Tear Classifications
Rotator cuff tears are classified as either partial thickness or full-thickness tears, with the full-thickness tears being more severe.9 Before treatment occurs, the characteristic of the tear needs to be evaluated. First, the tear size can be evaluated by measuring the maximum diameter and cross-sectional area of the involved region of the tendon. 9 As described by DeOrio and Cofield, tears can be classified as small (one cm.), medium (one to three cm.), large (three to five cm.), and massive (more than five cm.). 9 Second, rotator cuff tears are evaluated based on the tear shape. 9 The first shape is a crescent shaped tear, which involves the insertions of the tendons torn from the head of the humerus. 9 To repair this, the tendon insertions must be reattached to the head of the humerus. 9 The second shape of tear is the U-shaped or L-shaped, which is the tearing between tendons and tearing between tendon and bone. 9 To repair this tear, the tearing of tendon to tendon is sutured, and the tearing of tendon to bone is fixed by the reattachment of the tendon to the bone. 9 The last parameter of assessing rotator cuff tears is tissue quality. 9 Muscle, bones, and tendons are all assessed through MRI for fatty infiltration/degeneration and for muscle atrophy. 9
Conservative Treatment The most immediate treatment for a
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This repair was formulated to address the possible deltoid failure caused by the open repair.9 First, the arthroscopic portal is inserted one to two cm., and the deltoid muscle is split vertically.9,11 Also, acromioplasties can be done with this technique arthroscopically.9 During this technique, "debridement of tendon edges, releases, mobilization and sometimes single row anchor placement are all performed arthroscopically."11 This procedure shows similar results to the open repair, with patients having good to excellent results at long-term
Many factors like patients age, symptoms, size of the tear, and nature of onset (traumatic or degenerative) are responsible for determining the prognosis of the physical therapy treatment 9. Since it’s a partial thickness tear of the rotator cuff, the non-operative treatment is reasonable unlike, a full thickness tear where surgery will be required to treat the patient 9. The patient shows symptoms of moderate irritability without significant functional deficit which makes him a good candidate for conservative treatment 10. The pain reported by the patient is 6/10 so the patient participates well in physical therapy exercise to increase shoulder strength, and flexibility. There was a study done from Finland which asserted that physical therapy alone can produce results which are equal to those produced by arthroscopic surgery and open surgical repair in cases of rotator cuff tears 11. In this case, with three weeks of physical therapy the patient has showed a decrease in pain and reported it as 4/10 on pain rating scale and showed improvements in abduction (140̊) and external rotation (65̊). The MMT for shoulder abduction was 4-/5 and external rotation is still same as
... It is not completely clear how it is that a tendon becomes a ligament, although Dr. Akizuki thinks that range of motion exercises help the tendon learn that it is being used as a ligament now and that it needs to adopt. Surgeons don't go back in to biopsy the repaired elbow to see how the tissue has changed, but follow-up MRIs show that the new tissue is acting as a ligament should.
Patient returned the next day still complaining of pain. The PT applied heat, then initiated the exercise program, but the patient could not perform theem to same extent as previously, secondary to pain. Therefore, the PT told the patient to schedule an appointment with his physician. The patient was seen by the MD the next day and an arthrogram performed that revealed a reinjure to the repaired site. And a second surgery repaired the rotator cuff.
A rotator cuff is simply a group of four tendons and muscles that are located right on the shoulder and on top of the humerus bone. (Source 1) The rotator cuff is what controls the shoulder and allows it to move and be mobile. The four main muscles that consist of the tendons are the supraspinatus, infraspinatus, teres minor, and subscapularis muscles. (Source 2). Too much wear and tear on these muscles (such as too many thrown fastballs) is precisely what causes the rotator cuff to begin to tear, as well as swelling in the tendons.
... This patient, after treatment, had completed ROM and was able to get back to daily activities (Papa 2012). GISTM has been shown to work on all types of injuries, whether the patient had surgery or not. GISTM is becoming a well-known tool in the clinical world and is a reason for faster recovery periods (Black 2010). Works Cited Black D. Treatment of knee arthrofibrosis and quadriceps insufficiency after patellar tendon repair: a case report including use of the graston technique.
...nge of external and internal motion while strengthening the muscles of the shoulder. When rest and physical therapy fail to correct an injury, surgery may be required. Common surgical procedures include labrum repairs, posterior capsular release, anterior capsular placation, or rotator cuff surgery. Many athletes are focusing on just one sport and training year round resulting in an increase in over-use injuries. It is recommended that athletes not play one sport year round to prevent overuse. Breaks should be taken and pitchers should not pitch on multiple teams.
