Rotator Cuff Tear

Question 1

What’s the first step in a repair?

Answer 1

To clear the subacromial bursa for vision

Question 2

What modifications to the bone and tendon are made to promote healing?

Answer 2

Injuring the tissues to promote blood flow and a healing environment

Holes are chiseled into the bone to also promote healing in the area

Question 3

What can cause a RCT?

Answer 3

Diminished blood supply with age or insult predisposes to tendon degen and tearing

Rotator cuff impingement under the acromion can repetitively impinge and physically degenerate the tendon to the point of tearing

Question 4

When do tears most commonly occur?

Answer 4

Age > 40

Fall or other traumatic injury

Question 5

What’s the treatment for RCTs?

Answer 5

Conservative tx: first-line (50% successful, 50% no relief or worsened sxs d/t further dmg/degen), rest + ice + anti-inflammatories + avoid overhead exercises

• glucocorticoid injection available
• methylprednisone

Surgery: recommended in young pts immediately

• arthroscopic
• removal of bursa, place wide-thread mounts and ultra-high molecular wt polyethylene sutures
• sling 6 weeks with PT right after surgery (elbow, wrist, hand), at 6 weeks shoulder exercises begin, at 12 weeks strengthening starts

Surgery:

Question 6

How long until pain relief post-surg? How long is recovery?

Answer 6

Few weeks

6 months