Rotational cuff of the shoulder: treatment of rotator cuff injuries

Rotational cuff of shoulder joint and its damage

Back and joint health »Miscellaneous

The shoulder joint is the most mobile in the human body due to its complex anatomy.

Its design allows a person to rotate the hand in three planes, performing complex movements with different amplitudes. Due to the large volume of movements, the shoulder joint is at high risk of various types of damage.

Often when referring to a doctor with pain in the shoulder, the pathology of the rotator (rotational) cuff of the shoulder joint is diagnosed.

Rotator cuff is a combination of tendons and four muscles:

• Terrible. This muscle controls the deltoid muscle during compression. As a result, the head of the shoulder joint is compressed into the capsule and the arm is lifted.
• Subacute, which provides rotational movements of the shoulder outward.
• The subscapular. The muscle, which allows you to rotate the shoulder inward.
• Small round, whose functions consist in rotating the arm outward and in bringing it to the trunk.

Structure of the rotator cuff of the shoulder joint

The cuff muscles connect to the scapula using a tendon that extends from the shoulder in front and laterally next to the large tubercle of the humerus.

Damage or rupture of any component of the rotational cuff leads to the appearance of pain, disruption of functions and restriction of movements of the shoulder joint.

Factors leading to rupture of the rotator cuff

Read the article:Shoulder-scapular periarthrosis

In various acute injuries, such as a bruise, fracture or dislocation of the shoulder, the underlying disease can be complicated by the rupture of the rotator cuff.

In this case, there is a violation of stabilization of the shoulder joint, soreness in its movement. If you do not engage in timely treatment, your shoulder will weaken until you can not raise your hand.

Although the cuff rupture can occur at one point as a result of trauma, but more often it is a consequence of degenerative processes occurring in the body.

Most often, tendonitis affects the tissues and tendons of the supraspinatus and subscapular muscles. Signs of degenerative processes begin to appear after 35-40 years.

However, some factors and activities may increase the wear period of the rotator cuff and cause its rupture at a younger age.

Constant loads on the shoulder joint can cause damage to the rotator cuff of the shoulder

Such factors include:

• Repeated stereotyped movements. Some professions cause a constant tension of the rotational cuff. So, doctors with complaints of pain in the shoulder often turn to people whose professions require constant raising their hands up: teachers, painters, plasterers.
• Chronic traumatism of the shoulder joint. Some sports, such as swimming, tennis, badminton, basketball, volleyball cause permanent overstrain of the muscles of the rotator cuff, which increases its wear and tear. As a result, high and prolonged physical activity can cause cuff rupture.
• Anatomic features of the structure of the shoulder joint. When due to the narrow distance between the head of the humerus and the acromial process, friction and traumatization of the tendons of the rotational cuff occurs.

Symptomatic, indicating a rupture of the rotator cuff

The first and main symptom of the disease is pain. With the gradual development of the disease, the appearance of pain is of a periodic nature. Painful sensations increase in certain positions of the hand, depending on which muscle or tendon is injured.

When the rotational cuff breaks, the pain becomes acute and permanent. Muscles lose their strength and eventually become atrophied. The patient can not lift and move his hand to the side.

Pain in the shoulder is the main sign of damage to the rotator cuff

Diagnosis and treatment of the disease

To diagnose the doctor uses special clinical tests: assesses the localization and level of pain syndrome, the state of muscles, the degree of restriction of movement. To confirm the diagnosis, an x-ray or an MRI is used.

The method of treatment is chosen depending on the severity of the disease. So, with small ruptures of the cuff muscles, the doctor can stop on conservative treatment, which is as follows:

• admission of non-steroidal anti-inflammatory drugs;
• wearing a fixative bandage;
• performance of exercise therapy and physical therapy.

If the rupture cuff rupture is large or conservative treatment does not work, then surgery may be required. Depending on the location and size of the cuff rupture, one of the types of surgical intervention is chosen:

• arthroscopic treatment;
• surgical intervention through a minimal incision;
• open operation.

