SEARCH RESULTS FOR: Rotator-Cuff-Disease

Rotator Cuff Disease

Rotator Cuff Disease: Pathogenesis and clinical findings Authors: Jared Topham Reviewers: Raafi Ali, Yan Yu*, Kelley DeSouza* * MD at time of publication Aging Collagen fiber disorientation and myxoid degeneration Tendons, ligaments, and connective tissue are replaced by gelatinous and/or mucoid substance Obesity ↑ Loading on shoulder structures ↓ Static stability (from glenoid labrum and ligamentous components) of glenohumeral joint Tensile forces Repeated eccentric tension from overhead activities Trauma, sports, and occupation ↑ Torque, compression, and translational stresses Metabolic syndromes Reactive oxygen species interact with ↑ glucose forming advanced glycation end-products (AGEs) which accumulate in soft tissues Smoking Impingement syndromes Vessel damage, ischemia, tenocyte apoptosis Macro-trauma causing an acute, complete tear in the rotator cuff muscle(s) ↓Dynamic stability (from rotator cuff and periscapular muscles) and range of motion of the shoulder at the glenohumeral joint ↑ Bone on bone contact of proximal humeral head and boney structures of the scapula Subacromial bursa degeneration ↓ Protection of underlying supraspinatus muscle from attrition between humeral head and acromion Rotator Cuff Syndrome (Inflammation, impingement, or tearing of one or more of the four muscles/tendons of the rotator cuff: supraspinatus, subscapularis, infraspinatus, teres minor) Repetitive loading and micro-tearing of tendon/muscle fibers ↑ Oxidative stressors and inflammatory cascades ↓ Vascularity of rotator cuff structures Radiographic changes: See Rotator Cuff Disease: X-ray and ultrasound features slide, in addition to: calcific tendonitis, calcification of in the coracohumeral ligament, and hooked acromion (calcification from tendon pulling) In some cases, soft tissues enclose/surround shoulder joint capsule thicken (fibrose) and tighten Degenerative joint disease and rotator cuff arthropathy Proximal humeral head migration and ↓ subacromial space Inflammation and insufficient healing of rotator cuff structures, which may lead to: Supraspinatus (shoulder abduction) degeneration Pain, shoulder stiffness, ↓ active AND passive range of motion Adhesive Capsulitis (frozen shoulder) Infraspinatus and teres minor (external rotation) degeneration Rotator cuff tendons become inflamed and irritated as they rub against acromion Subacromial impingement Subscapularis (internal rotation) degeneration +Lift-off test: Inability to hold dorsum of the hand off lumbar spine while internally rotating shoulder ↓ Shoulder strength and muscular atrophy Pain with passive shoulder flexion beyond 90° Winging of the scapula during arm adduction +Empty-can test: Weakness and/or arm depression with resisted abduction with arm internally rotated in 90° +Drop-arm test: Inability to maintain shoulder in abducted position at 90° and/or adduct the arm in a controlled manner (resulting in ”dropping”) Weakness to resisted external rotation with elbow in 90° flexion, inability to keep arm externally rotated (infraspinatus) +Hornblower’s sign: decreased external rotation strength in arm abduction (suggests additional teres minor tear) Legend: Pathophysiology Mechanism Sign/Symptom/Lab Finding Complications Published July 30, 2023 on www.thecalgaryguide.com

Rotator Cuff Disease Xray and Ultrasound Features

Rotator Cuff Disease: X-ray and ultrasound features Rotator cuff tears can affect each of the muscles making up the rotator cuff individually, or in combination Authors: Jared Topham Reviewers: Raafi Ali, Kelley DeSouza* * MD at time of publication Supraspinatus tear (most common) Chronic (>3 months) tear with degenerative-type changes Rotator cuff insufficiency, loss of supporting structures holding humeral head inferiorly Displacement of the humeral head anterosuperiorly and instability of joint Microtrauma affecting superior aspect of glenohumeral joint “Acetabularization” or coracoacromial arch: concave acromial erosion and increased sclerosis (hardening) Subscapularis tear (second most common) Teres minor tear Infraspinatus tear Rotator Cuff Syndrome (Inflammation, impingement, or tearing of one or more of the four muscles/tendons of the rotator cuff: supraspinatus, subscapularis, infraspinatus, teres minor) Acute (partial or full thickness) tear of rotator cuff tendons Humeral subluxation (partial displacement of humeral head relative to glenoid) High riding humerus: decreased acromial humeral distance Decreased acromial humeral interval/space (impinging tendons of rotator cuff) Full: Defect extends from the subacromial bursa (fluid filled sack beneath the acromion and above the rotator cuff tendons) to the articular surface of the glenohumeral joint Tendon/muscle fibers completely separated from bone and/or muscle fiber connections severed Partial: Focal defect affecting a portion of the tendon which may involve the bursa or glenohumeral articular surface Non-visualization of the tendon Acetabularization of glenoid Fluid replaces empty space of tendon tear Overlying fat around the sub acromial bursa falls into tendon gap Sagging peribursal fat sign on ultrasound “Femoralization” of the humerus: bone erosion (destruction) and rounding of greater tuberosity Osteoarthritis of glenohumeral joint: See Osteoarthritis (OA): X-ray features slide Hyperechoic (brightened) line between articular cartilage of humeral head and muscle tendon on ultrasound Cartilage interface sign on ultrasound Hypoechoic (darkened) tendon outline discontinuity on ultrasound imaging Femoralization (rounding) of greater tuberosity Subluxation of the humeral head relative to the glenoid Legend: Pathophysiology Mechanism Sign/Symptom/Lab Finding Complications Published September 6, 2023 on www.thecalgaryguide.com