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Rotator cuff disorder
This document describes the anatomy and function of the rotator cuff muscles, as well as causes, diagnosis, and treatment of rotator cuff injuries. It notes that the rotator cuff is comprised of 4 muscles that stabilize the shoulder joint. Rotator cuff injuries can range from inflammation to complete tears and are usually caused by overuse, aging, or trauma. Treatment involves rest, anti-inflammatories, cortisone injections, and physical therapy, with surgery reserved for tears not improving otherwise.
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Rotator cuff disorder
- 1. Presented by Aser mohamedkamal Physiotherapist
- 2. Describe anatomyof rotator cuff muscles. ROTATOR CUFF FUNCTION ETIOLOGY CLINICAL DIAGNOSIS INVESTIGATION OUTLINE OF MANAGEMENT
- 3. an anatomicalterm 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. actionNerve supplyinsertionorigin Abduction of theshoulder 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
- 7. hold thehead 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.
- 8. injury to1 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
- 9. 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
- 10. ◦ Impingement inwhich 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
- 11. Extrinsic factors ◦Repetitive use Tensile overload Muscle fatigue Microtrauma ◦ Glenohumeral instability Accentuates abnormal loading Can lead to internal impingement
- 12. As largermuscles 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
- 13. Pain and/or fatigue ofcuff Rotator Cuff dysfunction Impingement with motion
- 15. 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
- 16. • Impingement signs •Neer • Pain with passive forward flexion while internally rotated • Hawkins • Pain with passive internal rotation while abducted 90 degrees
- 17. Diagnose with history,physical exam, xrays, and a likely successful result with conservative treatment
- 18. 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
- 19. • 90% successfulwith non-operative treatment Shot Medicine Exercises/Posture Correction
- 20. 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
- 21. • Arthroscopic subacromialdecompression • 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
- 22. As aresult 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
- 23. Adhesive capsulitis ◦ Capsulesurrounding shoulder ball and socket scars and “shrink wraps” itself inhibiting full motion and causing pain
- 24. • 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
- 25. Three phases •Inflammatory • Frozen • Disability Loss of exernal rotation Passive and active motion loss Normal strength
- 26. 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
- 27. Arthroscopic capsularrelease with manipulation • Sling 2-4 weeks for comfort only • Immediate motion • Immediate therapy to maintain motion • Capsulitis may grow right back without stretching
- 28. • Rare • Calciumbuildup inside tendon • Cortisone injection • Arthroscopic removal
- 29. Detachment ofthe tendon from the bone Does not heal on own Acute: single injury greater than threshold Chronic: long term overuse, wear and tear
- 30. 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
- 31. Exam findings •Weakness/Pain • Active motion loss/Pain • Passive motion maintained
- 32. Diagnosed with •History • Exam • Xrays • Mri (or ultrasound)
- 33.
- 34. Nonoperative • cortisoneinjection • physical therapy • oral analgesics Temporary relief It will get worse with time
- 35.
- 36. • Sling 1month • Healing 3 months • 98% with small tears • 50-85% with large tears • Maximum recovery 6 – 12 months
- 37. • Arthroscopic Rotatorcuff 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