Rotator Cuff Case Study

Most of us all have an intact shoulder that for the most part does not give us a problem. We can take it for granted that we are able to comb our hair, can carry groceries without any pain, or sleeping on our side with no pain until something happens like a rotator cuff tear. This unfortunate event is not very uncommon. We will take a look at the anatomy of our shoulder, specifically the rotator cuff and what might lead to a tear or make it more prone to a tear. We will also discuss some of the options that are available to repair a torn rotator cuff. After reading this, hopefully you will have a better understanding of the rotator cuff tear and repair.
Let us begin with the anatomy of the rotator cuff. It is comprised of a group of muscles
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The teres minor, infraspinatus, supraspinatus, and the subscapularis all are attached to the humerus via their tendons. These tendons are fused together to form the cuff, that in turn, allow for the movement of the shoulder to play sports and do the daily activities that most of us take for granted such as comb our hair. Athletes such as baseball players or swimmers, or lifting heavy weights, to using your arm to break a fall, can cause injury or a tear to the rotator cuff. Another possible situation that can lead to a tear is what is known as impingement syndrome (AAOS, 2011). This is where the supraspinatus tendon becomes inflamed and painful, because of the location, between the head of the humerus and the acromion of the scapula which is compressed during abduction and adduction of the shoulder. If the impingement syndrome is not treated, usually by rest and strengthening exercises as well as massage, and there is a continuation of use, this can cause the tendon(s) to tear away from the bone (AAOS, 2011). The most common tendon to tear is the supraspinatus tendon (AAOS, 2011). There are different types of tears that can occur. Sometimes the tendons begin to fray and then a single action can cause the fray to progress into a tear. There are partial tears in which the tissue is damaged but is …show more content…
One traditional surgery performed is an open repair surgery (JOSPT, 2010). Prior to the incision, the surgeon marks the landmarks of the anterior and lateral borders of the acromion and clavicle on the affected shoulder. In this procedure, an incision is made over the anterior superior aspect of the shoulder in the length of three to six cm to expose the subcutaneous fat layer. From there the deltoid muscle insertion into the acromion is identified clearly. The deltoid is lifted off of the anterior aspect of the acromion and the deltoid is split laterally for approximately three to five centimeters. At this point the bursa (lubricating sac that helps with movement) resection helps to better visualize the rotator cuff and also cut down on pain caused from inflammation. Once the identification of the tendon is visualized, the debridement of the torn tendon is done. If there are bone spurs they can be removed at this time also. For many repairs a hole through the bone suture is exercised. This is where a hole is drilled through the hard, compact bone distal to the greater tuberosity of the humerus. A braided nylon suture is placed through the drilled hole and then through the tendon tissue. This is used to improve bone healing and fixation strength. The deltoid is then reattached to the acromion to both the superficial and deep deltoid layers. The statistics for success in this type of surgery show that 80% to

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