My Orthopaedic Surgeon

16th Annual Meeting San Diego Shoulder Arthroscopy Course Stephen C. Weber, M.D.
I. Cuff repair options:
A. Open repair/open acromioplasty. Good results reported by Ellman, Cofield, and numerous others. Anticipate about an 85% success rate.
B. Arthroscopic debridement. Good initial results reported by Ellman and Esch for full thickness tears. Early results of debridement of small to moderate size tears very equivalent to open repair.
C. Mini open repair. Multiple studies presented in the early 90’s of retrospec- tive reviews of arthroscopic evaluation and acromioplasty followed by open repair through a deltoid splitting incision. Appeared to combine advantages of open repair (direct visualization of repair, palpation of acromioplasty, long term success of repair) with arthroscopic visualization and decreased morbidity.
D. All arthroscopic repair. Intellectually attractive procedure which is perceived by virtually all patients and many surgeons to be superior to open procedures. Early retrospective series by Snyder, Wolf, Tippett, and others demonstrated that skilled surgeons could apply these new techniques with one to two year results comparable to prior series of open repair.

Notes on optimal management of rotator cuff tear. Christian Gerber, Zurich, Switzerland
Archive Copy last posted 2006

abduction of shoulder is a smooth, integrated motion which has been termed scapulohumeral rhythm by Codman;
- disruption of this smooth motion is important since asymmetrical movement usually indicates a chronic pathological disorder of the shoulder;
- there is a 2:1 ratio of movement in GHJ & scapulothoracic joints;
- Clavicle also plays part in elevation of the arm, w/ about 40 deg of motion occurring at sternoclavicular joint & 20 deg in AC joint during full abduction of the shoulder;
Wheeless' Textbook of Orthopaedics

Notes on Arthroscopic Cuff Repair. Felix H. Savoie, III, MD Arthroscopy And Arthroplasty 16th Annual Meeting June 23-26,1999
Web Archive. Last posted 2006

Arthroscopic Rotator Cuff Findings -- Alessandro Castagna, MD Web Arhive Copy. Last posted 2006
The understanding and treatment of the pathology of the rotator cuff muscle-tendon complex is probably still the most stimulating challenge for the shoulder surgeon. Anatomy, biomechanics, presence of multiple layers of tissues, limited subacromial space make often difficult a precise assessment of the cuff disorders and therefore a proper repair. History, clinical examination and imaging will help the surgeon for an exact diagnosis. Imaging of the rotator cuff tears improved a lot in the last years. MRI, especially with gadolinium enhancement, allows a rather precise pre-operative assessment. But other basic tests like x-rays (AP, Axillary and Arch-View) should never be skipped. Finally the surgeon should always compare the radiologist report with the history and clinical exam. This procedure allows avoiding over- or under- diagnosis of rotator cuff disorders. Arthroscopy demonstrated a great role in the assessment of rotator cuff disorders and in the operative decision making.

Arthroscopic Rotator Cuff Repair. Web Archive Copy. Last posted 2007

Painter described calcification in the shoulder in 1907. Codman established that the calcification was within the tendons of the rotator cuff. Calcifying tendinitis of the shoulder is characterized by the presence of macroscopic deposits of hydroxyapatite (a crystalline calcium phosphate) in any tendon of the rotator cuff.1 This article addresses only calcifying tendinitis as it occurs in the shoulder.
Synonyms and related keywords: calcifying tendinitis, calcific tendinitis, calcified tendinitis, calcareous tendinitis, tendinosis calcarea, calcific tendinopathy
Anthony H Woodward, MD 2007

Corkscrew Rotator Cuff Repair -- Burkhart Web Archive Copy Last posted 2006
The Arthrex Corkscrew Rotator Cuff Repair System offers superior pullout strength in soft bone and a simplified, reproducible technique for min-open and arthroscopic rotator cuff repairs. The Corkscrew Anchor has a unique auger type thread and a thin 2.0 mm core diameter. This provides outstanding holding strength and cancellous bone usually encountered in rotator cuff repair. The 5.0mm Corkscrew is preloaded with two #2 braided sutures to increase soft tissue fixation with fewer anchors. The Corkscrew requires no predrilling and can be inserted easily into cancellous bone by hand with the convenient preloaded handled inserter. The Corkscrew can be easily removed and leaves only a small 2mm diameter hole in the bone after removal.

