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
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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