Rotator Cuff Research Paper

Inspection of the right shoulder joint reveals atrophy. Movements are restricted with flexion to 90 degrees limited by pain and abduction to 75 degrees limited by pain. Hawkin’s test, Neer’s test, Shoulder crossover test, Empty Cans test, Lift-off test, and Apprehension test is positive. On palpation, tenderness is noted in the acromioclavicular joint and subdeltoid

DOI: 5/8/2016. Patient is a 48-year old male maintenance operator who sustained a strained shoulder when he was throwing waste metal into a bin.The patient was subsequently diagnosed with left shoulder impingement syndrome with massive tear of the supraspinatus and infraspinatus tendons. MRI report dated 5/28/16 revealed suboptimal examination; massive full-thickness rotator cuff tear involving the entire supraspinatus and infraspinatus tendons with severe medial retraction beyond the level of the glenoid measuring approximately 6.2 cm. Severe fatty atrophy and loss of muscle bulk in the supraspinatus and infraspinatus muscles; large glenohumeral joint effusion with fluid in the subacromial/subdeltoid bursa and subcoracoid bursa; mild to moderate degenerative changes of the glenohumeral joint; severe acromioclavicular joint arthritis with

Rotator cuff surgery affects the function of the shoulder. It is very painful injury and there is loss in strength. If the rotator cuff tendon becomes inflamed or is partially torn, it can be painful and will most limit shoulder movement. This injury occurs from a sudden impact, like falling on your arm which might accrue in motocross, snowboarding, playing football, and similar collision sport. Activities that might cause overload to the tendon have a possibility to tear the tendon. Other ways a rotator cuff can tears is from old age and over use over the years.

^8,5 ASI occurs when the arm is in adduction with the shoulder internally rotated. The biceps complex pulley, also known as a capsuloligamentous complex, adjoins the anterior glenoid causing injury when in extreme motions. With the PSI, the pulley is put into risk with abduction and external rotation on the posterosuperior glenoid. ^8 PSI is also associated with partial-thickness tears on the deep side of the articular surface of the rotator cuff. ^5 This can be a common cause for a peel-back mechanism associated with a SLAP lesion. ^8 Peel-back mechanisms can be produced many different ways, but are mostly seen with a SLAP lesion or internal impingement. These can occur when the shoulder is placed into abduction and extreme external rotation with a torsional force added to the labro-bicipital complex that is at the base of the biceps on the posterior superior labrum. ^1,5 This causes fatigue and failure of the humeral head that rotates medially over the upper rim of the glenoid fossa creating a shearing force. ^1,5 Increased superior labral strain in overhead athletes occurs during the late-cocking phase of throwing when arm is externally rotated. ^1

DIAGNOSIS: Impingement syndrome, right shoulder; full-thickness rotator cuff tear with retraction, right shoulder; adhesive capsulites, right shoulder; post-op pain, right shoulder; Right elbow strain/sprain; Right wrist strain/sprain; Right upper extremity overuse syndrome.

Impingement syndrome: As indicated by Shahabpour, Kichouh, Laridon, Gielen, & De Mey (2008, p. 194), magnetic resonance imaging is the imaging tool of choice for evaluation of articular structure and soft tissue of the shoulder; it can aid in the detection of soft tissue anomalies linked to shoulder impingement. Similarly, Wise et al. (2011, p. 605) acknowledge the importance of MRI as an instrument in identifying osseous and soft tissue irregularities that may lead to or be the consequence of shoulder impingement.

On 3/15/17 due to a schedule conflict Laurie Wawrzyniak met Mr. Rife at the office of Dr. Wines. Mr. Rife has made positive gain in range of motion with physical therapy. He still reports pain when raising the left arm. A cortisone injection was recommended along with a MRI. The injection was done under ultra sound in the office. While performing the injection under ultra sound Dr. Wines noted the rotator cuff was thinning and he was concerned there was a tear. Dr. Wines recommended a MRI of the shoulder. Physical therapy will continue and treatment options will be. The MRI will be done on 3/15/17. I have advised Mr. Rife to obtain a copy of the MRI CD to bring to the appointment on 3/23/17 with Dr. Wines.