When conducting timely treatment, doctors give a positive prognosis for a full recovery.

A source: http://MoyaSpina.ru/raznoe/vrashchatelnaya-manzheta-plechevogo-sustava-povrezhdeniya

Damage to the rotator cuff of the shoulder

OrthHouseMD details

• Anatomy
• Causes
• Symptoms
• Diagnosis
• Treatment
• Rehabilitation

The shoulder joint is an elegant and complex mechanism.

Its design allows us to move our shoulders and use our hands in different positions. However, in spite of the fact that the shoulder joint has a large amplitude of motion, it is not very stable.

The shoulder joint is very vulnerable if any of its parts are not in good working order.

Normal functioning of the rotator cuff of the shoulder is the key for normal functioning of the shoulder joint. Because of the constant load, the cuff can degenerate, break and tear.

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The traumatic rupture of the rotator cuff tendons is particularly painful. If the rotator cuff is damaged, the function of the shoulder joint suffers.

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In most cases, the age of patients with this pathology is about 40-50 years, although cuff rupture can occur at any age.

Anatomy of the shoulder joint

Causes

In the tendons of the rotator cuff of the shoulder there are areas with very low blood supply. The more blood supply to the tissues, the better and faster the tissue is restored.

The rotator cuff of the shoulder is particularly vulnerable to various kinds of damage, the recovery processes are not very fast. Over the years, the structure of the tendons may change, which makes the shoulder cuff even more vulnerable. This process is called degeneration.

Degeneration in aging helps explain why damage to the rotator cuff of the shoulder is such a common disease. Tears tendon rotator cuff usually occur in areas with low blood supply.

Usually, with age due to degeneration, the blood supply suffers even more, and the strength of the tendons decreases. Degeneration of tendons of the cuff can also occur in young people, especially those with a shoulder joint constantly experiencing excessive loads.

This usually happens with athletes, for example, weightlifters and baseball players. Those people who, by their activities often raise their hands up, for example, window cleaners, painters, this pathology also occurs at a young age.

The rupture of the rotator cuff of the shoulder can be painful, although it can sometimes be painless. With a slight damage to the rotator cuff of the shoulder, there may be no loss of function in the shoulder joint, and patients do not even seek medical help.

A typical patient with a rupture of the tendons of the rotator cuff of the shoulder is a middle-aged man who has been troubled by shoulder problems for some time. Against this background, he lifted something heavy, after which the hand stopped rising. Less often are young people.

Symptoms

Most often, there is pain and weakness in the affected shoulder. In some cases, the rotator cuff of the shoulder can only partially tear. The shoulder can be painful, and the amplitude of the movements in the joint remains normal.

In general, the larger the gap, the stronger the function of the joint, that is, the patient can not lift the hand independently. In cases where the tendons of the rotator cuff are completely ruptured, the patient can not raise his arm and hold it in the raised state.

Most patients with rupture of the rotator cuff of the shoulder suffer from constant pain in the shoulder region. They can also complain about the feeling of jamming when trying to move the hand.

Most patients can not sleep on the side of the lesion because of the pain.

Diagnosis

The doctor asks questions about the history of the development of pathology, possible trauma and the manifestation of pain. The doctor will conduct a physical examination of the shoulder. Inspection is the most useful part of the study in diagnosing a rupture of the rotator cuff of the shoulder.

Full gaps, as a rule, are very obvious. If the doctor can reproduce the movements in the test shoulder joint in the normal range, and the patient can not raise his hand by himself, then, most likely, there is a rupture of the rotator cuff shoulder.

On the X-ray, the cuff tendon rupture will not be visible, since soft tissues, including tendons, are not visible on X-rays.

However, the doctor will assign an X-ray to see if there are bone spurs, the width of the articular gap in the joint, the shape of the acromion, and exclude other diseases of the shoulder joint.

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The rupture of the rotator cuff may be accompanied by other diseases of the shoulder joint, such as calcifying tendonitis, impingment syndrome, arthrosis of the acromioclavicular joint.

