
- Tibialis posterior
- Patellar tendon
What is the difference between tendinitis and tendinopahty?
Tendinitis is inflammation whereas tendinopathy is collagen degeneration
What does supraspinatus tendinopathy cause?
Painful arc syndorme
How its supraspinatus tendinopathy resolved?
Time, physio and analgesia
Causes of supraspinatus tear?
- When tendons are violently stretched (e.g. lifting something too heavy or falling on outstretched arm)
- More common in OA and RA
What are the clinical features of a supraspinatus tear?
- Intense pain in shoulder that radiates down arm (pain is in first 60 degrees)
- Inability to abduct arm (can’t initiate movement)
What are the examination findings for supraspinatus tear?
- Shoulder looked normal
- Tenderness below lateral margin of acromion
- Normal passive movement but no active abduction
- Positive drop arm and Jobes test
How can Jobes test differentiate between supraspinatus tendonitis and suprapinatus tear?
- Pain with weakness = tear
- Pain without weakness = tendonitis
Signs of infraspinatus or teres minor tear?
Pain and weakness on external rotation especially against resistance
Signs of subscapularis tear?
Inability to lift hand of back in Gerber’s lift off test
What imaging is used in rotator cuff tear?
USS (but MRI more sensitive)
What is the management of rotator cuff tear?
- If can’t move muscle at all: refer urgently due to atrophy risk
- PRICE
- Surgery for younger patients (not done in RA or elderly)
