===== Rotator Cuff Syndrome =====

A specific pattern of shoulder degenerative joint disease that results from

    *rotator cuff tears leading to loss of joint congruence
    *results in abnormal glenohumeral wear 
    *leads to the specific pattern of degenerative joint disease

[{{ :wiki:musculoskeletal:rotator_cuff_arthropathy.jpg?300|superior migration of humerus}}]

Rotator cuff arthropathy is characterized by the combination of
    *rotator cuff insufficiency
    *glenohumeral cartilage destruction
    *superior migration of the humeral head
    *subchondral osteoporosis
    *humeral head collapse

=== Clinical ===


Inspection & palpation
        *supraspinatus/infraspinatus atrophy
        *prominence of humeral head anteriorly (anterosuperior escape) with elevation of arm
        *subcutaneous effusion from loss of fluid from capsule

Range of motion
        *limitations in active and passive ROM
        *crepitus in glenohumeral and/or subacromial joints with ROM
        *pseudoparalysis - inability to abduct shoulder

=== Provocation tests ===
==  external rotation lag sign  ==
    *inability to maintain passively externally rotated shoulder with elbow at 90<sup>o</sup> - consistent with a massive infraspinatus tear

==  Hornblower sign  ==
     *inability to externally rotate or maintain passive external rotation of a shoulder placed in 90<sup>o</sup> of elbow flexion and 90<sup>o</sup> of shoulder abduction - consistent with teres minor dysfunction

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==== Management ====

  *physiotherapy with a scapular and rotator cuff strengthening exercises
  *non-steroidal anti-inflammatories
  *subacromial steroid injections - some trials suggest no benefit over NSAIDs and also have risk of increasing degeneration of soft tissues including ligaments and tendons here.
  *surgical