Rotator Cuff Tear

Question 1

Incidence of acute full thickness rotator cuff tears in 40-70s

Answer 1

2.5 per 10,000

Question 2

Prevalence of rotator cuff tears in general population

Answer 2

20%

Question 3

When rotator cuff tears are classed as acute

Answer 3

Lasting <3 months

Question 4

When rotator cuff tears are classed as chronic

Answer 4

Lasting >3 months

Question 5

Classification of full thickness tears by size (4)

Answer 5

Small <1cm; Medium 1-3cm; Large 3-5cm; Massive >5cm or multiple tendons

Question 6

Muscles contained in rotator cuff (4)

Answer 6

1 Supraspinatus 2 Infraspinatus 3 Teres minor 4 Subscapularis

Question 7

Function of supraspinatus

Answer 7

Humerus abduction 0-15 degrees

Question 8

Function of infraspinatus

Answer 8

External rotation

Question 9

Function of subscapularis

Answer 9

Internal rotation

Question 10

Function of teres minor

Answer 10

External rotation

Question 11

Overall function of rotator cuff

Answer 11

Stabilising shoulder

Question 12

Pathophysiology of acute rotator cuff tear (2)

Answer 12

1 minimal force due to pre-existing degeneration 2 high energy force in young

Question 13

Tissue damaged in rotator cuff tears

Answer 13

Rotator cuff tendons

Question 14

Pathophysiology of chronic tears (3)

Answer 14

1 degenerative microtears 2 overuse 3 increasing age

Question 15

Risk factors for rotator cuff tear (7)

Answer 15

1 increasing age 2 trauma 3 overuse 4 overhead shoulder motions 5 BMI>25 6 smoking 7 DM

Question 16

Common presentation of rotator cuff tear (3)

Answer 16

1 pain over lateral shoulder 2 inability to abduct over 90 degrees 3 in dominant arm

Question 17

O/E look signs in massive rotator cuff tear

Answer 17

Supraspinatus/infraspinatus atrophy

Question 18

O/E feel sign in rotator cuff tear (2)

Answer 18

1 tenderness over greater tuberosity 2 tenderness of subacromial bursa region

Question 19

Special tests for ? rotator cuff tear (3)

Answer 19

1 Jobe’s test 2 Gerber’s lift-off test 3 posterior cuff test

Question 20

What does Jobe’s test assess

Answer 20

Supraspinatus

Question 21

How is Jobe’s test performed (3)

Answer 21

A abducted shoulder flexed to 30 degrees B gently push down on arm C weakness on resistance +ve

Question 22

What does Gerber’s lift-off test assess

Answer 22

Subscapularis

Question 23

What does the posterior cuff test assess

Answer 23

Infraspinatus and teres minor

Question 24

How is Gerber’s test performed (3)

Answer 24

1 internally rotate so dorsal hand rests on lower back 2 hand lifted from back against resistance 3 weakness is +ve

Question 25

How is posterior cuff test performed (3)

Answer 25

A arm at side with elbow at 90 degrees B external rotation against resistance C weakness is +ve

Question 26

DDx for ? rotator cuff tear (3)

Answer 26

1 fracture 2 persisten glenohumeral subluxation 3 brachial plexus injury

Question 27

Investigations for ? cuff tear (3)

Answer 27

1 urgent plain film radiograph 2 USS 3 MRI

Question 28

Use of plain radiograph in rotator cuff tear

Answer 28

exclusion

Question 29

Use of USS in ? rotator cuff tear

Answer 29

Establish presence and size of tear

Question 30

Use of MRI imaging in ? rotator cuff tear (3)

Answer 30

Detect: 1 size 2 characteristics 3 location of tear

Question 31

Indications for conservative management in rotator cuff tear (3)

Answer 31

1 pain 2 loss of function 3 significant co-morbidity so unsuitable for surgery

Question 32

Describe conservative management of rotator cuff tear within two weeks of injury (3)

Answer 32

1 analgaesia 2 physiotherapy 3 subacromial space corticosteroid injection

Question 33

Describe surgical management of rotator cuff tears presenting within two weeks of injury

Answer 33

arthroscopic

or open repair

Question 34

Prognosis following surgical repair

Answer 34

1 very good; Unless: 2 large or massive tears 3 age >65

Question 35

Main complication from rotator cuff tear (2)

Answer 35

1 adhesive capsulitis 2 leading to glenohumeral joint stiffness

Question 36

Risk of enlargement of age-related tears

Answer 36

40% within 5y

Question 37

Proportion of enlarged tears which become symptomatic

Answer 37

80%