Rotator Cuff Tears

Question 1

prevalence

Answer 1

age >60: 28% have a full thickness tear, Age>70: 65% have a full thickness tear

Question 2

risk factors for rotator cuff tear

Answer 2

age, smoking, HLD, family history

Question 3

age you worry about cuff tears with dislocation

Answer 3

> 40 years

Question 4

what is internal impingement

Answer 4

Due to posterior capsular contracture, leading to partial thicknes articular sided tear of the roattor cuff do to wind up (wrong - its the deceleration phase)

Question 5

fucntion of the rotator cuff

Answer 5

balances the force couples in the shoulder: subscap vs. infra/teres and subscap/infra/teres vs. the deltoid. Supraspinatus is the primary initiator of abduction

Question 6

function of supraspinatus

Answer 6

Initiates and assists deltoid in abduction of arm and acts with other rotator cuff muscles

Question 7

rotator cuff footprint

Answer 7

supraspinatus 12.7 mm in wdith mediolateral, a a tear of 6-7 mm is a 50% tear

Question 8

where does tear start

Answer 8

15 mm posterior ot biceps tendon at junction of supraspinatus and ifnraspinatus, in degenerative tears

Question 9

AP dimensino of infra/supra

Answer 9

20 mm

Question 10

layers to the rotator cuff

Answer 10

5 layers, strong is layer 2 (3-5 mm thickness)

Question 11

contents of rotator interval

Answer 11

CHL, SGHL, biceps tendon, and capsule

Question 12

bursal or aritcular is more vascular

Answer 12

bursal is more vascular, articular side is more commonly involved in degen tears

Question 13

what is the rotator crescent

Answer 13

rotator cuff tendon extending from the cable medially to the footprint, it is thin and is comprised of the infra and supra

Question 14

what is rotator cable

Answer 14

it is a thickening of the tendon which is formed by the coracohumeral ligament, it is towards the end of the infra/supraspinatus tendons, it has been likened to a suspension bridge in terms of it’s function.

Question 15

sizes of rotator cuff tears

Answer 15

small is 0-1 cm, medium is 1-3 cm, large is 3-5 cm, massive is >5 cm (invovles 2 or more tendons)

Question 16

Classification for rotator cuff tears,

Answer 16

Cofield or Ellman, depeneding on the typeFu

Question 17

Full thickness tear classification

Answer 17

Cofield 1982, cuff tear sizes small 0-1, medium 1-3, large 3-5, massive >5 cm (2 or more tendons).

Question 18

partial thickness tear classification

Answer 18

Ellman, Grade 1 <3 mm, 2 is 3-6 mm, III is >6 mm (>50%) of supra tear. A is articular, B is bursal, C intratendinous

Question 19

SLAP lesion cuases

Answer 19

overuse injury in overhead atheletes or traumatic falls in older patients. Deep shoulder pain and biceps tendonitis.

Question 20

slap mechanism in throwers

Answer 20

tight PIGHL, shifts contact point of GHJ posterosuperiorly increasing the shear force on the superior labrum

Question 21

function of the biceps tendon during throwing

Answer 21

contributes to torsional and horizontal stability during late-cocking phase of throwing

Question 22

slap tear biceps tenderness?

Answer 22

yes can have biceps groove tenderness

Question 23

Tests for biceps

Answer 23

Speed’s test, Yergason’s and Kim biceps load test

Question 24

how to perform speed’s test

Answer 24

FF 90 degrees, supinated, resist downward pressure. Or initialy descrived as starting with arm at side and FF with supinated 0-60

Question 25

how to perform yergasons

Answer 25

pronated with arm at side, try to supinate, thumb on groove to feel for subluxation

Question 26

how to perform kim biceps load test

Answer 26

abduct shouler 120 degrees, elbow bent 90, have them bend elbow against resistance

Question 27

obriens test also known as

Answer 27

Active compression test

Question 28

Crank test description

Answer 28

abduct to 160 degrees supine patient, axial load and internally/exteronally rotate tyring to pinch the SLAp tear

Question 29

dynamic labral shear test

Answer 29

place in ABER position, push anteriorly on huemral head, then raise up to 90-160 degrees if pain or click

Question 30

kibler anterior slide test

Answer 30

place hands onhips, thumb pointing posteriorly, examiner axially pushes up on the elbow and pain should be felt anteriorly

Question 31

use of apprehension in SLAP tears

Answer 31

positive in 85% of patients

Question 32

treatment for slap tears by age

Answer 32

tenotomy/tenodesis for those over 40 years of age

Question 33

what is peel back

Answer 33

SLAP tear, go into ABER position should see labrum peel back

Question 34

most common complication SLAP repair

Answer 34

stiffness, 78% of patients

Question 35

SLAP repair in older patients with ARCR patients risk

Answer 35

stiffness

Question 36

Other NV risks with SLAP repair

Answer 36

overdrilling glenoid leading to Suprascapular nerve injury

Question 37

subacromial impingement due to what

Answer 37

impingenet of the cuff against acromion, CA ligament, AC joint

Question 38

acromial types

Answer 38

TYpe 1 flat, 2 curved, 3 hooked. Bigliani

Question 39

Yocum test

Answer 39

hand on contraltaeral extremity and raise the elbow up, sensitive but not specific.

Question 40

internal impingemnt test

Answer 40

positive if pain with ABER

Question 41

GIRD associated with

Answer 41

SLAP lesion

Question 42

normal acromiohumeral interval

Answer 42

7-14 mm

Question 43

findings of rotator cuff dsiease on xray

Answer 43

traction osteophytes, subchondral cysts at greater tuberosity, CA ligamen tcalficiation, typ3. hooked acormion

Question 44

Subacromial bursa histology

Answer 44

high levels of metalloprotesaes and other inflammatory cytokines

Question 45

prp for impingemnt

Answer 45

insufficient evidence to support use with a recent meta analysis

Question 46

Internal impingement symptoms

Answer 46

Diagnosis is may clinically with worsening posterior shoulder pain during maximal abduction and external rotation (position of late cocking) associated with decreased internal rotation and supplemented with MRI showing posterior rotator cuff and posterior labral pathology.

