Monday, August 29, 2011

Rotator Cuff 5 - Can the rotator cuff tear be repaired?



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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