Case Manager's Corner

Mechanism of Injury:

Results from a single traumatic event or due to repetitive microtrauma possibly in association with chronic impingement syndrome (i.e., stage III).

Subjective Symptoms:

May present with similar complaints as impingement syndrome with pain predominating, especially with overhead activities. Tears with inadequate compensation from surrounding intact musculature may be associated with weakness and greater passive than active motion.

Objective Signs:

Weakness against resistance in the plane of motion controlled by the torn tendon (muscle). Often accompanied by positive impingement findings (i.e., Neer's and Hawkin's signs). MRI helpful to determine extent and chronicity, but not always required for confirmation.

Natural History:

Depends upon patient factors and biologic factors related to the muscle-tendon unit. Smaller, partial-thickness tears in lower-demand patients may do well with nonsurgical management. Tears of any size in higher-demand patients may lead to chronic pain and weakness if left untreated. The extent of irreversible muscle atrophy depends upon chronicity, tear size, patient age and comorbidities.

Nonsurgical:

Physical therapy emphasizing glenohumeral and scapulothoracic strengthening and NSAIDs. Judicious use of cortisone injections primarily when surgical repair not anticipated.

Surgical:

Technique depends upon surgeon experience, tear size, location and chronicity:

1) Arthroscopic rotator cuff repair
2) Arthroscopically-assisted rotator cuff repair
3) Open rotator cuff repair

Nonsurgical:

Approximately 8-12 weeks

Limit overhead activities

Surgical:

Approximately 12-24 weeks

Light duty 1-2 weeks postop
Limit overhead activities