Transcript Rotator cuff tear

Shoulder
Anatomy and Arthroscopy
Mohsen Mardani-Kivi M.D.
GUMS
*Greatest ROM
*No inherent bony stability
*Relies on soft tissues for
stability
*Many injuries involve the soft
tissues (rotator cuff, labrum)
*Little glenoid bone stock
* Rotator Cuff-
* dynamic stabilizer
* passive muscle tension
* ligament tightening
* compression of
* articular surface
* GHL-
* static stabilizer
* SGLH
* MGHL
* IGHL
* PIGHL
* CAL
* CHL
* Axial plane
Bankart Lesion, BT
* Sagittal oblique plane
* Coronal oblique plane
Rotator cuff, SLAP
Rotator cuff
tear
Muscles comprising rotator *
cuff
Supraspinatus
Infraspinatus
Teres Minor
Subscapularis
Cause:
* the rotator cuff can be torn from a single traumatic
injury.
* A cuff tear may also happen at the same time as
another injury to shoulder,such as a fracture or
dislocation.
* Most tears, however, are the result of overuse of these
muscles and tendons over a period of years. People who
are especially at risk for overuse are those who engage
in repetitive overhead motions. These include
participants in sports such as baseball, tennis, weight
lifting, and rowing.
*
injury to
1 or more of the 4 muscles
in the *
shoulder.
Rotator cuff tears are most common in people who are
over the age of 40.
*
Younger people tend to have rotator cuff tears *
following acute trauma or repetitive overhead work
or sports activity.
Rotator cuff tear may often happen as a result of wear *
and tear.
*Pain on the lateral aspect of the shoulder
* Often worse at night
* When lifting the arm
* may radiate to deltoid insertion
*Weakness, instability, tenderness
* (There may be increase in the pain and weakness experienced
when elevating or rotating the arm)
*Atrophy or thinning of the muscles about
the shoulder
Physical exam:
How is it
diagnosed?
*Diagnosis of a rotator cuff tear is based on the
symptoms and physical examination. X-rays, and
imaging studies, such as MRI or ultrasound, are
also helpful.
*An MRI can sometimes tell how large the tear is, as
well as its location within the tendon itself or
where the tendon attaches to bone.
*Shoulder pain is variable and does not always
correspond to the size of the tear.
A complete tear of the
supraspinatus resulting in
a shift upwards of the
head of the humerus
*Mechanism/Etiology
*Hill-Sachs Lesion
*Bankart Lesion
*Mechanism/Etiology
*Hill-Sachs Lesion
*Bankart Lesion
*Traumatic avulsion of
anterior/inferior labrum
*Cadaver studies have shown
that 4 o’clock region is
weakest part of labrum
Superior Labrum Anterior to Posterior Tear
I.
Labral Fraying (21%)
II.
Labral Avulsion (55%)
III.
Bucket Handle Tear (9%)
I.
Bucket Handle Tear into Biceps Tendon (10%)
V.
VI.
VII.
Type II + Bankart
Type II + Unstable radial or flap
tears
Type II + Extension into MGHL
*Beach chair (the most common)
*Lateral
*Arthroscope
*30° and 70° scopes
*Arthroscope sheath with matching
sharp and blunt trochars
*Punches, Graspers, Seizers, Probes
*Suture passers, Knot pusher
*#11 scalpel blade
*Skin marking pencil
*18 g. needle
*20 cc syringe (if insufflating)
*76 mm plastic cannula with a rubber dam
*Motorized shaver with soft tissue and bone shaving
blades
*Suction punch
*Suture punch
*Metal Anchor Suture
5, 6.5
*Bio Anchor Suture
5, 6.5
*Knotless Anchor Suture; push lock
1- Arthroscopic Bankart repair (one row repair)
2-Casiope Repair (double Bankart row repair)
3-All arthroscopic Latarjet procedure
4- Capsular shift
5-Rotator interval closure
Repair of HAGEL lesion
Repair of SLAP lesion
*Arthroscopic Rotaor cuff Surgery
*Arthroscopic Subacromion decompression
*Arthroscopic Acropmioplasty
*rotator cuff repair
-one row
-double row
*
*Latissmos dorsi transfer for rotator cuff
deficiency, irreparable tears
*Arthroscopic priscapular bursectomy
*Arthroscopic AC arthroplasty
*Arthroscopic AC instability
reconstruction