mri of the rotator cuff

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<p>MRI of the rotator cuff</p> <p>Functional considerations The muscles of the rotator cuff resist the upwards force of the deltoid muscle by depressing the humeral head.</p> <p>Functional considerations The muscles of the rotator cuff compress the humeral head against the glenoid cavity, increasing joint stability</p> <p>Anatomic considerations Any process that narrows the subacromial space may affect the rotator cuff</p> <p>Anatomic considerations Any process that narrows the subcoracoid space may affect the rotator cuff</p> <p>Pathological considerations Exagerated tensile forces leads to failure at: Musculotendinous junction Tendon insertion to bone In bone</p> <p>Pathological considerations In presence of tendon degeneration excessive tensile forces may lead to failure within the tendon itself</p> <p>Pathological considerations In certain positions eg. Adduction, the avascular region is made larger</p> <p>Pathological considerations Cuff degeneration is associated with aging Pathology is fibrovascular proliferation and disorganisation with no inflammation Not a tendonitis tendonosis or tendonopathy</p> <p>Pathological considerations Cuff degeneration is associated with aging Pathology is fibrovascular proliferation and disorganisation with no inflammation Not a tendonitis tendonosis or tendonopathy</p> <p>Classification of tears Massive tear : Full thickness tear involving more than one tendon Articular side Bursal side Intrasubstance Low grade &lt; 50% thickness Medium grade 50% High grade &gt; 50%</p> <p>Classification of tears Retraction Presence or absence of muscle atrophy From muscle disuse related to tear Tendon retraction with nerve injury</p> <p> Irregularity of the tendon Articular fluid Bursal fluid</p> <p>Classification of tears Retraction Presence or absence of muscle atrophy From muscle disuse related to tear Tendon retraction with nerve injury</p> <p> Irregularity of the tendon Articular fluid Bursal fluid</p> <p>Classification of tears Direction of tear Vertical Oblique Horizontal</p> <p>MR arthrography Standard MR inconclusive Post op cases Special circumstances Posterior superior impingement Rotator interval lesions</p> <p>Cuff tears : special considerations Rim rent tears With aging the inner fibres of the tendon peel away from the greater tuberosity Less common than critical zone tears Young &gt; old</p> <p>Cuff tears : special considerations Intramuscular ganglia Rotator interval tears Musculotendinous tears Laminated tears Greater tuberosity fractures If &gt; 5mm displacement assoc. With cuff tear, my require ORIF</p> <p>Cuff tears : special considerations Lesser tuberosity fractures</p> <p>Treatment Non operative Modification of activity Exercises to strentghen muscles</p> <p> Operative Open or arthroscopic Rotator cuff repair Subacromial decompression</p> <p>Treatment Acromioplasty Resect and smooth undersurface of acromion Resect coraco-acromial ligament When needed, remove AC joint osteophytes, distal clavicle</p> <p>Treatment Repair torn tendon Advance cuff tendons Place and tighten tendon sutures Screws used to reinforce repair Arthroscopic repair</p> <p>Impingement External Subacromial or Subcoracoid Tendon degeneration Abnormality coracoacromial arch Altered acromial shape ACJ OA CAL thick Os acromiale GHJ instability</p> <p>Impingement Alteration acromial morphology Degree lateral slope: 10 degrees Shape in saittal plane 1=straight 2=curved 3=angular</p> <p>Impingement Alteration coracoid morphology Large or laterally placed Decrease coracohumeral distance</p> <p>Impingement Internal impingement Posterosuperior Impingement of undersurface of the cuff on the posterosuperior part of glenoid</p> <p> Anterosuperior Impingement of BT,CAL,SGHL and anterosuperior labrum Associated SLAP lesion and supraspinatus tears</p>