Rotator cuff injuries - physio 2014

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Transcript Rotator cuff injuries - physio 2014

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Mr Lee Van Rensburg
May 2014
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J Bone Joint Surg Am. 2014;96:265
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Farmer
Falls from tractor
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Pain and weakness in shoulder
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Diffuse pain in upper arm, following fall
X rays show some arthritis
Weakness and pain
No firm diagnosis
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Rheumatology 2006;45:215–221
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See’s physio - 2 weeks later
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Pain slightly better
Affecting sleep
Still struggling with elevation 90°
? Rotator cuff tear
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Why ? tear
 Jobe’s
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- Apley's Scratch Test
- Jobes Supraspinatus test
- Dawburn's sign
- Sherry Party sign
- Codman's Sign (Drop Arm Sign)
- Rent Test
- Zero Degree Abduction Test
- Burkhead's Thumbs down & Burkhead's Thumbs
up
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175
J Shoulder Elbow Surg. 2009 Jul-Aug;18(4):529-34
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Send back to GP ? Tear
 Refer on
 Image
 Inject
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Start rehab?
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? Tear in tendon
Special scan
Stop using it tear get worse……
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Keep it moving !
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Full thickness tear
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Supraspinatus
Infraspinatus
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1953 - 61
60-69 =30% FTRCT
1936 - 78
70-79 = 50% FTRCT
1930 - 84
80-89 = 80% FTRCT
Age-related prevalence of rotator cuff tears in asymptomatic shoulders;
Tempelhof et al; JSES July 1999 (Vol. 8, Issue 4, Pg 296-299
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Surgery
Rehabilitation
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Agency for healthcare research and quality
USA July 2010
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1 study
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Age 59 (44-75)
Age 61 (46-75)
Symptoms 10 - 12 months
+- 50:50 traumatic and atraumatic
J BJS - Br January 2010 vol. 92-B no. 1 83-91
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J BJS - Br January 2010 vol. 92-B no. 1 83-91
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Constant score
Satisfaction
Physiotherapy 7.2 (1-10)
Surgery 9 (1-10)
J BJS - Br January 2010 vol. 92-B no. 1 83-91
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Secondary surgery group
Delay in surgery 5 months
Final outcome
7.5 points less constant score
J BJS - Br January 2010 vol. 92-B no. 1 83-91
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Surgery did better
BUT
42 Happy not surgery
9 no surgery
constant score 7.5 less
J BJS - Br January 2010 vol. 92-B no. 1 83-91
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N = 37
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F/U ave. 7.0 years (range, 1 - 21 years)
Abduction
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Group 1 – Operated within 3 weeks (n=12)
Group 2 – Operated within 3 to 6 weeks (n=6)
Group 3 – Operated within 6-12 weeks (n=19)
Group 1 = 168°
Group 2 = 126°
Group 3 = 129°
Pain relief good for all
Repair best within 3 weeks
Clin Orthop 1983;175:18-24.
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N= 36
3 groups
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Group 1 - 0-8 weeks
Group 2 - 8-16 weeks
Group 3 - > 16 weeks
All improved
Pain 7 down to 1
Elevation 55 to 133
J Shoulder Elbow Surg (2011) 20, 62-68
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Surgery
Rehabilitation
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Anaesthetic
Infection
Stiffness
Incomplete resolution
Recurrence
Re tear
Rehab
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Day case overnight stay
60-80% better
Sling
3 weeks
 6 weeks social protection
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Nothing heavier cup of tea 6 weeks
Drive 6-8 weeks (2 weeks)
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Desk top 4-6 weeks
Manual work 3 months
Healed
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6 weeks 60%
3 months 80%
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Non operative
Relative rest
 NSAID
 Physio
 Steroid injection (controversial)
 Supra scapular nerve block
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Operative
3 months
JSES - 2008;17:863-870
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Non operative
Operative
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Arthroscopic
 Debridement
 Reverse decompression
 Biceps tenotomy
 Suprascapular nerve ablation
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Open
 Reverse shoulder replacement
3 months
JSES - 2008;17:863-870
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Many different types of procedures
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Standard anaesthetic
Wound closure
Initial recovery
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Sling till arm awake
Stay out of kitchen
Most wear off 8 Hours
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Pre emptive analgesia
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Subcuticular prolene suture
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Steristrips
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Mepore Dressings
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Pad
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Sling (Rotator Cuff Repair)
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J Shoulder Elbow Surg (2011) 20, 326-332
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J Shoulder Elbow Surg (2012) 21, 61-65