ROTATOR CUFF INJURIES Mr Lee Van Rensburg May
. ROTATOR CUFF INJURIES Mr Lee Van Rensburg May 2014
. www. shoulderses. co. uk
. J Bone Joint Surg Am. 2014; 96: 265
. 53 YO Male Farmer Falls from tractor Pain and weakness in shoulder
. Shoulder
. Referral - physio Diffuse pain in upper arm, following fall X rays show some arthritis Weakness and pain No firm diagnosis
. Rheumatology 2006; 45: 215– 221
. Physiotherapy See’s physio - 2 weeks later Pain slightly better Affecting sleep Still struggling with elevation 90° ? Rotator cuff tear
. ? Rotator cuff tear Why ? tear Jobe’s
. 123 Tests
. Supraspinatus - Apley's Scratch Test - Jobes Supraspinatus test - Dawburn's sign - Sherry Party sign - Codman's Sign (Drop Arm Sign) - Rent Test - Zero Degree Abduction Test - Burkhead's Thumbs down & Burkhead's Thumbs up
. 175 J Shoulder Elbow Surg. 2009 Jul-Aug; 18(4): 529 -34
. ? Rotator cuff tear Send back to GP ? Tear Refer on Image Inject Start rehab?
. Patient ? Tear in tendon Special scan Stop using it tear get worse…… Keep it moving !
. MRI Full thickness tear Supraspinatus Infraspinatus
. 1953 - 61 60 -69 =30% FTRCT 1936 - 78 70 -79 = 50% FTRCT 1930 - 84 80 -89 = 80% FTRCT Age-related prevalence of rotator cuff tears in asymptomatic shoulders; Tempelhof et al; JSES July 1999 (Vol. 8, Issue 4, Pg 296 -299
. RCR Surgery Rehabilitation
. Operative vs Non Operative Agency for healthcare research and quality USA July 2010
Early Surgery Vs Physiotherapy . 1 study
. Age 59 (44 -75) Age 61 (46 -75) Symptoms 10 - 12 months +- 50: 50 traumatic and atraumatic J BJS - Br January 2010 vol. 92 -B no. 1 83 -91
. J BJS - Br January 2010 vol. 92 -B no. 1 83 -91
. Constant score Satisfaction Physiotherapy 7. 2 (1 -10) Surgery 9 (1 -10) J BJS - Br January 2010 vol. 92 -B no. 1 83 -91
. Secondary surgery group Delay in surgery 5 months Final outcome 7. 5 points less constant score J BJS - Br January 2010 vol. 92 -B no. 1 83 -91
. Surgery did better BUT 42 Happy not surgery 9 no surgery constant score 7. 5 less J BJS - Br January 2010 vol. 92 -B no. 1 83 -91
. Traumatic Vs Atraumatic
. N = 37 Group 1 – Operated within 3 weeks (n=12) Group 2 – Operated within 3 to 6 weeks (n=6) Group 3 – Operated within 6 -12 weeks (n=19) F/U ave. 7. 0 years (range, 1 - 21 years) Abduction Group 1 = 168° Group 2 = 126° Group 3 = 129° Pain relief good for all Repair best within 3 weeks Clin Orthop 1983; 175: 18 -24.
. N= 36 3 groups Group 1 - 0 -8 weeks Group 2 - 8 -16 weeks Group 3 - > 16 weeks All improved Pain 7 down to 1 Elevation 55 to 133 J Shoulder Elbow Surg (2011) 20, 62 -68
. Surgery RCR Rehabilitation
. Anaesthetic Infection Stiffness Incomplete resolution Recurrence Re tear Rehab
. Arthroscopic RCR Day case overnight stay 60 -80% better Sling 3 weeks 6 weeks social protection Nothing heavier cup of tea 6 weeks Drive 6 -8 weeks (2 weeks) Desk top 4 -6 weeks Manual work 3 months Healed 6 weeks 60% 3 months 80%
. Massive Rotator cuff tear Non operative Relative rest NSAID Physio Steroid injection (controversial) Supra scapular nerve block Operative 3 months JSES - 2008; 17: 863 -870
. Massive Rotator cuff tear Non operative Operative Arthroscopic Debridement Reverse decompression Biceps tenotomy Suprascapular nerve ablation Open Reverse shoulder replacement 3 months JSES - 2008; 17: 863 -870
. Summary
. Questions
. Rotator cuff repair
. Arthroscopic shoulder
. Arthroscopic surgery general Many different types of procedures Standard anaesthetic Wound closure Initial recovery
. Interscalene block Sling till arm awake Stay out of kitchen Most wear off 8 Hours Pre emptive analgesia
. Wound closure Subcuticular prolene suture
. Wound closure Steristrips
. Dressings Mepore Dressings
. Dressings Pad
. Sling (Rotator Cuff Repair)
. Biceps tenotomy/ tenodesis J Shoulder Elbow Surg (2011) 20, 326 -332
. J Shoulder Elbow Surg (2012) 21, 61 -65
- Slides: 45