Rotator Cuff Tear ,injury - Everything You Need To Know - Dr. Nabil Ebraheim
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- Опубликовано: 1 июл 2024
- .Dr. Ebraheim animated video illustrates the shoulder rotator cuff muscles and associated tears and types of imaging for these injuries.it is a shoulder animation video that explains the rotator cuff anatomy , the rotator cuff MRI , ROTATOR CUFF INJURY ,TEAR IS explained .rotator cuff surgery is also explained .rotator cuff rehab is important .The video explains the anatomy of the rotator cuff in relation to rotator cuff ,rotator cuff nerve supply ,rotator cuff function and rotator cuff action.
Rotator cuff tears are a common source of shoulder pain.
Tear of the rotator cuff may involve a single tendon or multiple tendons.
The patient will present with a painful weak shoulder , rotator cuff tears occur more in older population.
In patients older than 80 years of age, 50% of these patients will have rotator cuff tear (majority are asymptomatic).
Partial thickness or full thickness tears may progress in size or increase in symptoms.
Evaluation:
- Patient younger than 40 years old with history of trauma.
- Patient older than 60 years old with no history of trauma.
- Between 40-60 years of age there can be either trauma or no trauma.
Clinical presentation:
- Patient will have pain or ache usually posteriorly.
The pain can be in the arm or in the shoulder.
- Patient will complain of pain during overhead activity or when attempting to reach behind the back.
- Patient may also complain about the presence of nighttime shoulder pain.
Night pain means that nonoperative treatment will not work.
- Patient also complains of shoulder weakness.
- Rotator cuff tears may be found in spinal cord injury patients due to overuse syndrome.
Rotator cuff examination:
- Inspect the shoulder first: you may find infraspinatus atrophy, this may be a sign of a chronic rotator cuff tear.
May also be a sign of injury to the suprascapular nerve.
- Palpation: palpate: the AC joint, the greater tubercle of the humerus, the coracoid process, the long head of the biceps tendon.
- Range of motion: active range of motion may be limited.
Do:
1- Neer test.
2- Hawkins impingement sign.
3- Strength testing: patient will have weakness of abduction, that will test the supraspinatus function, also you will test external rotation of the arm to the side, that will test the infraspinatus muscle function.
Horn Blowers Sign- testing massive tear of teres minor muscle.
Drop Arm Test: testing the supraspinatus function.
For the subscapularis muscle we have at least 3 tests:
1- Lift- Off Test: it tests the upper subscapularis muscle (important part).
The patient will be unable to hold the hand behind the back.
2- Belly Press Test: it tests the lower subscapularis muscle.
It is sometimes called “abdominal compression test”.
3- Excessive Passive External Rotation:.
If the subscapularis tendon is ruptured, it will move medially and the long head of the biceps tendon will sublux with the ruptured tendon.
Also check the deltoid strength to make sure there is functional deltoid muscle.
The tear size:
• Small: up to 1cm.
• Medium: 1-3cm.
• Large: 3-5cm.
• Massive: greater than 5cm, or involves multiple tendons.
Once the clinical diagnosis is established, get an X-Ray.
Get true AP view x-ray and check the acromiohumeral interval (normally between 7-14 mm).
True AP view 45° lateral, patient can be standing, sitting, or lying down.
Get an MRI:
T2 images are the best for showing the tear.
The sagittal view MRI will help to see the fatty infiltration, muscle atrophy, and the retraction of the muscle.
This will tell if the case is chronic or acute.
Using a dye with MRI will also help in seeing partial thickness rotator cuff tear.
If the patient has a pacemaker, you will use CT arthrography instead of MRI.
Some physician prefer to use ultrasound.
Remember: MRI will have a lot of false positives, especially in the elderly population.
Treatment:
• Conservative:
- Physical therapy.
- NSAIDS.
- Injection (possible).
• Surgery:
- Usually done when there is a traumatic tear.
- When there is failure of conservative treatment.
Complete tear of the rotator cuff will not heal by itself; you need to suture the tendon back to its insertion on the humeral head.
When the tear is large or the patient is older, the prognosis for successful repair is not as good.
Muscle atrophy and fatty infiltration will also cause a poor prognosis.
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Excellent summary - thank you, Dr. Ebraheim.
Very informative and clear explanation. ...Clearly this injury needs very special treatment if it is to return to its former effectiveness....It means I need to be extremely patient and give my body the required time so it heals completely....Excellent!!!....Thank you
Awesome Physician! The Most High created Doctors to help us. Thank you for working in your gift!
Excellent! Thank you for the detailed and thorough explanation. Extremely helpful.
Thank you Dr. Ebraheim. Very informative and lots of useful information.
Thanks Sir for your contribution . May Almighty bless you.
Desr professor your videos are one of the best if not the bestest. Thank you so so much for your effort.
Excellent explanation sir. Thank you very much😊
Thanks doctor Iam very happy to know that you are from Egypt
thank you, Dr. Ebraheim.
