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Rotator cuff disorder

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Rotator cuff disorder

  1. 1. Presented by Aser mohamed kamal Physiotherapist
  2. 2.  Describe anatomy of rotator cuff muscles.  ROTATOR CUFF FUNCTION  ETIOLOGY  CLINICAL DIAGNOSIS  INVESTIGATION  OUTLINE OF MANAGEMENT
  3. 3.  an anatomical term given to the group of muscles & their tendons that act to stabilize the shoulder.  These muscles are : 1. Supraspinatus . 2. Infraspinatus . 3. Teres minor . 4. Subscapularis .
  4. 4. actionNerve supplyinsertionorigin Abduction of the shoulder joint from 0- 15 degrees Suprascapular nerve Top of greater tuberosity of humerus Med 2/3 of supraspinus fossa of the scapula supraspinatu s External rotation of shoulder joint Suprascapular nerve Middle impression of greater tuberosity of humerus Med 2/3 of infraspinus fossa of the scapula Infraspinatus Adduction and external rotation of shoulder joint Axillary nerveLower impression of greater tuberosity of humerus Upper 1/3 of dorsal aspect of lat border of scapula Teres minor Adduction and internal rotation of shoulder joint Upper and lower subscapular nerve Lesser tuberosity of the humerus Med 2/3 of the subscapular fossa of the Subscapulari s
  5. 5.  hold the head of the humerus in the small and shallow glenoid fossa of the scapula. During elevation of the arm, the rotator cuff compresses the glenohumeral joint in order to allow the large deltoid muscle to further elevate the arm. In other words, without the rotator cuff, the humeral head would ride up partially out of the glenoid fossa and the efficiency of the deltoid muscle would be much less.
  6. 6.  injury to 1 or more of the 4 muscles in the shoulder. This shoulder injury may come on suddenly and be associated with a specific injury such as a fall (acute), or it may be something that gets progressively worse over time with activity that aggravates the muscle(s) (chronic).  can range from an inflammation of the muscle without any permanent damage, such as tendinitis, to a complete or partial tear of the muscle that might require surgery to fix it
  7. 7.  Intrinsic Factors ◦ Reduce Vascular supply (significance) ◦ “Tendonitis” ◦ “Bursitis” • “Bone spur” Acromion rubs on the rotator cuff and bursa • bursitis and tendonitis early • rotator cuff tear over time ◦ Degenerative changes  Age related  Change in proteoglycan and collagen content in symptomatic tendons
  8. 8. ◦ Impingement in which a tendon is squeezed and rubs against bone.  Acromial spurs  Type III acromion and decreased geometric area of the supraspinatus outlet  Increased prevalance of symptomatic cuff disease  Coracoacromial ligament  AC joint osteophytes  Coracoid process  Posterior superior glenoid
  9. 9.  Extrinsic factors ◦ Repetitive use  Tensile overload  Muscle fatigue  Microtrauma ◦ Glenohumeral instability  Accentuates abnormal loading  Can lead to internal impingement
  10. 10.  As larger muscles fatigue, the posterior capsule and rotator cuff play a larger role in decelerating the arm.  Leads to tensile overload and fatigue  As rotator cuff fatigues, it no longer performs it’s role in keeping the humeral head centered.  This leads to superior migration of the humeral head and impingement.  This leads to pain and muscle inhibition….  ……and the cycles repeats itself
  11. 11.  Pain and/or fatigue of cuff Rotator Cuff dysfunction Impingement with motion
  12. 12.  Men = women  Any age  Ache  Activity related  Night pain  Treatment from Weeks to months • Started after Too much… • Computer use • Gardening • Heavy lifting • Tennis • Golf • Throwing • fishing
  13. 13. • Impingement signs • Neer • Pain with passive forward flexion while internally rotated • Hawkins • Pain with passive internal rotation while abducted 90 degrees
  14. 14. Diagnose with history, physical exam, xrays, and a likely successful result with conservative treatment
  15. 15.  Initial treatment • Relative rest • Ice • Anti-inflammatory medications • cortisone injection • Physical therapy: 1.electoro therapy (U.S, faradic ,ir ) 2.passive and active ROM 3.stretching ex 4.muscle energy techniques 5.trigger points realease 6.posture correction
  16. 16. • 90% successful with non-operative treatment  Shot  Medicine  Exercises/Posture Correction
  17. 17.  Cortisone Injection • primary indication is difficulty sleeping  70% improved with a single shot  20% better with a second shot  If no better, Check MRI • Consider arthroscopic subacromial decompression if symptoms persist
  18. 18. • Arthroscopic subacromial decompression • 30 minute day surgery • General anesthesia and a nerve block/pain pump • Sling 2-4 weeks • No restrictions • Begin rehab exercises immediately • 2-3 months to feel better
  19. 19.  As a result of microtrauma and inflammation.  Capsule tightens and can no longer accommodate humeral head as it rotates.  Leads to obligatory anterior-superior migration of humeral head.  Reduces subacromial space
  20. 20. Adhesive capsulitis ◦ Capsule surrounding shoulder ball and socket scars and “shrink wraps” itself inhibiting full motion and causing pain
  21. 21. • Severe pain  Front of Shoulder • constant • stiff • Getting worse • May or may not know why • No injury • Shortly after minor injury • following breast or heart surgery  40 - 60 years old  Women > Men  Thyroid disease  Diabetes  Heart disease  Will Occur on Opposite Side 30% of Time
  22. 22.  Three phases • Inflammatory • Frozen • Disability  Loss of exernal rotation  Passive and active motion loss  Normal strength
  23. 23.  Initial treatment • Time  18+ months to spontaneous resolution • Pain medicine • Cortisone injections  2-3 • Stretching  May help or worsen  Arthroscopic capsular release with manipulation • If not improved with initial conservative measures • Capsule and ligaments are partially excised • Stretched to full motion while anesthetized • Cortisone Injection
  24. 24.  Arthroscopic capsular release with manipulation • Sling 2-4 weeks for comfort only • Immediate motion • Immediate therapy to maintain motion • Capsulitis may grow right back without stretching
  25. 25. • Rare • Calcium buildup inside tendon • Cortisone injection • Arthroscopic removal
  26. 26.  Detachment of the tendon from the bone  Does not heal on own  Acute: single injury greater than threshold  Chronic: long term overuse, wear and tear
  27. 27.  history • Injury (25%) • Pain without injury (75%) • Loss of overhead or behind the back activity without pain  Symptoms • Pain: anterior superior shoulder or deltoid insertion  Rest  Night  activity related • Weakness or disability • instability
  28. 28.  Exam findings • Weakness/Pain • Active motion loss/Pain • Passive motion maintained
  29. 29.  Diagnosed with • History • Exam • Xrays • Mri (or ultrasound)
  30. 30. Full thickness Partial thickness
  31. 31.  Nonoperative • cortisone injection • physical therapy • oral analgesics  Temporary relief  It will get worse with time
  32. 32.
  33. 33. • Sling 1 month • Healing 3 months • 98% with small tears • 50-85% with large tears • Maximum recovery 6 – 12 months
  34. 34. • Arthroscopic Rotator cuff tear Repair: predictors of success • Tear size • Small < 1.5 cm • Large >3 cm • Age of Tear • Muscle and Tendon Atrophy • Patient age • <62 years • Tobacco usage

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