Rotator Cuff Tear

Partial thickness tear based on location

 Bursal side tear

 Intratendinous tear

 Articular side

based on depth ; E'l Man's

 3 mm

  3-6 mm

  > half of tendon

Anatomical classification

 C - shaped

 U-shaped

 L-shaped

 Longitudinal

Pain at deltoid  side


Investigations

 Plain radiographs

    sclerosis on undersurface of acromion

     Traction spurs in coracoacromial line

     upward displaced humeral head

    acetabularized coracoid , acromion and glenoid

    degenerative calcification of cuff


Cuff tendon imaging


   USG - dynamic evaluation of cuff

   MRI - detects cuff tear and assesses cuff vasculature


  Treatment

 
   Partial thickness tear


 Non - operative


   activity modification

    stretching and  strengthening

    anti-inflammatory medications

   Surgery - Principles
 
              > 50 % tears (large )

             failure of conservative management from 3 -6 months

  during surgery  ,

        assess thickness of tear

       release of capsular contracture

       reinduce healing - debridement of tendon

       subacromial decompression

        Reattach tendon to its anatomical alignment

      protect repair

 


Full thickness tear

   NSAIDs, Rest

  Stretching , Strengthening

  Open /Mini-open or Arthroscopic technique

   Repair back to Greater tuberosity

     Crescent tear , U-shape tear

  Side -side repair

       long tear



 Irrepairable rotator cuff tear

  large gap in supraspinatus insertion

 latissimus dorsi transfer for posteriosuperior defects

  Pectoralis and teres major transfer for anterosuperior defects



  Deltoid and rotator cuff non function

    Glenohumeral Arthrodesis














   



























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