Rotator cuff tear: Basic

understanding and treatment

options
Irsan kurniawan
1102090066

Supervisor
dr. Ariyanto, Sp.OT

Advisor
dr. thomson manurung
They Fuse together with the articular capsule
into a common insertion on the tuberosities of
the humerus, which is known as the footprint
of the rotator cuff.
Action of rotator cuff

Rotator cuff acts as a

mechanical couple in
conjunction with Deltoid
in shoulder rotation &
elevation
Important functions:
• Counterbalance the upward pull of the deltoid on the
humerus.
• Hold the head of the humerus secure in the glenoid.
• Externally rotate the shoulder which is important
during arm elevation.
 Etiology

Traumatic Non-Traumatic
(Age >40 years)

high velocity trauma

( partial- or full-thickness tears)

Repetitive microtrauma (overuse,

athletic)

(Age <40 years)

 Non-Traumatic

•Degenerative (Work related: Painters,electrician)

•Subacromial Impingement syndrome
 Non-Traumatic

• Others:
o Shoulder Instability
o Inflammatory dz : Calcific tendinitis/RA/Crystal
induced arthropathy
o Scapulohumeral neuromuscular dysfunction:
o Entrapment syndromes
p
Pathophysiology
Torn Rotator Cuff

Can not Counterbalance the upward

pull of the deltoid on the humerus

Not able to Hold the head of the

humerus secure in the glenoid
AHD <6mm
 Leads to abutement of humeral
head against acromion

Acetabulization: Concave deformity of

under surface of Acromion
Narrowing & Arthritis
of Gleno-Humeral Joint

Last stage of Cuff tear

arthropathy with collapse of
humerus head
Hamada and Fukuda Stages of
Cuff Arthropathy
 History
• Pain around shoulder
• Sleep disturbed by pain
• Weakness during activities of daily living
• Previous trauma
• Time lag before presentation
• Occupation
• Predominant hand
 Physical Examination
• Passive and Active ROM
• Strength of motions
• Supraspinatus :
Resisted elevation
of arm kept in
"empty can" position
• Subscapularis
“ Lift-off test”

•Infraspinatus : Resisted
External Rotation

•Teres minor:Resisted external

rotation with arm abducted
more than 45°.
 Impingement Test
• Hawkin-kennedy test
• Injection test:Very effective test
for diagnosis
• Approx 7-10 ml of Xylocaine
injected in subacromial bursa
• Wait for 2-3 minutes
• Pain in ROM will be minimal
 Treatment of Rotator Cuff Tears
o Conservative :
Physical Therapy ± Injection
treatment
Indication:
• Medical Cormodities
• Relatively Inactive lifestyle
• Patients not willing for post-op
rehab.
 Surgical Management

Open Mini-Open Arthroscopic

(not recommended)

four major objectives:

(1) closure of the cuff defect.
(2) eliminating impingement.
(3) preserving the origin of the deltoid muscle.
(4) preventing adhesions postoperatively without
disturbing the repair by a careful exercise program
 Cl.
Mini open repair Acr.

• Midway between open &

arthroscopic repair
• Less than 5 cms. incision in the line from
centre of acromion
• Axillary N. should be protected, 5 cm. below
acromial line
• Deltoid splitting approach, not erased
 Mini open RC repair
• Identify bursa
Torn cuff
• Mimics rotator cuff
• Bursectomy
• Tear evaluation
• Preparing foot print
• Freshning of tear
• Transosseus sutures or
suture anchor cuff repair
• Meticulous Deltoid repair
Arthroscopic rotator cuff
repair

Post. Op. regimen

• Shoulder immobilizer for 6 weeks
• Post. op physiotherapy is as
important as good surgery
• Recovery time 12 to 16 weeks
• Total time 1 year
Arthroscopic cuff repair
Deltoid
• Tears of all sizes can be done detachm
arthroscopically- 95% tears can be
repaired by an experienced surgeon ent
• Minimal damage to Deltoid muscle-
potential source of post-op morbidity
in open repairs
• Greater versatility for
characterization, assessment,
mobilization as well as fixation
• Complete evaluation of Shoulder
joint anatomy- PASTA, SLAP, Arthritis
etc.
•Day care surgery
•Early & Easier postop rehabilitation
 Arthroscopic cuff repair

Despite these advantages, arthroscopic

rotator cuff repair is technically
demanding procedure that needs
prerequisite skills as diagnostic shoulder
arthroscopy, arthroscopic subacromial
decompression, and arthroscopic knot
tying in order for a surgeon to obtain
proficiency in this procedure.
RC repair-
Contraindications
• Severe OA of Glenohumeral jt.
• Medically unfit patient
• Low activity level individual who can live with
deficient shoulder
• Adhesive capsulitis
• Failed prior RC surgery
• Fatty infiltration in muscles
 Rotator cuff injury
If not addressed in time…
• Young active individuals- torn cuff cannot heal to
bone- late cuff arthropathy
- continuous pain & weakness
• Muscles undergo atrophy & fatty degeneration
• Waiting too long- repairable cuff
becomes irreparable with poor tissue
& poor prognosis
• At >1 year of f’up, a’scopic and
mini-open rotator cuff repairs produces
similar results with equivalent Fatty degeneration

patient satisfaction rates

Thank You