Rotator Cuff Disease

• rotator cuff consists of 4 muscles that act to stabilize the humeral head within the glenoid

Impingement, Tendonitis, Micro and Macro Tears

Etiology

• compression of rotator cuff tendons (primarily supraspinatus) and subacromial bursa between the head of the humerus and the acromion; leads to bursitis, tendonitis and, if left untreated, can lead to rotator cuff thinning and tear
• anything that leads to a narrow subacromial space:
  1. glenohumeral muscle weakness leading to abnormal motion of humeral head
  2. scapular muscle weakness leading to abnormal motion of acromion
  3. acromial abnormalities such as congenital narrow space or osteophyte formation

Clinical Features

• night pain and difficulty sleeping on affected side
• trouble with overhead activities
• tenderness to palpation over greater tuberosity
• Jobe’s test (supraspinatus): weakness with active resistance when examiner pushes arms to ground at 90o forward flexion in scapular plane with forearm pronated suggests supraspinatus tear
• Lift-off (subscapularis): internally rotate arm so dorsal surface of hand rests on lower back. Inability to actively lift hand away from back against resistance indicates subscapularis tear
• Posterior-cuff (infraspinatus and teres minor): weak resisted active external rotation with elbow flexed 90o and at patient’s side indicates posterior cuff tear
• signs of impingement
  1. +ve Neer’s test: pain with passive shoulder flexion between 130-170 degrees
  2. +ve Hawkins’ test: pain with shoulder flexion and passive internal rotation

Investigations

• x-rays: AP view may show high riding humerus relative to glenoid, evidence of chronic tendonitis
• U/S: see large cuff tears
• arthrogram: see full thickness tear
• MRI arthrogram: geyser sign (injected dye leaks out of joint through rotator cuff tear)

Treatment and Prognosis

• mild (“wear”)
  • treatment is non-operative (PT, NSAIDs)
• moderate (“tear”)
  • non-operative treatment +/- steroid injection
• severe (“repair”)
  • impingement that is refractory to 2-3 months physio and 1-2 injections
  • may require surgical repair; i.e. acromioplasty, rotator cuff repair

Attachments:

shoulder problem2.jpg (image/jpeg)