Yesterday's post covered some of the key factors bearing on the repairability of a rotator cuff tear.
Below are listed findings that have been shown to be encouraging or discouraging about the prospect of the shoulder having a durably reparable cuff tear. It is of interest that many of these factors can be determined without advanced testing.
ENCOURAGING DISCOURAGING
History
Age less than 55 Age over 65
Acute traumatic onset Insidious, atraumatic onset
No relation to work Attribution of tear to work
Short duration of weakness Weakness over 6 weeks
No history of smoking Many smoking pack-years
No steroid injections Repeated steroid injections
No major medications Steroids/antimetabolites
No concurrent disease Inflammatory joint disease
No infections History of previous infection
No previous shoulder surgery Previous cuff surgery
Benign surgical history History of failed tissue repairs
Physical Examination
Good nutrition Poor nutrition/obesity
Mild weakness Severe weakness
No spinatus atrophy Severe spinatus atrophy
Stable shoulder Anterior superior instability
Intact acromion Previous acromioplasty
No stiffness Stiffness
Radiographs
Normal radiographs Upwards head displacement
Cuff tear arthropathy
MRI or Ultrasound
Good tendon quality Thin tendon
One tendon tear Multiple tendon involvement
Small gap to close Severe retraction
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How you can support research in shoulder surgery Click on this link.
Here are some videos that are of shoulder interest
Shoulder arthritis - what you need to know (see this link).
How to x-ray the shoulder (see this link).
The ream and run procedure (see this link).
The total shoulder arthroplasty (see this link).
The cuff tear arthropathy arthroplasty (see this link).
The reverse total shoulder arthroplasty (see this link).
The smooth and move procedure for irreparable rotator cuff tears (see this link).
Shoulder rehabilitation exercises (see this link).
