Rotator Cuff Tear ,injury - Everything You Need To Know - Dr. Nabil Ebraheim

.Dr. Ebraheim animated video illustrates the shoulder rotator cuff muscles and associated tears and types of imaging for these injuries.it is a shoulder animation video that explains the rotator cuff anatomy , the rotator cuff MRI , ROTATOR CUFF INJURY ,TEAR IS explained .rotator cuff surgery is also explained .rotator cuff rehab is important .The video explains the anatomy of the rotator cuff in relation to rotator cuff ,rotator cuff nerve supply ,rotator cuff function and rotator cuff action.
Rotator cuff tears are a common source of shoulder pain.
Tear of the rotator cuff may involve a single tendon or multiple tendons.
The patient will present with a painful weak shoulder , rotator cuff tears occur more in older population.
In patients older than 80 years of age, 50% of these patients will have rotator cuff tear (majority are asymptomatic).
Partial thickness or full thickness tears may progress in size or increase in symptoms.
Evaluation:
- Patient younger than 40 years old with history of trauma.
- Patient older than 60 years old with no history of trauma.
- Between 40-60 years of age there can be either trauma or no trauma.
Clinical presentation:
- Patient will have pain or ache usually posteriorly.
The pain can be in the arm or in the shoulder.
- Patient will complain of pain during overhead activity or when attempting to reach behind the back.
- Patient may also complain about the presence of nighttime shoulder pain.
Night pain means that nonoperative treatment will not work.
- Patient also complains of shoulder weakness.
- Rotator cuff tears may be found in spinal cord injury patients due to overuse syndrome.
Rotator cuff examination:
- Inspect the shoulder first: you may find infraspinatus atrophy, this may be a sign of a chronic rotator cuff tear.
May also be a sign of injury to the suprascapular nerve.
- Palpation: palpate: the AC joint, the greater tubercle of the humerus, the coracoid process, the long head of the biceps tendon.
- Range of motion: active range of motion may be limited.
Do:
1- Neer test.
2- Hawkins impingement sign.
3- Strength testing: patient will have weakness of abduction, that will test the supraspinatus function, also you will test external rotation of the arm to the side, that will test the infraspinatus muscle function.
Horn Blowers Sign- testing massive tear of teres minor muscle.
Drop Arm Test: testing the supraspinatus function.
For the subscapularis muscle we have at least 3 tests:
1- Lift- Off Test: it tests the upper subscapularis muscle (important part).
The patient will be unable to hold the hand behind the back.
2- Belly Press Test: it tests the lower subscapularis muscle.
It is sometimes called “abdominal compression test”.
3- Excessive Passive External Rotation:.
If the subscapularis tendon is ruptured, it will move medially and the long head of the biceps tendon will sublux with the ruptured tendon.
Also check the deltoid strength to make sure there is functional deltoid muscle.
The tear size:
• Small: up to 1cm.
• Medium: 1-3cm.
• Large: 3-5cm.
• Massive: greater than 5cm, or involves multiple tendons.
Once the clinical diagnosis is established, get an X-Ray.
Get true AP view x-ray and check the acromiohumeral interval (normally between 7-14 mm).
True AP view 45° lateral, patient can be standing, sitting, or lying down.
Get an MRI:
T2 images are the best for showing the tear.
The sagittal view MRI will help to see the fatty infiltration, muscle atrophy, and the retraction of the muscle.
This will tell if the case is chronic or acute.
Using a dye with MRI will also help in seeing partial thickness rotator cuff tear.
If the patient has a pacemaker, you will use CT arthrography instead of MRI.
Some physician prefer to use ultrasound.
Remember: MRI will have a lot of false positives, especially in the elderly population.
Treatment:
• Conservative:
- Physical therapy.
- NSAIDS.
- Injection (possible).
• Surgery:
- Usually done when there is a traumatic tear.
- When there is failure of conservative treatment.
Complete tear of the rotator cuff will not heal by itself; you need to suture the tendon back to its insertion on the humeral head.
When the tear is large or the patient is older, the prognosis for successful repair is not as good.
Muscle atrophy and fatty infiltration will also cause a poor prognosis.
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