sport injuries or trauma or dislocations of shoulder cause rotator cuff instabilty. here presenting detail about rotator cuff anatomy & treatment options.

1. By Dr. Ranveer Patel
Orthopaedic Surgeon,
Shreeji Orthopaedic Care

2.  It is a group of 4 muscles & tendons that
surround the shoulder joint.
1. Supraspinatus
2. Infraspinatus
3. Teres minor
4. subscapularis
 Its function is to provide strength & stability
 Among most common causes of shoulder
pain & instability.

3.  Stabilisers of shoulder mainly anterior &
posterior cuff providing fixed fulcrum for
concentric rotation of the humeral head.
 Neutralises shearing forces of deltoid in early
abduction.
 Initiation of abduction
 Rotation of shoulder.

9.  Duration- acute or chronic
 Degree of tear- partial or full thickness tear
 Etiology- traumatic or degenerative
 Cofield- based on size of tear

10. Size of tear Degree
<1 cm Small
1-3 cms Medium
3-5 cms Large
>5 cms Massive
Ellmans classification
1.Articular
2.Bursal
3.interstitial

13.  Pain on the lateral aspect of the shoulder
which may radiate to deltoid insertion
anterior (acromion) with impingement
with or without biceps tendonitis
 Stiffness
 Cant lie on affected side
 weakness, instability, crepitus

15. 1. Neers test: most diagnostic test
 Sensitivity : 72%
 Specificity : 60%
2. Hawkins test
 Sensitivity : 79%
 Specificity : 59%

16.  For supraspinatus : jobs test & drop arm test
 For infraspinatus : drop sign
 Subscapularis : lift off test, belly press test

17.  X-ray
 ULTRASOUND
 MRI

20.  Best diagnostic aid
 Defines site of cuff damage
 Demonstrates fatty changes of muscle-Poor
quality of cuff
 Exact size shape & locaion of tear

22.  Severity of symptoms
 Age
 Activity level
 Patient requirements

23.  Rest
 Activity modification
 NSAIDS
 PHYSIOTHERAPY (stretching & strengthening
exercises)
 Steroid injections.
 Not indicated when;
1. Tear > 1cm
2. Symptoms > 1yr
3. Significant functional impairment

24.  Pt. selection:
1. Pt. physiologically younger than 60 yrs.
2. Clinically or arthrographically demonstrable
full thickness cuff tear.
3. Failure to improve on nonoperative
management for minimum 6 wks.
4. Need to use shoulder in overhead elevation
5. Full passive range of motion
6. Ability & willingness to cooperate

25. 1. Repair of tear
 Open or arthroscopic
 Tendon to tendon or tendon to bone
2. Arthroscopic debridement, SAD &
acromioplasty with mini-open repair

26.  Advantages :
1. Lesser morbidity
2. Ability to identify & treat other pathology
3. Truly outpatient
4. Allows to address small undetected tears
5. Patient acceptance

29. Arthroscopic Open
Immidiate active & passive ROM Proceed slowly (deltoid detached)
Avoid active abduction >60 degree
for 3-4 weeks
Avoid active flexion or abduction
for 4 wks
Then electrical stimulation,
resisting exercises for 3-4 months
Requires 1-2 additional months
High demand activities within 4-6
months

30.  Treatment options
1. Debridement alone
2. Debridement with arthroscopic subacromial
decompression
3. Open repair with acromioplasty
4. Arthroscopic repair
5. Arthroscopic subacromial decompression
with mini open repair

31.  Pre operative diagnosis
1. AHI <3mms
2. Profound loss of external rotation
3. MRI- fatty degeneration of muscle

32.  Debridement
 Tendon transposition (subscapularis &
infraspinatus)
 Muscle transfer
 Partial repair
 Allograft substitution

33.  Progression of lesion
 Rotator cuff arthropathy
 Long head of biceps tendon rupture
 Anteroposterior instability

34.  Diagnosis is usually by good history &
examination
 Surgery in selective active individual
 Arthroscopy- early mobilization possible &
decreased morbidity
 Treatment is according to patient’s functional
needs.