rotator cuff tear
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Etiology
- tear of one of the rotator cuff muscles
Epidemiology
- common in the elderly
Clinical manifestations
- pain radiating from shoulder down lateral part of arm
- pain worsened by abduction, internal rotation, external rotation or flexion of shoulder depending upon involved tendons[2]
- overhead activities such as combing hair can be painful
- in some cases, pain may be minor
- muscle atrophy is common
- pain & weakness of shoulder elevation & external rotation
- active range of motion (shoulder) is impaired; passive range of motion is intact
- inability to maintain the arm in an abducted position (drop sign) indicates a supraspinatus tear
- loss of strength suggests full thickness tear[2]
- a painful arc & weakness of the rotator cuff with the shoulder abducted to 90 degrees in the scapular plane with the thumb pointing down (positive empty can test)
Radiology
- magnetic resonance imaging (MRI) of shoulder
- severity of pain is unrelated to imaging characteristics of full-thickness rotator cuff tears[5]
Management
- a brief period of rest & immobilization with a sling may be helpful[3]
- pain control with acetaminophen or short course of NSAID
- physical therapy (or home exercise)
- assisted range of motion
- wall walking
- orthopedic surgery
- younger patients with acute full-thickness tears benefit from surgery
- surgery confers benefit only in patients with full-thickness tears[11]
- if no improvement after 6-8 weeks of conservative manangement, refer to orthopedic surgery[3]
- patients mean age, 60 years, 10 year outcomes better with surgery than with physical therapy[9]
- surgery with better outcome than medical management for full-thickness tears[10]
- older patients with symptomatic, atraumatic supraspinatus tears did not benefit from surgery[7]
- ref[2] implies that arthroscopic surgery for rotator cuff tear in the elderly is indicated & would leave patient with significant disability if surgery not performed (seems a bit at odds with ref[7])
- younger patients with acute full-thickness tears benefit from surgery
More general terms
Additional terms
- rotator cuff tendonitis; impingement syndrome; painful arc syndrome; subacromial pain syndrome
- rotator cuff; musculotendinous cuff
- shoulder injury
References
- ↑ Intensive Course in Geriatric Medicine & Board Review, Marina Del Ray, CA, Sept 12-15, 2001
- ↑ 2.0 2.1 2.2 2.3 Medical Knowledge Self Assessment Program (MKSAP) 14, 17. American College of Physicians, Philadelphia 2006, 2015
- ↑ 3.0 3.1 3.2 Geriatrics at your Fingertips, 13th edition, 2011 Reuben DB et al (eds) American Geriatric Society
- ↑ Seida JC, LeBlanc C, Schouten JR et al Systematic review: nonoperative and operative treatments for rotator cuff tears. Ann Intern Med. 2010 Aug 17;153(4):246-55 PMID: https://www.ncbi.nlm.nih.gov/pubmed/20621893
- ↑ 5.0 5.1 Brett AS Tenuous Relation Between Rotator Cuff Tears and Pain NEJM Journal Watch. May 27, 2014 Massachusetts Medical Society (subscription needed) http://www.jwatch.org
Dunn WR et al. Symptoms of pain do not correlate with rotator cuff tear severity: A cross-sectional study of 393 patients with a symptomatic atraumatic full-thickness rotator cuff tear. J Bone Joint Surg Am 2014 May 21; 96:793 PMID: https://www.ncbi.nlm.nih.gov/pubmed/24875019 - ↑ Hermans J, Luime JJ, Meuffels DE, et al. Does this patient with shoulder pain have rotator cuff disease? The Rational Clinical Examination systematic review. JAMA. 2013;310:837-847 PMID: https://www.ncbi.nlm.nih.gov/pubmed/23982370
- ↑ 7.0 7.1 7.2 Kukkonen J et al. Treatment of nontraumatic rotator cuff tears: A randomized controlled trial with two years of clinical and imaging follow-up. J Bone Joint Surg Am 2015 Nov 4; 97:1729. PMID: https://www.ncbi.nlm.nih.gov/pubmed/26537160
- ↑ Nam D, Maak TG, Raphael BS et al Rotator cuff tear arthropathy: evaluation, diagnosis, and treatment: AAOS exhibit selection. J Bone Joint Surg Am. 2012 Mar 21;94(6):e34. PMID: https://www.ncbi.nlm.nih.gov/pubmed/22438007
- ↑ 9.0 9.1 Moosmayer S, Lund G, Seljom US et al. At a 10-year follow-up, tendon repair is superior to physiotherapy in the treatment of small and medium-sized rotator cuff tears. J Bone Joint Surg Am 2019 Jun 19; 101:1050 PMID: https://www.ncbi.nlm.nih.gov/pubmed/31220021 https://insights.ovid.com/crossref?an=00004623-201906190-00002
- ↑ 10.0 10.1 Ramme AJ, Robbins CB, Patel KA et al. Surgical versus nonsurgical management of rotator cuff tears: A matched-pair analysis. J Bone Joint Surg Am 2019 Oct 2; 101:1775. PMID: https://www.ncbi.nlm.nih.gov/pubmed/31577683 https://insights.ovid.com/crossref?an=00004623-201910020-00008
- ↑ 11.0 11.1 Cederqvist S et al. Non-surgical and surgical treatments for rotator cuff disease: A pragmatic randomised clinical trial with 2-year follow-up after initial rehabilitation. Ann Rheum Dis. 2020 Dec 3;80(6):796-802 PMID: https://www.ncbi.nlm.nih.gov/pubmed/33272959 Free PMC article. https://ard.bmj.com/content/80/6/796
- ↑ OrthoInfo: Rotator Cuff Tears http://orthoinfo.aaos.org/topic.cfm?topic=a00064