Makindo Medical Notes

Introduction

An acute rotator cuff tear involves damage to one or more of the rotator cuff muscles, such as the supraspinatus, infraspinatus, or subscapularis. The injury often occurs from a spontaneous rupture of a degenerated tendon under sudden stress, particularly in older individuals. In younger patients, it may result from a wrenching injury. In older patients, it may also occur post-dislocation.

Injury Site

• The tear commonly affects the supraspinatus, infraspinatus, or subscapularis muscles of the rotator cuff.

Typical Mechanism

• Spontaneous rupture of a degenerate tendon under sudden stress.
• Wrenching injuries are common in younger individuals.
• Post-dislocation rotator cuff tears are more frequent in older individuals.

Pitfalls and Complications

• Infraspinatus tears can be particularly debilitating, as they result in a significant loss of active external rotation. This can be identified using the "lag sign".

Treatment in ED/MIU/UCC

• A broad arm sling is typically applied.
• Early active mobilization is encouraged to prevent stiffness and loss of range of motion.

Follow-Up

• Elderly, low demand, or frail patients: Referral to a physiotherapist via the patient's GP or a next available appointment with the ED physiotherapist.
• Young, active, or high-demand patients: Urgent ultrasound scan (USS) in outpatient settings, followed by referral to a fracture clinic.