Connectivity with Iain Duncan
shoulder pain

Recommendations for Management of Rotator Cuff Tears

There are extensive recommendations from the American Academy of Orthopaedic Surgeons about Management of Rotator Cuff Injuries Clinical Practice Guidelines, Published in March 2019. Some strong and moderate recommendations are listed below. Weaker recommendations have not been listed. STRONG = Evidence from two or more “High” quality studies with consistent findings for recommending for or […]

Muscle Injury Classification

This is the muscle injury classification that I generally refer to with expected return to sporting activity:     GRADE DESCRIPTION RETURN TO SPORT 0 Oedema/fluid around tendon/epimysium <2 weeks 1 Myofibril disruption without epimysial or myofascial changes 1-4 weeks 2 plus epimysial/myofascial interuption or delamination 3-6 weeks 3 intramusculat tendon or epimysial failure/tear 6+ […]


STRESS FRACTURE GRADING GRADE XRAY SPECT-CT BONE SCAN MRI 1 normal mild /diffuse increase in tracer uptake. CT normal Increased periosteal T2 signal. Normal marrow signal. 2 normal moderately intense tracer uptake, mild sclerosis or thickening, but no fracture line plus changes on STIR and T2 sequences 3 Visible line intense (linear) focal tracer uptake with definite […]


0 incomplete additional imaging evaluation needed 1 negative   2 benign likelihood of malignancy ~0%. Routine screening recommended 3 probably benign 0-2% likelihood of malignancy. Follow-up in ~6 months 4 suspicious likelihood of malignancy 2-95% 5 highly suspicious >95% risk of malignancy. Requires tissue diagnosis 6 proven malignancy biopsy positive. Surgical excision recommended