Full thickness tears of the rotator cuff often present in the middle-aged and elderly population. There is wide variation in terms of the extent of rotator cuff tears, the patient's symptoms, the patient's goals and therefore the treatment options.

In 1834, Smith wrote the first description of a rupture of the rotator cuff tendon. Since then, with the work of such authors as Duplay, Von Meyer, Codman, and, more recently, Neer, degenerative changes to the rotator cuff have been better characterized; however, the exact mechanisms leading to the degeneration of the rotator cuff still are debated today. Moreover, despite numerous trials, questions still exist about the efficacy of different therapeutic modalities for rotator cuff disease. With the help of better methodology for studies, more successful treatment of degenerative rotator cuff disease can be expected.
Synonyms and related keywords: rotator cuff tendinitis, supraspinatus tendinitis, rotator cuff tear, subacromial impingement syndrome, subacromial bursitis, subacromial-subdeltoid bursitis, calcifying tendinitis, periarthritis humeroscapularis, shoulder periarthritis, painful shoulder syndrome
Roy et al 2006

Rotator cuff injuries are a common cause of shoulder pain in people of all age groups. They represent a spectrum of disease, ranging from acute reversible tendonitis to massive tears involving the supraspinatus, infraspinatus, and subscapularis. Diagnosis is usually made through detailed history, physical examination, and often, imaging studies. Often, younger individuals with rotator cuff injuries relate a history of repetitive overhead activities involving the rotator cuff or, less commonly, a history of trauma preceding clinical onset of symptoms. In contrast, older individuals usually present with a gradual onset of shoulder pain and, ultimately, after radiographic testing are shown to have significant partial or full rotator cuff tears without a clear history of predisposing trauma. Nonoperative or conservative treatment is usually sufficient to heal the problem in the vast majority of individuals, with a few exceptions that are discussed.
Synonyms and related keywords: rotator cuff tear, rotator cuff tendonitis, supraspinatus tendonitis, subacromial tendonitis, impingement syndrome, shoulder injury, shoulder pain, loss of shoulder motion, supraspinatus atrophy, infraspinatus atrophy, entrapments of suprascapular nerve, scapular winging, scapulohumeral rhythm, adhesive capsulitis, dropping of the arm, scapula rotators, drop-arm test, Neer impingement test, Hawkins-Kennedy impingement test, apprehension test, relocation test, intrinsic tendinopathy, curved acromions, hooked acromions, rotator cuff tendinopathy
Malanga et al 2006

The first description of rupture of the rotator cuff tendon was by Smith in 1834. With history, degenerative changes of the rotator cuff have been better characterized by Duplay, Von Meyer, Codman, and Neer. The exact mechanisms leading to the degeneration of the rotator cuff, however, are still being debated.
Synonyms and related keywords: rotator cuff tear, shoulder injury, rotator cuff injury, rotator cuff rupture, frozen shoulder, rotator cuff tendinitis, rotator cuff tendonitis, shoulder tendonitis, shoulder tendinitis
Bilal, Duffy & Hafi 2007

rotator cuff anatomy:
- frequency of tear:
- diff dx of cuff tears;: (partial rotator cuff tear)
- etilogy of tear:
- impingement syndrome: (75%)
- shoulder instability (anterior or multi-directional) (15%) (should be considered in any young active patient);
- trauma:
- occurs in 10% of patients;
- note that a displaced greater tuberosity frx is a RTC tear equivolent;
Wheeless' Textbook of Orthopaedics

Supraspinatus tendonitis is often associated with shoulder impingement syndrome. The common belief is that impingement of the supraspinatus tendon leads to supraspinatus tendonitis (inflammation of the supraspinatus/rotator cuff tendon and/or the contiguous peritendinous soft tissues), which is a known stage of shoulder impingement syndrome (stage II) as described originally by Neer in 1972. The causes of supraspinatus tendonitis can be broken down into extrinsic and intrinsic factors. Extrinsic factors are further broken down into primary impingement, which is a result of increased subacromial loading, and secondary impingement, which is a result of rotator cuff overload and muscle imbalance. In athletes whose sport involves stressful repetitive overhead motions, a combination of causes may be found.
Synonyms and related keywords: rotator cuff tendonitis, rotator cuff tendinopathy, rotator cuff tendinosis, shoulder impingement syndrome, shoulder pain, rotator cuff injury, rotator cuff tear, torn rotator cuff, shoulder injury, rotator cuff pathology, shoulder pathology, pitching injury, throwing injury
DeBerardino & Chang 2006