Rotator cuff tear

Background

• Majority of tears occur due to chronic impingement in pts >40yrs
• Acute tears require significant trauma: shoulder dislocation, FOOSH
• Consider rotator cuff tear in pt w/ weakness for >3wk after acute shoulder dislocation
• Supraspinatus is most commonly affected tendon

Clinical Features

• Acute Injury
  • "Tearing" sensation in shoulder followed by severe pain / inability to raise arm
  • Inability to abduct or externally rotate arm against even minimal resistance
  • Drop arm test is positive
  • Local swelling
• Chronic Injury
  • Gradual and progressive pain, worse at night
  • Pain localizes to lateral aspect of upper arm
  • Arm elevation, external rotation, and lifting objects worsens the pain
• Exam
  • Disuse atrophy may be present in chronic tears
  • TTP lateral aspect of upper arm or in subacromial region
  • Drop arm test
    • Pt is unable to hold or smoothly lower an extended arm at 90' of shoulder abduction w/o dropping it

Diagnosis

• Imaging
  • Diagnosis should rely on clinical findings; cannot use imaging to rule-out tear
  • May give some diagnostic information:
    • Narrowing of acromiohumeral space (<7mm) is most specific sign
    • May see humeral head sclerosis, osteophytes on undersurface of acromion/clavicle

Treatment

• Arm sling until acute symptoms subside
• Analgesia
  • NSAIDs, opioids, ice
• Exercises
  • Pendulum swings
    • Pt bends slightly at waist w/ arm hanging freely in front of body
    • Arms should be swung in gentle arcs of motion both clockwise and counter-clockwise
    • Swing to level of pain tolerance x 5-10min TID-QID
  • Walk fingers up wall
    • Stand sideways an arm's length from wall and walk fingers up wall to level of pain tolerance TID-QID

Disposition

• Ortho f/u within 1 week

See Also

• Shoulder (Acute - Trauma)

Source

• Tintinalli