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. Mr Lee Van Rensburg May 2014
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. J Bone Joint Surg Am. 2014;96:265
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. Farmer Falls from tractor Pain and weakness in shoulder
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. Diffuse pain in upper arm, following fall X rays show some arthritis Weakness and pain No firm diagnosis
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. Rheumatology 2006;45:215–221
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. See’s physio - 2 weeks later Pain slightly better Affecting sleep Still struggling with elevation 90° ? Rotator cuff tear
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. Why ? tear Jobe’s
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. - Apley's Scratch Test - Jobes Supraspinatus test - Dawburn's sign - Sherry Party sign - Codman's Sign (Drop Arm Sign) - Rent Test - Zero Degree Abduction Test - Burkhead's Thumbs down & Burkhead's Thumbs up
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. J Shoulder Elbow Surg. 2009 Jul-Aug;18(4):529-34 175
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. Send back to GP ? Tear Refer on Image Inject Start rehab?
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. ? Tear in tendon Special scan Stop using it tear get worse…… Keep it moving !
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. Full thickness tear Supraspinatus Infraspinatus
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. 60-69 =30% FTRCT 70-79 = 50% FTRCT 80-89 = 80% FTRCT Age-related prevalence of rotator cuff tears in asymptomatic shoulders; Tempelhof et al; JSES July 1999 (Vol. 8, Issue 4, Pg 296-299 1953 - 61 1930 - 84 1936 - 78
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. Surgery Rehabilitation
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. Agency for healthcare research and quality USA July 2010
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. 1 study
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. J BJS - Br January 2010 vol. 92-B no. 1 83-91 Age 59 (44-75) Age 61 (46-75) Symptoms 10 - 12 months +- 50:50 traumatic and atraumatic
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. J BJS - Br January 2010 vol. 92-B no. 1 83-91
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. Constant score Satisfaction Physiotherapy 7.2 (1-10) Surgery 9 (1-10)
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. J BJS - Br January 2010 vol. 92-B no. 1 83-91 Secondary surgery group Delay in surgery 5 months Final outcome 7.5 points less constant score
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. J BJS - Br January 2010 vol. 92-B no. 1 83-91 42 Happy not surgery 9 no surgery constant score 7.5 less Surgery did better BUT
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. Clin Orthop 1983;175:18-24. N = 37 Group 1 – Operated within 3 weeks (n=12) Group 2 – Operated within 3 to 6 weeks (n=6) Group 3 – Operated within 6-12 weeks (n=19) F/U ave. 7.0 years (range, 1 - 21 years) Abduction Group 1 = 168° Group 2 = 126° Group 3 = 129° Pain relief good for all Repair best within 3 weeks
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. J Shoulder Elbow Surg (2011) 20, 62-68 N= 36 3 groups Group 1 - 0-8 weeks Group 2 - 8-16 weeks Group 3 - > 16 weeks All improved Pain 7 down to 1 Elevation 55 to 133
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. Surgery Rehabilitation
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. Anaesthetic Infection Stiffness Incomplete resolution Recurrence Re tear Rehab
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. Day case overnight stay 60-80% better Sling 3 weeks 6 weeks social protection Nothing heavier cup of tea 6 weeks Drive 6-8 weeks (2 weeks) Desk top 4-6 weeks Manual work 3 months Healed 6 weeks 60% 3 months 80%
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. Non operative Relative rest NSAID Physio Steroid injection (controversial) Supra scapular nerve block Operative JSES - 2008;17:863-870 3 months
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. Non operative Operative Arthroscopic Debridement Reverse decompression Biceps tenotomy Suprascapular nerve ablation Open Reverse shoulder replacement JSES - 2008;17:863-870 3 months
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. Many different types of procedures Standard anaesthetic Wound closure Initial recovery
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. Sling till arm awake Stay out of kitchen Most wear off 8 Hours Pre emptive analgesia
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. Subcuticular prolene suture
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. Steristrips
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. Mepore Dressings
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. Pad
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. Sling (Rotator Cuff Repair)
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. J Shoulder Elbow Surg (2011) 20, 326-332
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. J Shoulder Elbow Surg (2012) 21, 61-65
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