Rotator Cuff Tear

Question 1

Physical Exam

Answer 1

Supraspinatus - empty can test (Jobe). Arm abducted 90 deg, thumb pointing down. Pt resists downward force from examiner
Infrapsinatus - arm adducted, elbow 90 deg. Pt resists shoulder internal rotation
Subscapularis - lift off test

Question 2

Ratio of shoulder motion

Answer 2

2:1 ratio of shoulder motion between the GH and ST joints (ie, 180 degrees of abduction consists of 120 degrees of GH motion and 60 degrees of ST motion).

Question 3

Shoulder joints

Answer 3

glenohumeral (GH), sternoclavicular (SC), acromioclavicular (AC), and scapulothoracic (ST) joints

Question 4

Xray findings associated with rotator cuff pathology

Answer 4

calcific tendonitis, proximal migration of the humerus (seen with chronic RCT), or a hooked acromion.

Question 5

MRI findings

Answer 5

muscle atrophy, medial biceps tendon subluxation (indicative of a subscapularis tear), and cysts in the humeral head (seen in the majority of patients with a chronic RCT).

Question 6

Management of RCT’s

Answer 6

young, active patients presenting with an acute tear and a primary complaint of weakness are best treated with early surgical repair, whereas older patients complaining of pain in the setting of chronic, degenerative tears are most responsive to nonoperative treatment.

Question 7

Most commonly torn tendon

Answer 7

Supraspinatus