Difference between revisions of "Rotator cuff tear"

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==Background==
 
==Background==
*Shoulder pain after acute trauma, chronic injury, or acute extension of chronic impingement
+
*Majority of tears occur due to chronic impingement in pts >40yrs
*Tears due to chronic impingement in pts >40yr accounts for majority
+
*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==
#Injury: 90% chronic arms overhead
+
*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==
 
==Diagnosis==
#result of extreme overuse in young adults (e.g. pitchers) or minor trauma in older adults
+
*Imaging
#sudden "pop" while lifting overhead
+
**Diagnosis should rely on clinical findings; cannot use imaging to rule-out tear
#lateral pain
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**May give some diagnostic information:
#worse at night
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***Narrowing of acromiohumeral space (<7mm) is most specific sign
#abduct arm pain after 20deg
+
***May see humeral head sclerosis, osteophytes on undersurface of acromion/clavicle
#relief of pain w/ lido inject
 
#(pain free weakness = full tear)
 
  
===Physical===
+
==Treatment==
#loss of active BUT NOT passive ROM (due to pain)
+
*Arm sling until acute symptoms subside
#positive impingement signs
+
*Analgesia
#weakness with drop arm test
+
**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
  
==Treatment==
+
==Disposition==
#Acute --> sling, PT,  ortho f/u
+
*Ortho f/u within 1 week
#Chronic --> PT, ortho
 
#Next: MRI, surgery for younger pts with big tear, rehab
 
#PT:  arm dangle at side, circle 5-10wt
 
  
 
==See Also==
 
==See Also==
 
*[[Shoulder (Acute - Trauma)]]
 
*[[Shoulder (Acute - Trauma)]]
 +
 +
==Source==
 +
*Tintinalli
  
 
[[Category:Ortho]]
 
[[Category:Ortho]]

Revision as of 04:17, 22 February 2012

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

Source

  • Tintinalli