Let's move on to a very common injury
called the rotator cuff injury.
Here, you see a baseball
player about to pitch.
Sometimes rotator cuff injuries
are associated with overuse,
generally in athletes,
particularly with repetitive overhead motions.
This is common with
pitchers, weightlifters, for example.
And, of course, it can be traumatic.
Rotator cuff anatomy is
actually quite complicated,
but it contains several
tendons and several muscles.
This is behind the
image and not shown.
This rotator cuff combination
of muscles and tendons
stabilize our shoulders.
For rotator cuff injuries,
the supraspinatus tendon is
most commonly injured.
You can elicit this pain
by asking a patient to do a-b-duction
or abduction above the head.
they’ll generally feel pain
and stop the motion.
This is called the arc test.
Have the pain –
their pain will be present
past 90° of abduction.
Try it yourself.
Maybe you’ll diagnose
rotator cuff tears in yourself.
Here are some imaging techniques.
because it’s a tendon injury,
most plain x-rays are not helpful.
There is increasing use of
what's called dynamic ultrasound.
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.
Ultimately, MRIs are usually performed.
In this image,
the white arrow points to an area
where on T2-weighted image
An edema is an indirect evidence
that there is swelling
and potentially ligamentous
injury in the rotator cuff.
Here you see the ligament wrapping
around the glenohumeral joint.
Remember that the rotator
cuff is very important
for stability of the shoulder joint.
How do we treat rotator cuff tears?
Well, vast majority of the time,
physical therapy and rehabilitation.
This can be combined with non-steroidals,
range of motion exercises,
and judicious rest.
Remember we don't want a frozen shoulder,
so we do encourage our
patients to continue moving them.