-
Discussion: 
-
rotator cuff anatomy:
-
frequency of tear:
-
diff dx of cuff tears;: (
partial
rotator cuff tear)
-
etilogy of tear:
-
how do RTC tears heal?
-
Shoulder Exam:
-
impingement sign and test:
- it is essential to document ROM deficits, since rotator cuff repair would
not be expected
to yield a good outcome in the face of fixed shoulder contractures;
-
Radiographic Findings:
-
scapular outlet view:
-
30 deg caudal tilt view AP view:
-
arthrography:
-
MRI of Shoulder:
Coronal Oblique View of
Shoulder:
-
Non Operative Management:
- Surgical Management:
-
tears due to impingement and trauma: (see:
impingement syndrome)
-
arthroscopic rotator
cuff repair
-
partial rotator cuff tear:
-
open rotator cuff repair and
open
acromioplasty
- assessment of cuff
tear / mobilization
of cuff / restoration of the
foot print
- note intervening bare area between the articular
margin and the infraspinatus and teres minor
-
references
-
management of massive rotator cuff tear:
-
concomitant procedures:
-
biceps
tenodesis;
-
distal clavicle excision (w/ concomitant arthrosis)
- references: The influence of distal clavicle resection
and rotator cuff repair on the effectiveness
of anterior acromioplasty.
-
arthroscopy (
arthroscopic
acromioplasty) followed by
rotator cuff repair
- allows accurate assesment of rotator cuff tear;
- look for hypervascularity at the base of the biceps
tendon as well as fraying of the cuff just lateral
to the biceps tendon;
- does not require elevation of the deltoid off the
acromioplasty;
- allows a more lateral incision, directly over the
rotator cuff tear, (avoid deltoid detachment);
- w/ restricted motion, consider arthroscopic capsular
release prior to rotator cuff tear;
-
precautions:
- rotator cuff repair should not be performed in the face of a
fixed contracture;
- consider aggressive PT to restore motion or arthroscopic
release of
rotator interval (for loss of
external rotation in adduction) or release of the posterior capsule (for loss of
internal rotation);
-
tears due to instability:
- requires
anterior reconstruction in addition to
rotator cuff repair;
- ref: Occult anterior subluxations of the shoulder in noncontact
sports. Garth WP, Allman FL,
Armstrong WS: Am
J Sports Med 1987;15:579-580.
- Complications:
-
Failed Acromioplasty / Rotator Cuff Surgery:
- Captured Shoulder:
- refers to restrictive subdeltoid adhesions which develop following
surgery and which limit ROM;
- may occur in about 5% of patients;
- treatment relies arthroscopic lysis of adhesions;
- references:
- Failed Repair of the Rotator Cuff. Evaluation and Treatment of
Complications. E.H. Karas MD
and J.P. Iannotti
MD PH.D. JBJS. Vol 79-A, No 5, May 1997. p. 784-793.
- Superior Humeral Dislocation: A Complication Following Decompression
and Debridement for Rotator
Cuff Tears.
- Operative Treatment of failed repairs of the rotator cuff. LU
Bigliani et al. JBJS Vol 74-A. 1992. p
1505-1515.
- Captured Shoulder: A complication of rotator cuff surgery. MA
Mormino MD et al. Arthroscopy.
Vol 12. No 4.
Aug. 1996. p 457.