The Evaluation and Treatment of Rotator Cuff Pathology Viviane Bishay, MD, Robert A. Gallo, MD  Primary Care: Clinics in Office Practice  Volume 40, Issue 4, Pages 889-910 (December 2013) DOI: 10.1016/j.pop.2013.08.006 Copyright © 2013 Elsevier Inc. Terms and Conditions

Fig. 1 (A) Radiographic image of rotator cuff tear arthropathy, whereby the humeral head is elevated relative to the glenoid and abuts on the undersurface of the acromion. (B) Rotator cuff tear arthropathy occurs in the setting of a chronic, massive rotator cuff tear usually involving at least supraspinatus (arrow) and infraspinatus tendons. Primary Care: Clinics in Office Practice 2013 40, 889-910DOI: (10.1016/j.pop.2013.08.006) Copyright © 2013 Elsevier Inc. Terms and Conditions

Fig. 2 The classic “Popeye” deformity of a depressed, bulged lateral portion of the biceps (right) occurs secondary to a rupture of the long head of the biceps tendon proximally. Primary Care: Clinics in Office Practice 2013 40, 889-910DOI: (10.1016/j.pop.2013.08.006) Copyright © 2013 Elsevier Inc. Terms and Conditions

Fig. 3 Radiographs taken in the anteroposterior (AP) (A) and outlet (B) projections are useful in determining the contour of the acromion, which in this case has a hooked appearance. Acromial morphology, including a curved or hooked contour of the anterior acromion in the sagittal projection, is thought to contribute to rotator cuff abnormality. Primary Care: Clinics in Office Practice 2013 40, 889-910DOI: (10.1016/j.pop.2013.08.006) Copyright © 2013 Elsevier Inc. Terms and Conditions

Fig. 4 Calcific tendinitis, glenohumeral arthritis, and proximal humerus fractures can present similarly to rotator cuff tears but are clearly distinguished radiographically. (A) Calcific tendinitis characteristically demonstrates a radio-opacity within the distal portion of the supraspinatus tendon. (B) Narrowing of the glenohumeral joint space is a hallmark finding of glenohumeral arthritis, and is best delineated on true AP or Grashey views. (C) A fracture line and/or displacement involving a tuberosity and/or humeral head are usually seen on radiographs, although occasionally magnetic resonance imaging is required to visualize a nondisplaced fracture. Primary Care: Clinics in Office Practice 2013 40, 889-910DOI: (10.1016/j.pop.2013.08.006) Copyright © 2013 Elsevier Inc. Terms and Conditions

Fig. 5 Though not commonly used, computed tomographic arthrography can provide a clear image of the rotator cuff tendons and adequate characterization of a tear (arrow). Primary Care: Clinics in Office Practice 2013 40, 889-910DOI: (10.1016/j.pop.2013.08.006) Copyright © 2013 Elsevier Inc. Terms and Conditions

Fig. 6 “Sleeper” stretches, which are useful for stretching the posterior capsule, are performed by lying on the affected side (A) and pressing the forearm of the affected shoulder toward the floor (B). Primary Care: Clinics in Office Practice 2013 40, 889-910DOI: (10.1016/j.pop.2013.08.006) Copyright © 2013 Elsevier Inc. Terms and Conditions

Fig. 7 To perform an arthroscopic rotator cuff repair, an anchor containing sutures is passed into the exposed tuberosity (A). Sutures from the anchor are passed through the tendon (B) and secured to reapproximate tendon to the tuberosity (C). Primary Care: Clinics in Office Practice 2013 40, 889-910DOI: (10.1016/j.pop.2013.08.006) Copyright © 2013 Elsevier Inc. Terms and Conditions

Fig. 8 Arthroscopic repairs are performed using either 1 (A) or 2 (B) rows of anchors. Though repairs using 2 rows of anchors appear biomechanically stronger, no technique has proved to be clinically superior. Primary Care: Clinics in Office Practice 2013 40, 889-910DOI: (10.1016/j.pop.2013.08.006) Copyright © 2013 Elsevier Inc. Terms and Conditions