Rotator cuff tears Flashcards
What are the rotator cuff muscles?
Supraspinatus, infraspinatus, teres minor and subscapularis
What is the main action of supraspinatus?
abduction
What is the main action of infraspinatus?
external rotation
What is the main action of teres minor?
External rotation
What is the main action of subscapularis?
internal rotation
What does the rotator cuff muscles do as well as move the shoulder?
stabilise the humeral head in the glenoid fossa and maintain overall shoulder stability
What joint does the rotator cuff support?
Glenohumeral joint
What is an acute rotator cuff tear?
lasting less than 3 months
What is a chronic rotator cuff tear?
lasting more than 3 months
What are the types of thickness of rotator cuff tears?
Partial or Full
Want are the 4 types of full thickness rotator cuff tears?
small (<1cm) medium (1-3cm) large (3-5cm) massive (over 5cm or multiple tendons)
When do acute tears commonly occur with the rotator cuff?
when there is pre existing degeneration usually alone with minimal force but can also be caused by large force
When do chronic tears commonly occur with the rotator cuff?
degenerative microtears to the tendon from overuse and in older people
What are the risk factors for rotator cuff tears?
age, trauma, overuse and repetitive shoulder motions, high bmi, smoking, and diabetes
What are the clinical features of rotator cuff tears?
Pain over the lateral aspect of the shoulder, inability to abduct the arm above 90 degrees , usually in the dominant arm
What would be found on examination of someone with a rotator cuff tear?
tenderness over the greater tuberosity and subacromial bursa regions, supraspinatus an dinfraspintus atrophy
What are the specific tests for rotator cuff tears?
Jobes test, Gerbers lift off test and Posterior cuff test
What is Jobes test?
empty can test, tests supraspinatus, place the shoulder in 90 degree abduction and 30 degree forward flexion and internally rotate fully, as if youre emptying a can, gently push forward on the arm, if there is weakness on resistance this is a positive test
What is Gerbers lift off test?
tests subscapularis, internally rotate the arm so the dorsal surface of the hand rests on the lower back, ask the patient to lift the hand away from back against examiners resistance, positive is weakness in actively lifting the hand away from the back
What is a posterior cuff tear test?
tests infraspinatus and teres minor, arm is positioned at the patients side with the elbow flexed at 90 degrees, patient is instructed to externally rotate their arm against resistance, positive test is present if there is weakness on resistance
What are the differential diagnosis for rotator cuff tears?
fracture, persistant glenohumeral subluxation, brachial plexus injury or radiculopathy
What investigations are done for rotator cuff injuries?
urgent plain radiograph to exclude a fracture, most will be unremarkable but there may be evidence of reduced acromiohumeral distance or sclerosis, cyst formation, can then do ultrasonography to see the size of the tear as can MRI
What is the conservative management for rotator cuff tears?
if present within 2 weeks since injury then analgesia and physiotherapy with activity modification, corticosteroids injections into subacromial space
What is the surgical management for rotator cuff tears?
If present after 2 weeks since injury or still symptomatic despite conservative management, also large and massive tears, athroscopically or open approach,
What is the main complication of rotator cuff tears>
adhesive capsulitis leading to stiffness of the glenohumeral joint and also enlargement or tears may occur
