ROTATOR CUFF TEAR

Question 1

Other names for rotator cuff tears

Answer 1

(a) Musculotendinous cuff rupture
(b) Rotator cuff rupture
(c) Rotator cuff tendinitis

Question 2

Acute injury to the rotator cuff does occur but most injuries are age-related:

Answer 2

(a) Tendon degeneration
(b) Chronic mechanical impingement
(c) Altered blood supply to the tendons

Question 3

Tears generally originate with the what muscle and may progress posteriorly and anteriorly

Answer 3

supraspinatus

Question 4

Clinical Symptoms of a patient with a Rotator

Cuff Tear.

Answer 4

(1) Chronic shoulder pain for several months
(2) Specific injury that triggered pain
(3) Night pain and difficulty sleeping on the affected side
(4) Complaints of weakness, catching and grating especially overhead activities

Question 5

Physical Exam of a patient with a Rotator

Cuff Tear.

Answer 5

(1) Visual
(a) Shoulder may appear sunken, indicating atrophy of the infraspinatus
following a long- standing cuff tear
(2) Palpation
(a) Tenderness over greater tuberosity is usually present
(b) Grating sensation can be felt at tip of shoulder
(3) ROM
(a) Usually full PROM
(b) Some patients may maintain full AROM
(c) Cannot raise arm with large tears. Can only shrug or hike shoulder upward
(4) Muscle Tests
(a) Abduction, forward flexion and external rotation may be limited
(5) Neurovascular Tests
(a) Usually intact
(6) Special Tests
(a) Positive Drop Arm test
(b) Positive Empty Can tests

Question 6

Diagnostic Tests of a patient with a Rotator

Cuff Tear.

Answer 6

(1) Radiographs needed to evaluate subacromial space for spurring and malalignment
due to long standing tears
(2) MRI necessary to confirm diagnosis

Question 7

Treatment of a patient with a Rotator

Cuff Tear.

Answer 7

(1) NSAIDs
(2) Ice
(3) Light duty to include no overhead activities
(4) Home exercise program for shoulder strengthening and stretching
(5) Physical therapy consult if failed local management
(6) Orthopedic consult if failed rehabilitation over 3 to 6 months

Question 8

Referral Decisions/Red Flags of a patient with a Rotator

Cuff Tear.

Answer 8

(1) Failure of 6 weeks of nonsurgical treatment is an indication for further evaluation
(2) Acute traumatic tears should be surgically repaired immediately or no later than 6
weeks post-injury
(3) Patients younger than 55 years old should be considered for surgical repair as
tears could enlarge with time