Rotator Cuff Tears
Car Wrecks, slip and falls and many on the job injuries result in injuries to the shoulder. ROTATOR CUFF TEARS: The shoulder is the most mobile joint in the body and is built more for function than for stability. Muscles of the shoulder include the supraspinatus, the teres minor, and the infraspinatus, which rotate the humerus externally, and the subscapularis, which rotates the humerus internally. Tears in the tendons of the rotator muscles at or near the insertions into the humeral tuberosities can occur as a result of "acute trauma". These tears can involve the entire thickness of the cuff (known as a complete tear) or can extend only partially through the cuff (known as a partial tear). At the time of the rupture (or tear), a snap and acute pain is often felt immediately and the patient cannot abduct the arm. A complete rotator cuff tear diagnoses depends on the extravasation of contrast medium through the tear into the subacromial-subdeltoid bursa.
There are several complications, which can occur after anterior acromioplasty and rotator cuff repairs. The most common is a stiff shoulder, inability to raise the arm over the head or reaching out, and the possibility of a re-tear because of either overzealous physiotherapy or a traumatic incident.
Subacromial impingement is a problem affecting the shoulder and rotator cuff area. Trauma in one of the leading causes of the impingement. Through studies, in recent years it has become apparent that "anterior sub-acromial impingement" is a leading cause of shoulder pain and disability. The acromion offers protection, stability, and mechanical advantage to the glenohumeral joint because it lies directly above the humeral head and provides the origin of the large deltoid muscle, a prime mover in forward elevation and overhead activity. Because of this relation between the acromion and the humeral head, the intervening rotator cuff tendons, and the biceps tendon, and the subacromial bursa may be impinged during elevation. Pain and disability from persistent impingement causing wear on the rotator cuff will occur. Due to the functional arc of elevation of the extremity in the forward plane, and therefore, subacromial impingement is usually between the anterior undersurface of the
There are three (I, II, and III) stages of "Subacromial Impingement Syndrome".
~In Stage I, treatment consists of applications of anti-inflammatory agents, rest from sports and related activities, biomechanical analysis of arm motion. ~In Stage II, treatment consists of steroid injections and/or bursectomy, coracoacromial ligament (CA LIGAMENT). ~Stage III is treated by Anterior acromioplasty and cuff repair, acromioclavicular arthoplasty if needed.