Rotator cuff tear
From Medical-Wiki
As America’s population ages and as the portion of that population who participated in long term, vigorous exercise increases, rotator cuff injuries, both acute and chronic, have become an increasingly common problem.
The tendons of the rotator cuff are the main stabilizers of the shoulder. The cuff consists of tendons from 4 muscles, the subscapularis, the supraspinatus, the infraspinatus, and the teres minor.
Clinical presentation of rotator cuff injury
When evaluating a shoulder for a rotator cuff tear, there are three clinical findings that have proven to be useful: supra-spinatus weakness, weakness of external rotation, and impingement. When all 3 tests are positive, or when 2 tests are positive for a patient older than 60, there is a 98% chance of the patient having a rotator cuff tear. Physical exam will often show pain located in the lateral deltoid. A patient with a full-thickness tear may often show compromised strength in a shoulder’s active mid-arc abduction and resisted external rotation with elbow flexed. A partial tear might not show weakness. Atrophy of the infraspinatus or supra-spinatus muscles is sometimes seen if a patient has a long-standing injury, i.e. several weeks old.
Historically, the mechanism of injury, i.e. falling on an outstretched arm or repetitive and excessive use of the shoulder as in pitching a baseball or serving a tennis ball, are also helpful clues. Pain is aggravated by activities such as combing one’s hair or reaching for a wallet in the back pocket. Because they have difficulty finding a comfortable position, patients often have trouble sleeping. [1]
Imaging rotator cuff injuries
Plain x-rays are of little use.
When considering the best means of confirming a diagnosis, both MRI and ultrasound have been used with a high degree of success. It is probably true that ultrasound is as accurate as is MRI, even in detecting partial tears. [2]
However, the accuracy of ultrasound depends closely on the equipment used and the skill of the technician performing the exam. [3]
Treatments of rotator cuff tears
The conservative treatment of rotator cuff tears has been favored for years primarily because of the invasive damage imparted to the shoulder in order to gain exposure. This had the effect of producing significant post-operative pain and a very prolonged period of rehabilitation. Further, a 2007 Cochrane study concluded, “There were no randomised controlled trials comparing conservative to surgical treatment. From two studies, open surgical repair is superior to arthroscopic debridement/cleaning of the joint in rotator cuff tears for overall improvement at five year and nine year follow-up. The limited data suggests favouring conservative interventions as less invasive and less expensive than surgery.” [4]
However, there are newer, less invasive surgeries that have been touted as having a higher success rate, lower rate of complications, and shorter period of rehabilitation. It remains to be seen if these procedures live up to their claims. [5]
