Rotator Cuff Disorders

Rotator cuff disorders

Dr. Ihsan Alshamy
FIBMS Orth.

Anatomy of rotator cuff

Formed by tendons of 1. supraspinatus muscle 2. Infraspinatus muscle3.Subscapularis muscle, the 3 tendons unite to form ( rotator cuff tendon) which pass beneath the coracoacromial ligament, separated from it by Bursa and inserted in head of the humerus. Function : initiation of abduction.

Rotator cuff

Deltoid
Scapula rotation on the chest


pathology
Friction of the rotator cuff under the coracoclavicular ligament occurs in position when the arm is abducted, slightly flexed and internally rotated ; this called ( impingement position), like in cleaning windows


1

2
Osteoarthritis of acromioclavicular joint with osteophytes



3
Subacromial bursitis like in rheumatoid arthritis or Gout

Continuous friction may lead to :

tendinitis or partial tear or complete tear


Clinical features
Anterior shoulder pain after vigorous activity like swimming , window cleaning, hair grooming

Examination for tendinitis

1- Painful arc test: anterior shoulder pain between 60-120 degree of shoulder abduction, repeating the movement with arm in external rotation is much painless.



2. Neers impingement test : flexion abduction internal rotation of the shoulder produce anterior shoulder pain under the acromion process, repeating the maneuver after injection of 10 ml of xylocaine ( local anesthesia) will greatly reduces the pain

Partial and complete tear

The same clinical features of tendinitis but the patient can Not initiates active abduction of the arm; to differentiate between partial and complete tear we inject 10 cc of local anesthesia ( xylocaine) in Subacromial space, if the patient can do active abduction of the arm after the injection means it is partial tear; and if he still can not do abduction it means complete tear


Drop arm sign: singe of complete tear

X- ray

-Erosion of greater tuberosity
-Upward migration of humeral head
-Osteoarthritis of acromioclavicular joint

MRI

Best method of diagnosis. It shows the cuff tear

Ultrasound

May show cuff tear

Treatment

conservative treatment
Avoidance of impingement position
NSAI
Physiotherapy
Active exercise in position of freedom

If no response to conservative treatment

Subacromial injection of steroid

Surgery ( called acrmioplasty)

Indicated in full thickness tear
Surgery includes removal of the coracoacromial ligament, removal of osteophytes from the under surface of acromion. It can be done open or arthroscopic.

Biceps tendinitis

Biceps muscle has 2 heads of origin; short head from coracoid process and long head from the glenoid margin, the muscle inserted in the radius bone below elbow, it is responsible for elbow flexion and forearm supination

Biceps tendinitis usually occurs in the long head, either alone or in association with rotator cuff syndrome

Diagnosis

1-Speed test: resisted flexion of the elbow with forearm supinated produce anterior shoulder pain.



2-Yergason test: resisted supination of the elbow with forearm flexion will produce anterior shoulder pain.

Treatment

• Conservative : local heat, NSAI, local injection of steroid.
• Surgery: include tendon decompression, biceps tenotomy.


Rupture biceps muscle

may occurs in elderly after lifting heavy weight, characterized by bruises and ecchymosis over the proximal arm

Resisted flexion of the elbow will produce lump (Popeye sign)

Treatment: in elderly usually conservative treatment. Young patient need surgical repair of the tendon.