Rotator Cuff Tear

Question 1

What joint do the rotator cuff muscles work on?

Answer 1

Glenohumeral joint

Question 2

How can rotator cuff tears be classified?

Answer 2

Either acute = less than 3 months or chronic = more than 3 months

Can be partial thickness or full thickness.

Full thickness can be classified into small, medium, large or massive.

Question 3

What are the rotator cuff muscles and what are their individual functions?

Answer 3

Supraspinatus - abduction

Infraspinatus - external rotation

Teres minor - external rotation

Subscapularis - internal rotation

They also provide stability to the glenohumeral joint

Question 4

What is the pathophysiology of rotator cuff tears?

Answer 4

Acute tears in tendons with pre existing degeneration common,y

Trauma can cause a large acute tear

Chronic tears occours in degenerative microtears to the tendon, commonly from overuse and seen in greater incidence with increased age

Question 5

What are the risk factors for tears?

Answer 5

Age 
Trauma 
Overuse 
Repetitive overhead shoulder motions 
Obesity 
Smoking 
Diabetic

Question 6

What are the clinical features of rotator cuff tears?

Answer 6

• Pain over lateral aspect of shoulder
• Inability to abduct arm over 90 degrees
• Tenderness over greater tuberosity
• Atrophy of supraspinatus and infraspinatus can be seen in massive tears

Question 7

What specific tests can be done for the rotator cuff muscles?

Answer 7

1) Jobe’s test - the ‘empty can test’; tests supraspinatus. Gently push downwards on the arm. A positive test is present if there is weakness on resistance.
2) Gerber’s lift-off test - tests subscapularis. internally rotate the arm so the dorsal surface of hand rests on lower back. Ask the patient to lift hand away from back against examiner resistance. A positive test is weakness in actively lifting the hand away from back (compare to the contralateral side).
3) Posterior cuff test (tests infraspinatus and teres minor) – the arm positioned at patient’s side, with the elbow flexed to 90°. The patient is instructed to externally rotate their arm against resistance.A positive test is present if there is weakness on resistance.

Question 8

What investigations can be done for rotator cuff tears?

Answer 8

Urgent plain film radiograph to exclude fracture

USS can establish size of year and MRI can be used to locate size, characteristics and location.

Question 9

How are rotator cuff tears conservatively managed?

Answer 9

Depends on type of tear and functional status

Conservative management is preferred if not limited by pain or loss of function, or those with significant co morbidities making them unsuitable for surgery.

If presenting 2 weeks since injury, conservative management includes analgesia and physiotherapy, with potentially corticosteroid injections into subacromial space.

Question 10

How are rotator cuff tears surgically managed?

Answer 10

2 weeks since the injury or remaining symptomatic despite conservative management should be referred for surgical intervention. Large and massive tears should also be considered for surgical repair.

Repairs can be done arthroscopically (allowing for earlier recovery) or via open approach (preferred in large or complex tears)

Question 11

What is the main complication of tears?

Answer 11

Adhesive capsulitis