Rotator Cuff Full Thickness Tears - David Houlihan-Burne 20/2/2001

INTRODUCTION

Incidence 15%    (28% > 60yo)

97% tears due to degenerate tendon secondary to impingement

Imaging -           Xray -    Superior migration of humeral head

                                    Porosis of gt tuberosity

                                    Spur detection (30 degree caudal view)

                        USS - Cuff integrity and defect size identifiable

                        MRI - Most sensitive (?too sensitive- 25% asymptomatic pts have PTT)

Treatment -        Tailor to the patient                    

                        Restore biomechanics and GHJ stability

                        Conservative

                        Surgical -          Open, Mini open, Arthroscopic repairs.

                                                Partial repair, Tendon transfers

Postoperative rehabilitation at 4/52

Authors

Robert H Hawkins et al. Vancouver , Canada

Title

Results of Nonoperative Management of Full-Thickness Tears of the Rotator Cuff.

Reference

CORR 294 : 103 “ 110, 1992

Summary

Retrospective study. 53 pts proven FTT by arthrogram Rx non-op. 7yr f/u.   Subjectively -   Pain ¯ by 70%, strength ­ by 45%, function returned to normal in all. Objectively -    moderate ­ in active ROM , no ­ strength and    57% ¯ in impingement sign. Av.   UCLA score ­ from 14.6   to 28.1

Critique

Pre-selected group of pts. Not all objectively f/u. Aetiology of tears not representative ( 20% due to dislocation, 80% due to traumatic event). Non standardised 'Rx' (16 received subacromial injection). Does show some value of a period   non op Rx   (ie waiting list)



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