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  • summary
  • Epidemiology
  • Etiology
  • Anatomy
  • Classification
  • Presentation
  • Imaging
  • Treatment
    • Treatment considerations
      • activity and age of patient
      • mechanism of tear (degenerative or traumatic avulsion)
      • characteristics of tear (size, depth, retraction, muscle atrophy)
        • partial thickness tears vs. complete tear
        • articular sided (PASTA lesion) vs. bursal sided
          • bursal sided tears treated more aggressively
    • Nonoperative
      • physical therapy, NSAIDS, subacromial corticosteroid injections
          • first line of treatment for most tears
          • partial tears often can be managed with therapy
        • technique
          • avoidance of overhead activities
          • physical therapy with aggressive rotator cuff and scapular-stabilizer strengthening over a 3-6 month treatment course
          • subacromial injections if impingement thought to be major cause of symptoms
    • Operative
      • subacromial decompression and rotator cuff debridement alone
        • indications
          • select patients with a low-grade partial articular sided rotator cuff tear
      • rotator cuff repair (arthroscopic or mini-open)
        • indications
          • bursal-sided tears >3 mm (>25%) in depth
            • release remaining tendon and debride degenerative tissue
          • partial articular-side tears>50% can be treated with tear completion and repair
            • Partial articular-side tears <50% treated with debridement alone
          • PASTA with >7mm of exposed bony footprint between the articular surface and intact tendon represents significant (>50%) cuff tear (must have at least 25% healthy bursal sided tissue)
            • younger patients with acute, traumatic tears
              • in situ repair leave bursal sided tissue intact
            • older patients with degenerative tears
              • tendon release, debridement of degenerative tissue and repair
        • postoperative
          • rate-limiting step for recovery is biologic healing of RTC tendon to greater tuberosity, which is believed to take 8-12 weeks
            • peribursal tissue and holes drilled in greater tuberosity are major source of vascularity to repaired rotator cuff
            • vascularity can increase with exercise
          • postop with limited passive ROM (no active ROM)
        • outcomes
          • Worker's Compensation patients report worse outcomes
            • higher postop disability and lower patient satisfaction
          • patients should expect to return to full work duty by 6-10 months after surgery
          • pain control 
            • patient pain scores improved at 1 week post-operatively with prescription of NSAIDs
      • tendon transfer
        • indications
          • massive cuff tears
        • techniques (see details below)
          • pectoralis major transfer
          • latissimus dorsi transfer
            • used for irreparable posterosuperior tears with intact subscapularis
          • lower trapezius transfer
            • recent literature suggests superior clinical outcomes when compared to the latissimus dorsi in irreparable posterosuperior tears
      • superior capsular reconstruction
        • indications
          • massive irreparable rotator cuff tear with intact subscapularis
      • reverse total shoulder arthroplasty
        • indications
          • massive cuff tears with glenohumeral arthritis with intact deltoid
  • Technique
  • Complications
  • Prognosis
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Question
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Shoulder & Elbow⎪Rotator Cuff Tears
  • Shoulder & Elbow
  • - Rotator Cuff Tears
50:4 min
11/5/2019
2976 plays
5.0
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