tears

British Athletics Muscle Injury Classification (MRI)

Epidemiology

Middle age men

Steroids / Growth Hormone

Aetiology

Usually occurs in gym

Bench Press

Clinical

Significant bruising in the acute phase

In chronic setting, ask patient to adduct against hip / resistance

Incidence

Variable

- may be up to 50% retear over time

- many asymptomatic

MRI

Options

Surgical Options

1.  Open antero-lateral approach 

Large / Massive Cuff Tear

2.  Deltopectoral approach

Large Subscapularis tear

3.  Arthroscopic Assisted Mini-open

Indication

- Small / Moderate Cuff Tear < 3cm

- no retraction

Technique

- arthroscopic SAD

Clinical

Pain & Stiffness

- often more pain than FT tears

Bursal side tears more painful than articular

Articular side more common

May see in young patient overhead throwing

Examination

Painful arc

Impingement signs

No weakness

- function good

Anatomy

Largest and most powerful rotator cuff

- arises coastal border of scapula

- superior 2/3 tendon inserts into LT

- inferior 1/3 inserts into proximal humerus

Action

- IR (with T major, P major, Lat Dorsi)

- part of force couplet depressing humeral head

Incidence

Definitions

Massive tear 

1.  > 5cm 

- retracted to humerus / glenoid margin

2.  At least 2 complete tendons

- lose SS / IS or SS / SC

Classification

Definition

Full thickness tear (FTT)

- variable amount retraction from insertion

Partial thickness tear (PTT)

- incomplete

- bursal or articular sided

Anatomy

Lateral compartment of leg

- run through retromalleolar groove

- pass superior and inferior to peroneal tubercle

- covered by inferior peroneal retinaculum

Peroneus longus

- origin lateral condyle of tibia and head fibula

- tendon PL superficial and inferior to brevis in retromalleolar groove

- runs in cuboid groove 

- insert plantar surface base of 1st MT and lateral aspect medial cuneiform