Rotator Cuff tears

Question 1

describe how tendons of the rotator cuff can tear

Answer 1

with minimal/no trauma due to degeneration of tendon, or through significant injury to shoulder(eg dislocation)

Question 2

what is the cause if most rotator cuff tears

Answer 2

degeneration of tendon with age with minimal/no trauma

Question 3

describe a classic history of a rotator cuff tear

Answer 3

sudden jerk of shoulder/arm, >40 y/o, with subsequent pain and weakness

Question 4

what different thicknesses rotator cuff tears can be

Answer 4

partial or full

Question 5

what tendon of the rotator cuff is usually involved in tear

Answer 5

supraspinatus

Question 6

what tendons of the rotator cuff can large tears affect

Answer 6

infraspinatus and subscapularis

Question 7

what clinical features are seen in rotator cuff tears

Answer 7

weakness of initiation of abduction(supraspinatus), internal rotation(infraspinatus) or external rotation(subscapularis), may be wasting of supraspinatus

Question 8

what investigations are used to detect rotator cuff tears

Answer 8

USS or MRI

Question 9

what non-operative treatment can be used for rotator cuff tears

Answer 9

physio to strengthen remaining muscles to compensate for supraspinatus, also steroid injections may help symptoms

Question 10

what operative treatment can be used for rotator cuff tears

Answer 10

rotator cuff repair(open or arthroscopic) with subacromial decompression

Question 11

what is the aims/possible benefit of surgery for rotator cuff tears

Answer 11

improve/maintain strength, prevent subsequent arthritis from chronic cuff deficiency

Question 12

what are the problems with surgical management of rotator cuff tears

Answer 12

tendon usually diseased and failure to repair occurs in ~1/3 cases, very large tears may be irrepairable