repair

Issues

Operative v Nonoperative

Levy et al Arthroscopy 2009

- systematic Review

- improved outcomes with operative management

https://pubmed.ncbi.nlm.nih.gov/19341932/

Vicenti et al. Injury 2019

- systematic review

- two studies compare operative v nonoperative

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

Definition

Present with pain but not instability

Types

Traumatic

Degenerative

Different treatment algorithms for each

History

Ulna side wrist pain

- may be worse with rotation

- opening doors and jars

History of trauma

Examination

Local tenderness DRUJ

Timing of Surgery

Issue

- reported higher incidence with immediate reconstruction in acute phase

- reduced by settling inflammation / effusion and obtaining FROM

- always best to delay if not professional athlete

- problematic if patient has locked bucket handle mensical tear

Results

Bottoni et al Am J Sports Med 2008

- RCT of early (average 9 days) v late reconstruction (average 85 days)

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

Anatomy

1. Seebacher's 3 layers of the medial knee

Layer 1

- sartorius and sartorius fascia

Layer 2

- superficial MCL

- posterior oblique ligament

- semimembranosus

Layer 3

- deep MCL (meniscofemoral and meniscotibial ligament)

- posteromedial capsule 

2. MCL

Superficial MCL