Rotator cuff tears

Question 1

What are the rotator cuff muscles?

Answer 1

Supraspinatus, infraspinatus, teres minor and subscapularis

Question 2

What is the main action of supraspinatus?

Answer 2

abduction

Question 3

What is the main action of infraspinatus?

Answer 3

external rotation

Question 4

What is the main action of teres minor?

Answer 4

External rotation

Question 5

What is the main action of subscapularis?

Answer 5

internal rotation

Question 6

What does the rotator cuff muscles do as well as move the shoulder?

Answer 6

stabilise the humeral head in the glenoid fossa and maintain overall shoulder stability

Question 7

What joint does the rotator cuff support?

Answer 7

Glenohumeral joint

Question 8

What is an acute rotator cuff tear?

Answer 8

lasting less than 3 months

Question 9

What is a chronic rotator cuff tear?

Answer 9

lasting more than 3 months

Question 10

What are the types of thickness of rotator cuff tears?

Answer 10

Partial or Full

Question 11

Want are the 4 types of full thickness rotator cuff tears?

Answer 11

small (<1cm) medium (1-3cm) large (3-5cm) massive (over 5cm or multiple tendons)

Question 12

When do acute tears commonly occur with the rotator cuff?

Answer 12

when there is pre existing degeneration usually alone with minimal force but can also be caused by large force

Question 13

When do chronic tears commonly occur with the rotator cuff?

Answer 13

degenerative microtears to the tendon from overuse and in older people

Question 14

What are the risk factors for rotator cuff tears?

Answer 14

age, trauma, overuse and repetitive shoulder motions, high bmi, smoking, and diabetes

Question 15

What are the clinical features of rotator cuff tears?

Answer 15

Pain over the lateral aspect of the shoulder, inability to abduct the arm above 90 degrees , usually in the dominant arm

Question 16

What would be found on examination of someone with a rotator cuff tear?

Answer 16

tenderness over the greater tuberosity and subacromial bursa regions, supraspinatus an dinfraspintus atrophy

Question 17

What are the specific tests for rotator cuff tears?

Answer 17

Jobes test, Gerbers lift off test and Posterior cuff test

Question 18

What is Jobes test?

Answer 18

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

Question 19

What is Gerbers lift off test?

Answer 19

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

Question 20

What is a posterior cuff tear test?

Answer 20

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

Question 21

What are the differential diagnosis for rotator cuff tears?

Answer 21

fracture, persistant glenohumeral subluxation, brachial plexus injury or radiculopathy

Question 22

What investigations are done for rotator cuff injuries?

Answer 22

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

Question 23

What is the conservative management for rotator cuff tears?

Answer 23

if present within 2 weeks since injury then analgesia and physiotherapy with activity modification, corticosteroids injections into subacromial space

Question 24

What is the surgical management for rotator cuff tears?

Answer 24

If present after 2 weeks since injury or still symptomatic despite conservative management, also large and massive tears, athroscopically or open approach,

Question 25

What is the main complication of rotator cuff tears>

Answer 25

adhesive capsulitis leading to stiffness of the glenohumeral joint and also enlargement or tears may occur