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Rotator cuff Injuries

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

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Rotator cuff Injuries

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  1. Rotator cuff Injuries Mr Lee Van Rensburg May 2014

  2. www.shoulderses.co.uk

  3. J Bone Joint Surg Am. 2014;96:265

  4. 53 YO Male • Farmer • Falls from tractor • Pain and weakness in shoulder

  5. Shoulder

  6. Referral - physio • Diffuse pain in upper arm, following fall • X rays show some arthritis • Weakness and pain No firm diagnosis

  7. Rheumatology 2006;45:215–221

  8. Physiotherapy • See’s physio - 2 weeks later • Pain slightly better • Affecting sleep • Still struggling with elevation 90° • ? Rotator cuff tear

  9. ? Rotator cuff tear • Why ? tear • Jobe’s

  10. 123 Tests

  11. 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

  12. 175 J Shoulder Elbow Surg. 2009 Jul-Aug;18(4):529-34

  13. ? Rotator cuff tear • Send back to GP ? Tear • Refer on • Image • Inject • Start rehab?

  14. Patient • ? Tear in tendon • Special scan • Stop using it tear get worse…… • Keep it moving !

  15. MRI • Full thickness tear • Supraspinatus • Infraspinatus

  16. 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

  17. RCR Surgery Rehabilitation

  18. Operative vs Non Operative Agency for healthcare research and quality USA July 2010

  19. Early SurgeryVsPhysiotherapy • 1 study

  20. Age 61 (46-75) Age 59 (44-75) Symptoms 10 - 12 months +- 50:50 traumatic and atraumatic J BJS - Br January 2010 vol. 92-B no. 1 83-91

  21. J BJS - Br January 2010 vol. 92-B no. 1 83-91

  22. Constant score Satisfaction Physiotherapy 7.2 (1-10) Surgery 9 (1-10) J BJS - Br January 2010 vol. 92-B no. 1 83-91

  23. 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

  24. Surgery did better 9 no surgery constant score 7.5 less BUT 42 Happy not surgery J BJS - Br January 2010 vol. 92-B no. 1 83-91

  25. Traumatic Vs Atraumatic

  26. 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.

  27. 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

  28. RCR Surgery Rehabilitation

  29. Anaesthetic • Infection • Stiffness • Incomplete resolution • Recurrence • Re tear • Rehab

  30. 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%

  31. 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

  32. 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

  33. Summary

  34. Questions

  35. Rotator cuff repair

  36. Arthroscopic shoulder

  37. Arthroscopic surgery general • Many different types of procedures • Standard anaesthetic • Wound closure • Initial recovery

  38. Interscalene block • Sling till arm awake • Stay out of kitchen • Most wear off 8 Hours • Pre emptive analgesia

  39. Wound closure • Subcuticular prolene suture

  40. Wound closure • Steristrips

  41. Dressings • Mepore Dressings

  42. Dressings • Pad

  43. Sling • Sling (Rotator Cuff Repair)

  44. Biceps tenotomy/ tenodesis J Shoulder Elbow Surg (2011) 20, 326-332

  45. J Shoulder Elbow Surg (2012) 21, 61-65

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