Question 47

GIRD findings

Answer 47

smaller arc of motion and elevated ER

Question 48

GIRD mechanism of pain

Answer 48

ABER in late cocking and early acceleration leads to pel back by the biceps. Supraspinatus undersurface impinges on posteroupseiro rglenoid

Question 49

bennet lesion

Answer 49

hypertrophy and scarring of posterior capsule glenoid. exostosis of posteroinferior glenoid on xray

Question 50

GIRD etiology

Answer 50

PIGHL tightness, anterior microinstaiblity

Question 51

apprehension test and internal impingement

Answer 51

positive for pain

Question 52

gird translates humeral head

Answer 52

anterosuperior, opposite of tight strecutures in flexion, however in ABER ledas to posteropusruperior translation

Question 53

slap and gird

Answer 53

throws with gird are 25% more likely to have a slap lesion

Question 54

GIRD number of IR degrees

Answer 54

>20-25 degrees decrease and smaller arc

Question 55

gird treatment

Answer 55

sleeper stretch, cross body adduction stretch, pec minor stretching

Question 56

gird surgery

Answer 56

posteiror capsule release and anterior stablization

Question 57

Arthroscopic Rotator Cuff Repair with and without Acromioplasty in the Treatment of Full-Thickness Rotator Cuff Tears A Multicenter, Randomized Controlled Trial MacDonald, Peter MD, FRCSC1; McRae, Sheila MSc1; Leiter, Jeffrey MSc, PhD1; Mascarenhas, Randy MD1; Lapner, Peter MD, FRCSC2 Author Information The Journal of Bone & Joint Surgery 93(21):p 1953-1960, November 2, 2011.

Answer 57

WORC and ASES scores improved significantly in each group over time (p < 0.001). There were no differences in WORC or ASES scores between the groups that had arthroscopic cuff repair with or without acromioplasty at any time point. There were no differences in scores on the basis of acromion type, nor were any interaction effects identified between group and acromion type. Four participants (9%) in the group that had arthroscopic cuff repair alone, one with a Type-2 and three with a Type-3 acromion, required additional surgery by the twenty-four-month time point. The number of patients who required additional surgery was greater (p = 0.05) in the group that had arthroscopic cuff repair alone than in the group that had arthroscopic cuff repair and acromioplasty. Conclusions: Our findings are consistent with previous research reports in which there was no difference in functional and quality-of-life indices for patients who had rotator cuff repair with or without acromioplasty. The higher reoperation rate was found in the group without acromioplasty. Further study that includes follow-up imaging and patient-reported outcomes over a greater follow-up period is needed.

Question 58

Risk factors for lack of repair healing

Answer 58

Factors influencing the risk of failure in tendon healing after primary rotator cuff repair1: ■ AP tear size ■ Grade of infraspinatus fatty infiltration ■ Bone mineral density ■ Tear retraction ■ Increasing age >70 years ■ Level of work activity

Question 59

Forsythe B, Agarwalla A, Puzzitiello RN, Mascarenhas R, Werner BC. Rates and Risk Factors for Revision Open and Arthroscopic Proximal Biceps Tenodesis. Orthopaedic Journal of Sports Medicine. 2019;7(2).

Answer 59

Results: There were 15,257 patients who underwent biceps tenodesis. Of these, 9274 patients (60.8%) underwent arthroscopic biceps tenodesis, while 5983 (39.2%) underwent open biceps tenodesis. A total of 171 patients (1.8%) and 111 patients (1.9%) required revision biceps tenodesis after arthroscopic and open biceps tenodesis, respectively (P = .5). Male sex (OR, 1.38 [95% CI, 1.04-1.85]; P = .02) was the only independent risk factor for revision biceps tenodesis after the index open biceps tenodesis. After arthroscopic biceps tenodesis, age >45 years (OR, 0.58 [95% CI, 0.39-0.89]; P = .01) and concomitant rotator cuff tear (OR, 0.58 [95% CI, 0.47-0.71]; P < .001) were independent protective factors for revision biceps tenodesis. The total cost of revision biceps tenodesis after open and arthroscopic biceps tenodesis was US$3427.95 and US$2174.33 per patient, respectively. Conclusion: There was no significant difference in the revision rate between arthroscopic and open biceps tenodesis. Risk factors for revision surgery included male sex for open biceps tenodesis, while age >45 years and rotator cuff tears were protective factors for arthroscopic biceps tenodesis.

Question 60

Journal of Shoulder and Elbow Surgery Volume 21, Issue 1, January 2012, Pages 66-71 Journal of Shoulder and Elbow Surgery Shoulder Clinical success of biceps tenodesis with and without release of the transverse humeral ligament Author links open overlay panelBrett Sanders MD a, Kyle P. Lavery BA b, Scott Pennington MD c, Jon J.P. Warner MD b

Answer 60

When all techniques that released the biceps sheath (6.8%, 4/59) were compared to those that did not release the biceps sheath (20.6%, 14/68), a statistically significant difference was found, P = .026 (chi-square). Proximal arthroscopic techniques were revised at a significantly higher rate than distal tenodesis techniques (P = .005). Conclusion Biceps tenodesis techniques which do not release the biceps sheath or remove the tendon from the sheath have increased revision rates, compared to techniques that do. This may be supportive evidence for the theory that residual pain generating elements in the biceps groove is a cause of failure of proximal tenodesis methods.