Specialists

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Partial Thickness Rotator Cuff Tears: Treatment

Partial thickness rotator cuff tears can result from intrinsic cuff degeneration and tendinopathy absent an injury or impingement. The lack of uniformity of collagen bundles and the paucity of vascular supply contributes to weakness, especially along the articular aspect of the rotator cuff. These degenerative tears often exit the articular surface and can be well […]

Impingement: Primary

Impingement of the tendinous portion of the rotator cuff as it passes under the coracoacromial arch is a classic cause of rotator cuff injury. The impingement syndrome, as originally described by Neer, encompasses a spectrum of pathologic changes involving the rotator cuff and associated bony changes within the coracoacromial arch, affecting primarily those 40 years […]

Diagnostic Imaging

It is essential that the initial evaluation of the painful shoulder include quality plain radiographs. The standard radiographs should include a true anterior-posterior view with the shoulder in the internal and neutral position, an axillary view, and the outlet (supraspinatus) view described by Neer and Poppen, which is used to evaluate and classify acromial morphology […]

Pathoanatomy

Before describing the mechanics of rotator cuff pathology, post-mortem studies provide an interesting backdrop to the issue of etiology. There is little doubt that rotator cuff tearing is a function of age among other factors. Post-mortem studies have indicated an incidence of full or partial thickness tears ranging from 5% to nearly 40% . Fukuda […]

Basic Science-Anatomy and Biology

The rotator cuff consists of the supraspinatus, infraspinatus, teres minor, and subscapularis muscles, all of which arise from the scapula and insert into the proximal humerus. The subscapularis muscle is innervated by the upper and lower scapular nerves, and arises from the anterior surface of the scapula, inserting into the lesser tuberosity.

The nerve supply […]

Incidence and Natural History

Shoulder pain is a common presenting complaint for patients of all ages and activity levels. In clinical frequency it is exceeded only by low back pain and neck pain. About 50% of the adult population will have at least one episode of shoulder pain each year.

The most common source of shoulder pain originates in […]

Other Causes of Impingement

In addition to outlet impingement, recent clinical and lab investigations have led to other mechanisms of impingement. These include functional overload, intrinsic tendonopathy, and internal anatomic impingement.

Functional overload results from excessive strain within the tendon from repetitive overuse or a one-time overload. The subsequent inflammation and tendonitis can lead to a continuous cycle, which […]