One of the functions of the rotator cuff muscles and the long head of the biceps, is to pull the head of the humerus down from the acromion process, to prevent impingement. Strengthening the subscapularis, infraspinatus and teres minor can help with this function. Dr. Fishman discovered a technique when doing yoga and experienced relief of his own rotator cuff pain. The technique is based on a headstand in yoga and is called the Triangular Forearm Support.
Ligaments are tough, non-stretchable fibers that hold bones together. Damage to cruciate ligaments, which crisscross the knee to give it stability, is one of the most common sports injuries. The “tear” occurs from changing direction rapidly, slowing down from running, or landing from a jump improperly. The A.C.L tear is one injury that worries athletes in all sports at all levels because of its devastating effects. People ages 15-25 that participate in basketball and other sports that require pivoting are especially at risk.
Impingement syndrome was originally described by Dr. Charles Neer as mechanical impingement of the supraspinatus muscle and the long head of the biceps tendon underneath the acromial arch. Neer classified three stages of impingement. Stage I is characterized by edema and hemorrhage of the rotator cuff and suprahumeral tissue. Stage II is characterized by fibrosis of the glenohumeral capsule and subacromial bursa and tendonitis of the involved tendons. Patients usually demonstrate a loss of active and passive range of motion because of capsular fibrosis. Stage III is the most difficult to treat and is characterized by disruption of the rotator cuff tendons. This includes rotator cuff tears, biceps rupture, and bone changes. Since this is a continuous disease process, there is often overlap of signs and symptoms (Hawkins and Abrams 1987).
"Chapter 37." Operative Techniques in Orthopaedic Surgery. Ed. Sam Wiesel. 4th ed. Vol. 2. Lippincott Williams & Wilkins, 2011. eBook.
Percutaneous Tenotomy where a surgeon identifies the painful area of the tendon with an ultrasound then inserts a needle into the skin and makes small incisions in the damaged tendon. This creates an enhanced healing response and leads to a faster tendon repair. The procedure typically lasts for about 20 minutes while the patient is under local anesthesia. Also if you ever have to do this you have to go do it every three to 4 weeks. Platelet-rich Plasma Therapy Platelet-rich plasma therapy is a technique that separates in the blood cells from the white and red blood cells and applies them directly to the injured area through injection or other methods.
On 2/9/18 I met Mr. Mossman at the office of Dr. Drayer. Travel time was extended due to several winter weather. Mr. Mossman’s last day of therapy is today. Dr. Drayer has a physical therapist in his office that will perform measurements before. Dr. Drayer does his evaluation. Per the physical therapist, the range of motion and strength has dramatically improved since the last office visit. Dr. Drayer was very happy with the progress. He told Mr. Mossman to do whatever is able to do, that he will not hurt the repair. Mr. Mossman denied any pain at all. He has been released to full duty work as of 2/12/18. There are no further follow up appointments.
The solution to this problem is located in the lab. Researchers across the country are working day in and day out to come up with a solution to accelerate the healing of soft tissues. They have come up with many solutions, from vibration therapy, to personalized rehab plans, but none of these are yielding truly significant results. I believe the solution lies at the molecular level. I believe that we can observe the healing of these soft connective tissues and learn from it. Then we can design a method from the observations to accelerate the production of the fibrils and collagen that will go on to make up the soft connective tissue. I have begun to take the beginning steps in solving this problem through my mentorship with Dr. Weinhold. Our research goals go hand in hand, which has led us to beginning research on the release of an angiogenic growth factor through a gelatin that will coat sutures. In theory, this angiogenic growth factor, once released from the crosslinking with the gelatin will stimulate the development of blood vessels around the recently repaired collagenous tissue. This, in turn, will allow the tendon/ligament to have a better oxygen supply and allow for quicker
Rotator cuff tear – The muscles adjoining the shoulder joint are required for rotating the shoulder, amid other movements. The tendons of these muscles furthermore influence the structural strength of the shoulder joint. Harsh, rapid actions, for example in tennis and baseball, can result in tearing of one of these tendons. This then causes pain as well as a decline in range of motion. Surgery possibly will be necessary to repair a torn
Prior treatments included medications and physical therapy (PT). Current medication included Ibuprofen. The patient underwent a laceration repair and repair of a crush-type laceration of the left DIP extensor tendon, and repair and realignment of the fracture of the distal phalanx on 04/13/17.