Rotator Cuff Injury

by Kevin Pei, MD

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    00:01 Let's move on to a very common injury called the rotator cuff injury.

    00:05 Here, you see a baseball player about to pitch.

    00:09 Sometimes rotator cuff injuries are associated with overuse, generally in athletes, particularly with repetitive overhead motions.

    00:19 This is common with pitchers, weightlifters, for example.

    00:24 And, of course, it can be traumatic.

    00:28 Rotator cuff anatomy is actually quite complicated, but it contains several tendons and several muscles.

    00:36 The supraspinatus, the subscapularis, teres minor and infraspinatus.

    00:44 This is behind the image and not shown.

    00:47 This rotator cuff combination of muscles and tendons stabilize our shoulders.

    00:54 For rotator cuff injuries, the supraspinatus tendon is most commonly injured.

    00:59 You can elicit this pain by asking a patient to do a-b-duction or abduction above the head.

    01:06 Typically speaking, they’ll generally feel pain and stop the motion.

    01:13 This is called the arc test.

    01:14 Have the pain – their pain will be present past 90° of abduction.

    01:20 Try it yourself.

    01:21 Maybe you’ll diagnose rotator cuff tears in yourself.

    01:26 Here are some imaging techniques.

    01:28 Unfortunately, because it’s a tendon injury, most plain x-rays are not helpful.

    01:36 There is increasing use of what's called dynamic ultrasound.

    01:39 As the title sounds, the ultrasound is done over a range of motion, particularly in the a-b-duction or abduction past 90°, when the pain is elicited, one may be able to see tears or edema around the ligaments.

    01:57 Ultimately, MRIs are usually performed.

    02:00 In this image, the white arrow points to an area where on T2-weighted image there's edema.

    02:06 An edema is an indirect evidence that there is swelling and potentially ligamentous injury in the rotator cuff.

    02:14 Here you see the ligament wrapping around the glenohumeral joint.

    02:18 Remember that the rotator cuff is very important for stability of the shoulder joint.

    02:26 How do we treat rotator cuff tears? Well, vast majority of the time, physical therapy and rehabilitation.

    02:32 This can be combined with non-steroidals, ice, range of motion exercises, and judicious rest.

    02:40 Remember we don't want a frozen shoulder, so we do encourage our patients to continue moving them.

    About the Lecture

    The lecture Rotator Cuff Injury by Kevin Pei, MD is from the course Special Surgery.

    Included Quiz Questions

    1. Supraspinatus
    2. Teres major
    3. Infraspinatus
    4. Subscapularis
    5. Teres minor
    1. Pain past 90 degrees abduction
    2. Pain past 80 degrees abduction
    3. Pain past 60 degrees abduction
    4. Pain past 40 degrees abduction
    5. Pain past 10 degrees abduction

    Author of lecture Rotator Cuff Injury

     Kevin Pei, MD

    Kevin Pei, MD

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