Rotator Cuff Tear Flashcards
What are the rotator cuff muscles?
Supraspinatus - abduction
Infraspinatus - external rotation
Teres minor - external rotation
Subscapularis - internal rotation
How are rotator cuff injuries classified?
Acute <3 months
Chronic >3 months
Partial thickness
Full thickness
How are full thickness rotator cuff tears classified?
Small - <1cm
Medium - 1-3 cm
Large - 3-5cm
Massive - >5cm
Pathophysiology of acute rotator cuff tears
Occur in tendons with pre-existing degeneration
Force can cause a tear
Pathophysiology of chronic rotator cuff tears
Degenerative microtears
Risk factors for rotator cuff tears
Increasing age
Trauma
Overuse - repetitive overhead shoulder movements
Clinical features of rotator cuff tears
Pain - lateral aspect of shoulder
Inability to abduct arm >90 degrees
Tenderness over greater tuberosity
What are the specific tests for rotator cuff tears
Jobe’s test - supraspinatus
Gerber’s lift-off test - subscapularis
Posterior cuff test - teres minor + infraspinatus
What is Jobe’s test?
Empty can test - tests supraspinatus
- shoulder in 90’ abduction + 30’ forward flexion + fully internally rotate
- gently push down
- positive if weakness on resistance
What is Gerber’s lift-off test?
Tests subscapularis
- internally rotate arm so dorsum of hand on back
- ask patient to lift hand away from back
- positive if weakness actively lifting hand
What is the posterior cuff test?
Tests infraspinatus + teres minor
- arm at patients side
- elbow flexed 90’
- externally rotate against resistance
- positive if weakness on resistance
Investigations for suspected rotator cuff tear
X-ray - exclude fracture
Ultrasound - establish presence and size of tear
MRI
Conservative management of rotator cuff tear
Presenting within 2 weeks of injury
Analgesia
Physiotherapy
Corticosteroid injections into subacromial space
Surgical management of rotator cuff tear
2 weeks since injury OR remaining symptomatic
Repairs done arthroscopically
