1	Rotator Cuff Injuries David M.Lintner MD Chief of Sports Medicine Baylor College of Medicine
2	TSAOHN 2002 Talk is available on website: www.drlintner.com
3	Rotator Cuff Anatomy 4 muscles / tendons: Supraspinatus Infraspinatus Teres Minor Subscapularis
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13	Rotator Cuff Anatomy The contraction of these muscles causes rotation of the humeral head and thus the arm. Also, keeps the humeral head centered in the glenoid
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15	Rotator Cuff Injuries The position of jeopardy for the rotator cuff is overhead. Why?
16	Rotator Cuff Injuries Overhead position Impingement between humerus and acromion Least efficient / weakest position for cuff Poor circulation to cuff
17	Rotator Cuff Injuries How do they happen: Trauma Fall onto outstretched arm. Arm pulled to side or down. Overuse lifting, loading manipulatiing objects, valves
18	Rotator Cuff Injuries Trauma Tear of tendons partial complete
19	Rotator Cuff Injuries Overuse Bursitis Fraying Gradual progression of tear Once tearing starts, easier to progress
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21	Rotator Cuff Injuries Weakened cuff can not protect itself space between acromion and humerus narrows Impingement worsens Tear progresses
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25	Rotator Cuff Tears
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27	Symptoms Pain in deltoid region Worse with overhead usage Night pain Lifting
28	Symptoms Must evaluate neck! Symptoms are similar to herniated disk or nerve root impingement
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30	Evaluation History Physical examination MRI
31	Evaluation History Trauma, location and provocation of symptoms Exam pain with cuff testing impingement signs weakness
32	Evaluation MRI Need high quality magnet! In-office Open magnets Without contrast
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34	Treatment If partial tear or only inflamed (tendonitis) Physical therapy, NSAID, relative rest avoid overhead use! Healing takes a long time - 6 weeks usually (minimum)
35	Cuff Exercises
36	Cuff Exercise - High Level
37	Treatment If complete tear: Surgery is almost always indicated. Recovery takes months 3 months- begin overhead use 6 months- overhead use improves, can begin repetitive overhead use 12 months- MMI
38	Rehab Healing of repair: 6 weeks minimum Regain range of motion: below horizontal for 6 weeks Regain strength: atrophy, weakness
39	Rehabilitation The cuff heals slowly and is easily damaged if stressed too soon! Slow progression with motion and strengthening necessary but may result in stiffness!
40	Goals of Treatment Full ROM Full strength No pain
41	Goals of Treatment Nonoperative Lesser injuries Better results If fails nonoperative treatment Surgery Decompression - acromioplasty Repair
42	Goals of Treatment Surgery Repair tear Rehabilitation Regain ROM, strength
43	Surgery Arthroscopic Open Healing time is the same!
44	Surgery Arthroscopic: Less pain Less stiffness Some tears are not repairable with scope Some are not repairable at all.
45	Arthroscopic Cuff Repair
46	Acromioplasty
47	Pass Sutures
48	Place Anchor
49	Repaired!
50	New Technology Arthroscopic techniques Xenograft patch “Pig patch” Porcine small intestine mucosa (purified)
51	Rotator Cuff Tear
52	Porcine patch
53	Porcine Patch
54	Porcine Patch
55	Thank You