rotator cuff

Platelet Rich Plasma

Definition

 

Platelet rich plasma

 

Concept

 

2 main components

 

1.  Platelets

- contain PDGF, TGF, VEGF

 

2.  Growth factors

- ILGF

- FGF

 

Formed from the separation of whole blood into plasma and RBC

- separation usually achieved with centrifugation

 

Platelet concentration

Impingement

DefinitionLateral Acromial Spur

 

Painful impingement of rotator cuff

- on anterior 1/3 of Acromion, CA ligament & ACJ

- causes tendinosis of the RC

 

Anatomy Subacromial Space

 

1.  Roof / CA Arch

- acromion

- CA ligament

- coracoid process

Full Thickness Tears

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

Partial Thickness Tears

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

Subscapularis Tears

AnatomySSC Longitudinal Tear

 

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

 

Massive Tears

DefinitionsMassive RC Tear High Riding Humeral Head MRI

 

Massive tear 

 

1.  > 5cm 

- retracted to humerus / glenoid margin

 

2.  At least 2 complete tendons

- lose SS / IS or SS / SC

 

Classification

 

Background

Definition

 

Full thickness tear (FTT)

- variable amount retraction from insertion

 

Rotator Cuff Tear Large

 

Partial thickness tear (PTT)

- incomplete

- bursal or articular sided