1. Clinical & Diagnostic Evaluation for Rotator Cuff Disease John F. Meyers, M.D.

3. History Age Type of Pain Night Pain Weakness Age Type of Pain Night Pain Weakness

4. History Duration of Symptoms Overuse Trauma Duration of Symptoms Overuse Trauma

5. Physical Examination Observation Range of Motion Palpation Observation Range of Motion Palpation

7. Physical Examination Strength Stability Impingement Special Tests Strength Stability Impingement Special Tests

8. Observation

12. Range of Motion

17. Palpation

21. Strength Testing

27. Impingement Tests

32. Stability

34. Special Tests

37. X-Rays Superior migration of humeral head Greater tuberosity cycts Acromial sclerosis DJD Superior migration of humeral head Greater tuberosity cycts Acromial sclerosis DJD

41. Arthrogram

42. Arthrogram Advantages Gold standard 95% accurate Inexpensive Gold standard 95% accurate Inexpensive

43. Arthrogram Disadvantages Invasive Misses bursal side tears Misses intratendon pathology Allergic reactions Invasive Misses bursal side tears Misses intratendon pathology Allergic reactions

44. Ultrasound

46. Ultrasound Advantages Noninvasive Inexpensive Rapid Noninvasive Inexpensive Rapid

47. Ultrasound Disadvantages 65 – 95% accurate Misses partial & small tears Technique dependant ! 65 – 95% accurate Misses partial & small tears Technique dependant !

48. MRI

50. MRI Advantages Noninvasive Full thickness tears Partial thickness tears Tendon inflammation Noninvasive Full thickness tears Partial thickness tears Tendon inflammation

51. MRI Disadvantages Expensive Claustrophobia <95% accurate Too sensitive Expensive Claustrophobia <95% accurate Too sensitive

52. Arthroscopy

54. Arthroscopy Advantages Accurate Exam of joint and bursa Treat pathology Convert to open procedure Accurate Exam of joint and bursa Treat pathology Convert to open procedure

55. Arthroscopy Disadvantages Expensive Risk of anesthesia Risk of surgical complications Expensive Risk of anesthesia Risk of surgical complications

56. Case Histories

57. Ultrasound

58. C-Rays Superior migration of humeral head Greater Tuberosity Cysts Sclerosis of Undersurface of Acromion Outlet View – Acromial Morphology Superior migration of humeral head Greater Tuberosity Cysts Sclerosis of Undersurface of Acromion Outlet View – Acromial Morphology

59. Diagnostic Tests Routine X-Rays Arthrography Ultrasound MRI Routine X-Rays Arthrography Ultrasound MRI