Thank you for such a great visual explanation!
Thank you so much Dr.
Thank you for this one!
Thanks for the effort and information for us, respect!!
thank you so much sir .I love all your videos. Great contribution. Please keep uploading more videos. May god bless you. Thank you
Excellent explanation with images... Congratulations...
THANK U VERY MUCH.U HAVE GOOD STEADY PRONUNCIATION..IT HELPS WORLD WIDE LISTENERS.I HAVE SEEN PLENTY OF VIDEOS TODAY BUT YOURS IS VERY BEST
Thank you Sir. You were most helpful. God bless you.
Great video on rotators cuff. Love your videos.
very helpful. Thank you!
excellent/informative presentation; i learned alot more here than my from my dedicated specialists! good visuals- thanx for presenting this
thank you Dr
Ouch. Oww. Man, this hurts everyday and night. No, I haven't seen a doctor yet. I am glad to be able to have learned about it here on yt. I feel like a big baby..
Because: Ouchy ouch.
Thanks Doctor and yes, I will make an appointment to have this painful shoulder of mine checked out. Appreciation in Mi.
Hows your shoulder now?
Night pain means non-operative treatment won't work, BS. I've done both my shoulders at different times in the past, they both hurt at night for months on end and they both recovered.
Thanks, this had me very worried as night time is worst for me. Your comment gives me hope.
Sir you had operation?
So, are you saying it's best to have the surgery or not
Thank you for all this great information.
After watching your video , decided to get surgery yesterday , thank you 👍👏
Thanks alot for going through the different stages of Tares.. Your video helped me to have a small insight into what my Right Rotator Cuff should look like, or not..lol.. Pain, Pain & more Pain..
Yesterday I had my MRI & X-RAY.. Im about to look at the CD 💿 of Both tests, to see what my Right Rotator Cuff looks like/what damage I've done..
Thanks again..
Thank you so much
Excellent presentation
Thanks prof. Very nice &helpful video
awesome explanation!
You were very helpful. Thank you. I have a tear being repaired next week.
This video was very helpful. Thank you!
Very heplful,thank you sir.
Thanks Dr. very informative
Very helpful - thank you x
Thank you. Yes it was more informative than my GP who was dismissive & did not impart information.
Thank u Sir, u are always helpful
Outstanding! Thank you
Thank you I can now make an informed decision
Excellent video, thank you Dr. Ebraheim. -Cheers
You really give me an excellent understanding & ideas of my rotator cuff tears.. I'm still on my 2nd set of rehab of my partial tear (supraspinatus, subscapularies & bicep) pain still there during night time though it subside so little but don't know yet until when pain totally gone.. but tnx anyway doc for such an excellent explanation!!!
Thanks Doc it helped me
Great to the point information,Thanks..
thank you dr
Very helpful thank you 💯
Thank you more informative than my Doctor
Thanks again for your support and prayers and alleluia alleluia Amen
Thnks for the details...
Thank you
Thank you . Best information
Excellent
Thankyou for your valuable time Doctor, I do have a diagnosed tear, the only self test I fail is when trying to raise the arm forward, particularly above shoulder height Also have night pain. As a matter of interest which muscle/tendon do you think is torn?
All the clips are unique n Nice.
nabil sir u r awesome sir
Very helpful
excellent
Wow nice mr
Ty again, Sir! Im an avid fan now
THANKS YA 7ABB DR NABIL WHICH MEANS IN ARABIC SMART !
Thanks very nice channel
Thamk You very mucho gor your valuable informativo. Dt
Great information. Thank you. What is the latest treatment for Rotator cuff repair, for full thickness tears?
thank u sir
Oh this is it. Blaa so painful. It sounded like you said it can kill you 😯 but upon hearing it again now hear that you said it can tell you. Feeling relieved 😅
Thank you 😊
Dear Dr Nabil, is there any correlation between shoulder pain and lower back pain. I am told that shoulder pain can radiate to the lower back and thus surgeon might diagnosis Lumbar spinal stenosis pain. Thank you and your expert advice is much appreciated.
Thank you, I had Fall a week ago and it injured my shoulder. This video is helpful
Very helpful. Mine is minor infraspinatus tear. Any exercises you recommend for rehab. I'm in Thailand during Corona lockdown, no physio available
Superb! I should have come to you
Thank you Sir for detailed explanation. I had fall 3 weeks ago tear of rotator cup is 1.3cm. I am 72 yrs old. Is it worth to try conservative treatment for couple of moths and wait or surgery is the best and only option?
Thx you
Been dealing with this injury for about 3 to 4 months. Painful but slowly getting better. I failed all the tests besides the drop arm test. I have no problem holding my arm up.
Same here it's been 3 weeks for me still feel pain when I move it a certain way especially overhead or test behind the back
What treatment you using?
I have a partial tear after a fall that was on the borderline of needing surgery. I had a prior fall that caused a dozen tiny tears. Had physical therapy both times. I do exercises every day to loosen up the joints and rotator cuffs. Still have pain occasionally if I overdo it, but it's better than going through surgery.
