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Rotator cuff tear

The tear can be caused by trauma, a fall on an outstretched arm. It can be the repetitive microtrauma in your thrower or a dislocation in your 40-45 year old patient.

Evaluation of a rotator cuff tear is pretty straightforward. You are going to do your physical examination of their shoulder. They are going to have some impingement. They will have a painful arc which is usually between 70 and about 120ļ of abduction or forward flexion and then you are going to pick up some weakness on your rotator cuff.

When do you need an MRI scan? An MRI scan may be indicated if they have impingement pain and youíve been treating them for a few months and theyíve failed the nonoperative treatment. If they have had an acute injury with immediate loss of strength in the shoulder, they canít abduct or they canít forward flex, an MRI may be indicated initially. Other indications. Ruptured long head of the biceps tendon or a shoulder dislocation with persistent pain. In this MRI scan it is going to be difficult to see but what this shows is a very large rotator cuff tear. The supraspinatus should be coming out all the way over here attaching into the greater tuberosity and we donít see any rotator cuff up.

The other thing that we see is that the humeral head is riding superiorly. Here is the superior aspect of the glenoid right here. So the humeral head is riding up superiorly. The head depressor function of the rotator cuff is gone so that head is riding up contacting the under surface of the acromion and you will see this with very large rotator cuff tears.

Treatment will affect the outcome of a surgical repair. Patients typically do better with traumatic injuries if they are fixed acutely. The age of the patient. That is pretty straightforward. A young patient is going to better than an older patient.

Cortisone status. We will see patients who have come in and theyíll say, "Well, Iíve had ten cortisone shots in my shoulder and it is still not any better." Too many injections of cortisone actually thin and weaken the rotator cuff and cause more problems. When we get in there to repair a rotator cuff that has had multiple injections, it is just thin tissue paper looking stuff that you canít get any sutures in and it is not going to hold. I limit my patients to two subacromial injections if Iím doing it over a couple of month period of time. I wonít keep injecting them. If I havenít gotten them better with some anti-inflammatory medicines, a good rehab program and one or two subacromial injections, that tells me that there is probably more going on in there than we can get better with rehab and multiple injections so it is time to get your MRI scan.