What is a full thickness tear of the rotator cuff?
Tears that comprise the entire thickness (from top to bottom) of the rotator cuff tendon or tendons.
What is often associated with a tear of the subscapularis tendon?(2)
- Subluxation of the bicep long tendon from the intertubercular groove.
- Partial or complete tears of biceps tendon
What are partial thickness rotator cuff tears?
Partial thickness tears can occur on the superior surface (bursal side) or the undersurface (articulate side) of the rotator cuff.
What are partial thickness tears on the undersurface(articular side) of the rotator cuff generally associated with?
- Tensile loads
- Glenohumeral joint instabilities
- Commonly found in overhead throwing athletes
- Athletes usually have
- anterior instability
- capsular and labral insufficiency
- dynamic muscular imbalance
What are sizes of thickness rotator cuff tears? (4)
- Small tear 1 cm across
- medium tears between 1 -3cm
- large tears between 3 -5 cm
- massive tears larger than 5cm
Post operative treatment of complete rotator cuff tear are based on what principles?(3)
- Tear pattern recognition
- Secure fixation
- Restoration of the footprint
What are the two types of tear patterns?
- Crescent shape
- do not usually retract from greater tuberosity
- usually repaired back to greater tuberosity - U pattern-
What are the type of suture placement?(3)
- Simple
- Mattress
- combination(modified Mason-Allen)
What is important with suture placement?(2)
- How secure the sutures are tied
2. How much load is carry across each suture
What is a better suture double or single row?
- Clinical reports demonstrate good results with either a single or double row technique.
- Double row results in closer re-approximation of rotator cuff footprint
- Double roll repairs have theoretical ability to increase healing potential and ultimately tensile strength
Supraspinatus origin, insertion and nerve?
- Origin-supraspinatus Fosse the scapula
- Insertion-Greater tubercle of humerus
- Subscapular nerve C4-C6
Infraspinatus origin, insertion and nerve?
- Origin-Infraspinous Fosse the scapula
- Insertion-Greater tubercle of humerus
- Subscapular nerve C5-C6
Teres Minor origin, insertion and nerve?
- Origin-Lateral border of scapula
- Insertion-Greater tubercle of humerus
- Axillary nerve C5-C6
Subscapularis origin, insertion and nerve?
- Origin-Subscapular foss
- Insertion-Lesser tubercle of humerus
- Upper and lower subscapular nerve C5-C6
Transosseous equivalent or suture bridge technique has shown to do what? (2.)
- Increase fixational strength
2. Greater tendon bone content forces surface area compared to both single row and double row strategy.
What do initial post surgical rehabilitation focus on?
- ROM to prevent capsular adhesions
2. Protecting surgical repaired tissue
What does the Biceps do in the setting of rotator cuff tears?
Active contraction of biceps prevents superior migration, normalizing kinematic of GHJ.
What is a Bursal-sided rotator cuff tear?(3)
- Partial-thickness RTC tears extending from the bursal side into the RTC
- Less common than articular-sided rotator cuff tears
- Associated with subacromial impingement and spurs on the acromion undersurface
What is a Articular-sided rotator cuff tear?(4)
- Articular-sided RTC are referred to as partial-thickness RTC tears extending from the articular side into the rotator cuff.
- Commonly occur in athletes with overhead activity
- less common than intra-substance tears in the general population but more common than bursal-sided tears
- Extrinsic factor is glenohumeral instability
What is a Intrasubstance rotator cuff tears?(3)
- Concealed partial-thickness rotator cuff tear neither extending to the articular nor the bursal side of the rotator cuff.
- Most common form of partial-thickness RTC tear.
- Most commonly found in the posterior supraspinatus tendon
What is the clinical presentation for subacromial Impingement?(6)
- Painful arc
- increased pain with OH activity
- reaching across the body
- reaching behind back
- sleeping
- pain likely localized to anterior lateral shoulder