Hi.. do you have to do an mri? my left arm isnt reaching my back and up to some degree
hello doctor i am suffering from subscapularis tear 8mm tear! do I need surgery for 100% cure or not? and can I do gym or boxing with this problem?
What are good exercises for this?
Dear Sir, What's the main difference between the frozen shoulder and rotator cuff syndrome?
Thanks for your great comment much appreciated it is a bad injury that takes time to heal for me I am epileptic and had a bad seizure in the bathroom where I fell with a gran mal and my left shoulder hit the side of bath pushing it 90degrees backwards tearing the tendons and this was nearly 5 years ago and the tendons have never stitched together so my right shoulder has 100%power but my left shoulder with injury has only 20-30% power basically my left arm is way down in working but thank you for all your help ♥️♥️👍👍
what is done is youhave supracapular entrapement?
I’m curious about your statement regarding non-op management of RTC tear being ineffective had patients had night pain. Why is that? Thank you!
Thank you so much. I've watched a lot of cuff videos and yours was the best! You showed exactly what I was looking for: how each specific range of motion is affected by each specific tendon or muscle malfunction. I appreciate your video 💙
I got shoulders surgeries back to back. I been in such much pain I can't ever push pull I think the repair has a tear is that possible?
Im 80 but sport man. I have seen so many videos this the best. I have made test and found with Hawkins impingement sign the problem. What kind of self treatment can I do? Thank you very much in advance.
Thank you very much Dr for good and informative vedio. The doctors are not explaining the patients as you explained .
Hi doctor I'm karthick I'm a boxer i got shoulder dislocation in my boxing meet and it's over 4years and i have not go for any kind of medical treatment as enough for tera and i have slip will lifting weights and im scared about my future in boxing i don't know what to do and which one i effective and give 100 percent results in my shoulder injury
thank you sir
Which injection need for this?
What is the frozen shoulder and rotator cuff tear different 1 year completed pain is still in my shoulder I did MRI ex ray they said frozen shoulder
one cold winter day, i threw a object, bang instant pain, almost dropped me to my knees. had ultra sounds and X-rays, physo, chiropractor, different healing types, after 18 years it still hurts. constant dull pain, up to levels of 8 or more. limited range, pain especially at night, nothing has helped for more than a day or two. i have not even turned 50 years old yet, what kind of life will i have as an old man..
Hi there. Did it get any better. I also fear the pain won’t go away and the quality of life is terrible with this.
I can across a great collection of videos that may help you at Seans Shoulder Fixer
Dear sir i have one problem last 4 months i have considered 3 doctors 6times but no use and not improvement for shoulder pain sir iam being cricketer so bowling and throwing right arm more then pain full sir so correct solutions and avoid shoulder pain problem any advise sir last 4months iam not play cricket sir so please any treatment or medicine or advise issued sir please please
I tore my rotary cuff 4 years ago, according to the hospital after i was referred by my doctor. I was given no help apart from pain killers. (I Don't believe in taking drugs).
It wakes me up at night. Today, if have slight improvement. The pain is horrid as it my right rotary cuff. Another year of pain, sadly. 🤨 😭
Badly tore my rotator cuff over 40 years ago and been in agony since. Was due to have an operation back then but they told me I'd have to take 3 months off work. Being self employed all my life I wasn't entitled to any help so would have lost my house. Only got another year of mortgage so might apply for the opp then😁👍
I’m literally in that exact position now. Massive tear, surgery needed. Run a tree surgery business 🤓
Greetings doctor , how can I contact u by email if possible to describe a shoulder situation with no doctor diagnosing me right
Ive had my rotacuff tear for 40yrs and still suffer intence pain
my supraspnatus is completely cutoff and I am 69.Also th infraspinatus has a cut(small) What can I do?help.
Please help me sir , I have the same problem,it's been 10 months but the shoulder in not rotating ,after s serious accident ,the loaded truck was over my shoulder ,but I didn't have shoulder surgery ,still I can't rotate my shoulder.
@3:32 you mention the belly press test...
All that is shown is a slightly different position of the elbow...
I don't fully understand this...
Furthermore, what if the patient describes intense pain in the POSTERIOR shoulder when performing this action?... but not in the ANTERIOR shoulder?
Dear Doctor,
I have pain in my right shoulder since last 3 months due to playing of cricket but in xray nothing seems like dislocation or fracture. Is it rotator cuff injury? And how long it take time to heal naturally. Please guide me I will be very thankful to you.
Did you heal ? Pls give an update
@@farood5 it's feel better now after 2 months proper arm rest
dr. i have a 31 mm rotator cuff injury should i go for surgery
Hii. My shoulder don't open for 15 years
I hurt mine using a machete and axe. Been 3 months , sudden movements the pain drops me to my knees. Today i tried to grab a tree branch, i heard it pop, dropped me to my knees. I think its healing, if i can stop hurting it. I hope. Ill know after a year or more.