Rotator Cuff Tear

Question 1

What are the rotator cuff muscles

Answer 1

SITS

Supraspinatus– abduction
Infraspinatus – external rotation
Teres minor – external rotation
Subscapularis – internal rotatio

Question 2

How are rotator cuff muscle tears classified

Answer 2

Acute - lasting for less than 3 months

Chronic - more than 3 months

Partial thickness

Full thickness

Question 3

What is the classification of full thickness tears

Answer 3

Small - less than 1cm

Medium - 1 to 3cm

Large - 3 to 5 cm

Massive - more than 5cm

Question 4

Identify the rotator cuff muscles on the diagram

Answer 4

Refer to teach me surgery images

Question 5

What is the pathophysiology of acute tears

Answer 5

Occur in tendons with pre-existing degeneration

Question 6

What is the pathophysiology of chronic tears

Answer 6

Due to degenerative microtears occurring with increasing age

Question 7

What are the risk factors of rotator cuff tears

Answer 7

Age

Trauma

Overuse

Repetitive overhead shoulder motions

Obesity

Smoking

DM

Question 8

What are the clinical features of rotator cuff tears

Answer 8

Pain in the lateral aspect of shoulder

Inability to abduct the arm above 90 degrees

Examination: tenderness over the greater tuberosity, muscle atrophy ( in big tears ).

Question 9

What is the Jobes test

Answer 9

Empty can test - assesses supraspinatus

Position - 90 degree abduction, 30 degree forward flexion, internal rotation

Doctor then pushes down on arm, test is positive if weakness on resistance

Question 10

What is the gerbers lift off test

Answer 10

Tests subscapularis

Position: internal rotation of arm, dorsal had on the back.

Ask patient to push on examiners hand

Question 11

What is the posterior cuff test

Answer 11

Tests - infraspinatus and teres minor

Arms next to patient with 90 degree elbow flexion

Patient then asked to externally rotate arm against resistance

Question 12

What are the differential diagnosis of rotator cuff tears

Answer 12

glenohumeral subluxation, brachial plexus injury, or radiculopath

Question 13

How do you investigate rotator cuff tears

Answer 13

Urgent Plain film radiograph - to exclude fracture

After exclusion then:
Ultrasonography

MRI

Question 14

What is the conservative management of rotator cuff tears

Answer 14

Treated within 2 weeks of presenting complaint:

Analgesia

Physiotherapy

Corticosteroid injections

Question 15

What are the indications for surgery for rotator cuff tears

Answer 15

Those presenting 2 weeks after injury/conservative treatment not working:

Question 16

What are the surgical indications for rotator cuff tears

Answer 16

Remain symptomatic despite conservative treatment

Large and massive Tears

Presenting 2 weeks after injury

Question 17

What are the two ways that you can repair RCT

Answer 17

Arthroscopically ( earlier recovery) or open ( large/massive tears )

Question 18

What is the main complication of RCT

Answer 18

Adhesive capsulitis