MRI of the left shoulder obtained on 07/28/15 showed rotator cuff tendinosis with undersurface fraying of the supraspinatus tendon. There is no discrete high-grade partial or full-thickness rotator cuff tear detected. Moderate long head biceps tendinosis without discrete tear is seen.

Status post rotator cuff repair is seen, with expected post-surgical changes. The post-contrast images suggest a full-thickness partial-width tear at the junction of the supraspinatus and infraspinatus tendons measuring at least 4 mm in anteroposterior dimension. The contrast does slightly extravasate into the subacromial recess and outlines the supraspinatus tendon. The superior glenoid labrum demonstrates a single focus of contrast extravasation anteriorly. The findings in the superior labrum are less prominent than were identified on the prior exam. These findings suggest prior surgical repair of the glenoid labrum, but would correlate with prior operative report for further evaluation of this finding. Infraspinatus and subscapularis tendinopathy is

Rotator cuff injuries are known as the most common shoulder injuries. They are especially common among regular gym visitors, who underestimate the power of the weights and the pressure that the shoulders bare. All the repetitive motions above the head are a direct cause of a rotator cuff injury. As a result of the challenging workout programs, the shoulders become exhausted, developing a condition followed by shoulder stiffness, soreness and shoulder immobility.

Based on the latest medical report dated 11/05/15, the patient had a minimally displaced “GT” avulsion fracture, nondisplaced incomplete fracture at the surgical neck and nondisplaced anterosuperior glenoid fracture. He had a rotator cuff tendonitis without full thickness tearing. There is some

Knowing the anatomy in the regions of injury is vital when solving for the route cause of the pain. When looking at the shoulder, it is important to understand the locations and names of the various muscles and ligament that allow for specific movement for this appendage. For instance, on the superior side of the shoulder joint, the deltoid muscle works with the supraspinatus to abduct the arm at the shoulder. On the anterior side of the shoulder, the coracobrachialis, serratus anterior, pectoralis major, and pectoralis minor muscles work together to flex and abduct the scapula and humerus anteriorly toward the sternum. This knowledge of anatomy becomes advantageous when used to isolate specific areas through palpation exercises in order to further identify and diagnose the presented

Ruptures of the rotator cuff are more often seen in players over the age of 40 years. “This is because of the wear and dehydration that tendon structures suffer with advancing age.” (Silva, 2010) The younger sports population usually experience tendinopathy. Treating a rotator cuff injury is usually more successful in the older population and this is mainly due to the fact that the person is no longer active in sports. On the other hand an active player does not feel the pain and therefore continues to play the sport. The repair of a rotator cuff can be performed both arthroscopically and open procedure. (Silva, 2010)

Therefore, numerous spectrums of instability types and associated lesions affecting capsuloabral, ligamentous, and osseous structures can be identified (Stayner et al., 2000). The pathophysiology of an anterior shoulder dislocation involves violent external rotation in abduction levers causing the humerus to be dislodged from the glenoid socket, tearing the shoulder capsule and detaching the labrum from the glenoid (the Bankart lesion) (Farber et al., 2006). Additionally, the posterior part of the humeral head exits the joint, colliding with the anterior rim of the glenoid, producing a bony depression at the back of the humeral head (the Hill Sachs lesion) (Farber et al., 2006). Furthermore, anterior dislocation can occur when people fall with a combination of abduction, extension, and a force directed posteriorly on the arm; this is a common mechanism in the elderly (Stayner et al. 2000). A fracture of the humeral head, neck or greater tuberosity can occur with a dislocation (Stayner et al., 2000). In contrast, a posteriorly dislocated shoulder is less common. It is commonly caused by external forces acting on the shoulder when the shoulder is held in internal rotation and adduction caused by direct trauma experienced during sporting activities (Hegedus et al., 2008). Additionally, it may be result from an epileptic fit,

The conduction of the Apley’s Scratch Test and Gerber’s Lift off Test along with the MRI scans was to identify Rotator Cuff Tendonitis. These tests trial the movement of the rotator cuff to see how the limitations of movement correspond with the receptance of pain. With Rotator Cuff Tendonitis, the individual will experience uncomfortable pain during movement and at night. Occurrence will happen if the individual holds the arm at a certain position for long periods of time, such as working on the computer for continuous hours, branching with poor posture. Another contribution to the occurrence is the individual’s participation in activities that needs the arm to actively and continuously maneuver