Rotator cuff tear: Difference between revisions
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*Majority of tears occur due to chronic impingement in patients >40yrs | *Majority of tears occur due to chronic impingement in patients >40yrs | ||
*Acute tears require significant trauma: shoulder dislocation, FOOSH | *Acute tears require significant trauma: shoulder dislocation, FOOSH | ||
*Consider rotator cuff tear in patient | *Consider rotator cuff tear in patient with weakness for >3wk after acute shoulder dislocation | ||
*Supraspinatus is most commonly affected tendon | *Supraspinatus is most commonly affected tendon | ||
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*Exercises | *Exercises | ||
**Pendulum swings | **Pendulum swings | ||
***Patient bends slightly at waist | ***Patient bends slightly at waist with arm hanging freely in front of body | ||
***Arms should be swung in gentle arcs of motion both clockwise and counter-clockwise | ***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 | ***Swing to level of pain tolerance x 5-10min TID-QID | ||
Revision as of 20:06, 14 July 2016
Background
- Majority of tears occur due to chronic impingement in patients >40yrs
- Acute tears require significant trauma: shoulder dislocation, FOOSH
- Consider rotator cuff tear in patient with 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
Diagnosis
- See Shoulder (Tests)
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
Differential Diagnosis
Shoulder and Upper Arm Diagnoses
Traumatic/Acute:
- Shoulder Dislocation
- Clavicle fracture
- Humerus fracture
- Scapula fracture
- Acromioclavicular joint injury
- Glenohumeral instability
- Rotator cuff tear
- Biceps tendon rupture
- Triceps tendon rupture
- Septic joint
Nontraumatic/Chronic:
- Rotator cuff tear
- Impingement syndrome
- Calcific tendinitis
- Adhesive capsulitis
- Biceps tendinitis
- Subacromial bursitis
- Cervical radiculopathy
Refered pain & non-orthopedic causes:
- Referred pain from
- Neck
- Diaphragm (e.g. gallbladder disease)
- Brachial plexus injury
- Axillary artery thrombosis
- Thoracic outlet syndrome
- Subclavian steal syndrome
- Pancoast tumor
- Myocardial infarction
- Pneumonia
- Pulmonary embolism
Management
- Arm sling until acute symptoms subside
- Analgesia
- NSAIDs, opioids, ice
- Exercises
- Pendulum swings
- Patient bends slightly at waist with 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
- Pendulum swings
Disposition
- Ortho follow-up within 1 week