Rotator Cuff Tears

Question 1

What phase of throwing is a/w rotator cuff tears?

Answer 1

Deceleration phase; overhead throwing athletes suffer partial thickness tears

Question 2

What is commonly injured in shoulder dislocation in patients >40yo?

Answer 2

Rotator cuff; occurs in 35-85%

Question 3

What are the rotator interval, crescent and cable?

Answer 3

Rotator interval- capsule, SGHL, and the coracohumeral ligament that bridge the gap between the supraspinatus and the subscapularis

Rotator crescent- thin, crescent-shaped sheet of rotator cuff comprising the distal portions of the supraspinatus and infraspinatus insertions

Rotator cable- thick bundle of fibers found at the avascular zone of the coracohumeral ligament running perpendicular to the supraspinatous fibers and spanning the insertions of the supra- and infraspinatus tendons

Question 4

How are cuff tears classified by size?

Fatty infiltration?

Answer 4

Size:
Small- 0-1cm
Med- 1-3cm
Large- 3-5cm
Massive- >5cm (or involving 2 or more tendons)

Goutallier (fatty infiltration):
0- normal
1- some fatty streaks
2- more muscle than fat
3- equal fat and muscle
4- more fat than muscle

Question 5

What portion of patients >60yo will have an asymptomatic RCT on MRI?

Answer 5

30-55%

Question 6

Medial biceps tendon subluxation is a sign of?

Answer 6

Subscapularis tear
May also see retraction of the tendon to the glenoid
Uncovered lesser tuberosity
Avulsed SGHL

Question 7

Which RCT shoulder be repaired?

Answer 7

Bursal sided tear >25% (>3mm)

Articular sided tear >50% (>7mm exposed bone)

Question 8

What is the rate limiting step in repair of RCT?

Answer 8

Healing of tendon to bone; takes 8-12 weeks

Can improve with drill holes in greater tuberosity

Question 9

What is indicated in large supraspinatus and infraspinatus tears with intact subscapularis tendon?

Answer 9

Latissimus dorsi transfer; best candidate is young laborer

Question 10

What can be done for chronic subscapularis tendon tears?

Answer 10

Pectoralis major tendon transfer; tendon passed under conjoined tendon

Question 11

What is a risk factor for not healing a rotator cuff repair?

Answer 11

Age >65yo

Question 12

What are some relative surgical indications for repair of rotator cuff tears?

Answer 12

Articular sided >50%

Bursar sided >25%

Question 13

What is the average AP and medial-lateral size of the supraspinatus footprint?

Answer 13

AP: 22-24mm
ML: 14-16mm

Question 14

What is an appropriate protocol for mini open and arthroscopic repair of rotator cuff tears?

Answer 14

early passive range of motion exercises are initiated to prevent adhesive capsulitis. Active range of motion exercises should be initiated no earlier than 6 weeks postoperatively

Question 15

Resection of the coracoacromial ligament during shoulder arthroscopy results in?

Answer 15

Increased glenohumeral translation
CA ligament provides a suspension function and restrains anterior and inferior translation through an interaction with the coracohumeral ligament