Treatment of Rotator Cuff Lesions.
Last updated Wednesday, January 26, 2005
Effectiveness of treatmentDurability and functional needs Many of the factors that determine the durability of a repair can be
determined without special imaging of the rotator cuff; they are
discernible from the history, physical examination, and plain
radiographs. MRI is not necessary to determine muscle atrophy. Factors
that are encouraging about repair durability include: age less than 55,
acute traumatic onset, short duration of weakness, no history of
smoking, no steroid injections,no systemic steroids or antimetabolites,
no concurrent disease, no infections, no previous shoulder surgery, no
failed soft tissue repairs (eg. dehiscence, infections complicating
herniorraphy), good nutrition, mild weakness, minimal spinatus atrophy,
shoulder stability, intact acromion, no stiffness,and normal
radiographs (without upwards displacement of head against
coracoacromial arch).
Treatment of shoulder weakness caused by cuff failure is determined
by the functional needs of the patient and the likelihood of a durable
surgical repair. Patients with low functional requirements and a
substantial number of the "discouraging" factors from the list above
are given a nonoperative program to help optimize the strength and
coordination of the muscles about the shoulder that remain intact. At
the opposite extreme, patients with major functional demands and mostly
"encouraging" factors are presented with the option of an attempted
surgical repair, and informed that the success of this repair will be
determined primarily by the quality of the tendon and muscle and the
amount of tissue lost.
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