Makindo Medical Notes

🩺 Introduction

An acute rotator cuff tear involves disruption of one or more of the rotator cuff tendons, most often the supraspinatus, infraspinatus, or subscapularis. It usually results from either:

• ⚡ A spontaneous rupture of a degenerate tendon under sudden stress (common in older adults).
• 🏋️‍♂️ A wrenching injury or heavy lifting in younger patients.
• 🦴 In older individuals, tears may occur post-dislocation of the shoulder.

📍 Injury Site

• Most often the supraspinatus tendon (classic site, initiates abduction).
• Can involve the infraspinatus (external rotation) or subscapularis (internal rotation).
• Multiple tendons may be affected in severe trauma.

⚙️ Typical Mechanism

• Sudden loading of a weakened tendon → spontaneous rupture.
• High-force injuries (falls, sudden pulls, heavy weights) in younger adults.
• Older patients: may follow anterior shoulder dislocation.

⚠️ Pitfalls & Complications

• Infraspinatus tears → marked loss of active external rotation, detected with the lag sign.
• Delayed diagnosis → chronic pain, weakness, and poor functional recovery.
• Adhesive capsulitis (“frozen shoulder”) may develop if mobilisation is delayed.

🏥 Treatment in ED / MIU / UCC

• Immobilise initially in a broad arm sling for comfort.
• Encourage early, gentle active mobilisation (within days) to prevent stiffness.
• Provide analgesia and safety-net advice.

📅 Follow-Up

• 👵 Elderly / low-demand / frail patients: Referral to physiotherapy via GP or on-site ED physiotherapist. Focus on rehabilitation rather than surgical repair.
• 💪 Young / active / high-demand patients: Urgent ultrasound scan (USS) to confirm diagnosis → rapid referral to fracture clinic or orthopaedics for possible surgical repair.

💡 Revision Pearls

• 🌟 Classic sign = painful arc + weakness on resisted abduction.
• 🧪 USS is quick, sensitive, and the usual first-line investigation in UK practice.
• 🚨 Missed tears in younger active patients → poorer surgical outcomes if delayed.