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Perhaps the doctor will prescribe an X-ray image with the introduction of contrast material in the cavity of the shoulder joint (radiography with contrasting).

Contrast substance is clearly visible on the X-ray.

If the contrast goes beyond the shoulder joint, then there is a rupture of the rotator cuff of the shoulder.

There is an even more expensive method of research - magnetic resonance imaging (MRI). This study uses magnetic waves to create a computer image of the slices of the shoulder joint in standard planes. MRI can clearly see soft tissues, including tendons, as well as bones. This test is painless, requires injection of medication, but may be limited in use in patients with fear of confined spaces and in those who were delivered metal implants.

Treatment

Conservative treatment

The first goal is to control pain and inflammation in the shoulder joint. In the first place, as a rule, prescribe anti-inflammatory drugs, such as diclofenac or ibuprofen. If the desired effect is not achieved, the doctor will suggest injecting cortisone into the cavity of the shoulder joint.

Cortisone is a very effective anti-inflammatory drug. It is necessary to create an individual rehabilitation program from the very beginning. For this, a doctor's consultation is necessary. Initially, simple means such as heat or ice on a painful area can help.

Various types of exercises within the curative gymnastics program are used to improve the range of movements in the shoulder and nearby joints. Later, it is necessary to perform exercises to strengthen the muscles of the rotator cuff of the shoulder and the muscles of the shoulder blade.

Most patients return to their daily activities to the fullest.

Operative treatment

Complete breaks usually require surgical intervention. If it is determined that there is a complete damage to the tendons of the rotator cuff, then it is not advisable to expect the recovery of the muscles of the rotator cuff.

If your goal is to completely restore the shoulder joint, then in this case recommend surgical treatment. The exception is elderly patients or patients with contraindications for surgical treatment.

They have a possible method of treatment is the immobilization of the shoulder joint in the position of the lead. There is some evidence that restoring the rotator cuff of the shoulder for three months after injury leads to better results.

Partial damage to the rotator cuff of the shoulder may also require surgical intervention. If there is a partial gap, then, after discussing the problem with the surgeon, you can try to hold a course of conservative treatment first.

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But if it is impossible to endure pain during exercises of exercise therapy, or if it is not possible to perform the exercises, then it is possible to reconsider the expediency of surgical treatment.

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Before determining the tactics of treatment, it is necessary to perform an x-ray image (X-ray) of the shoulder joint and MRI. This is necessary in order to confirm the diagnosis, as well as to identify the concomitant pathology in the joint, for example arthrosis of the acromioclavicular joint or impingment syndrome. During the operation on the shoulder joint, problems are solved in a complex manner.

Arthroscopy of the shoulder joint

Arthroscopy belongs to minimally invasive operations. This means that the operation is performed through small cuts.

This operation is carried out with the help of an arthroscope - a small tube with a video camera, which is inserted into the joint cavity and podkromilnoe space. All joint structures are clearly visible on the monitor screen.

Through another incision, you can enter tools and perform various manipulations.

Acromioplasty

It is believed that small rupture of the rotator cuff can not be closed. For this type of lesion, surgical intervention may include arthroscopic debridement and acromioplasty.

Arthroscopic debridement is the removal of all the deformed, damaged structures that do not perform any functional role, do not participate in the healing of the rupture and can block movements in the joint, damaging the articular cartilage. Acromioplasty is the removal of a part of the acromion that squeezes or can squeeze in the process of rehabilitating the tendon of the rotator cuff of the shoulder, causing impingment syndrome.

Arthroscopic restoration of cuff integrity

Surgeons usually get excellent results using an arthroscope (mentioned earlier) to repair a torn rotator cuff of the shoulder.

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The first step involves a thorough debridement - the removal of all the deformed, damaged structures. Then the humeral bone is prepared to reattach the tendons.

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To do this, the surgeon removes all soft tissues from the bone surface and drills the holes for the joints. Tendons are then sewn to the humerus (reinforcement).

After a certain time, the connective tissue is formed and the tendons are firmly fixed to this site.

Using Anchors

Surgeons can use a special fixation of the rotational cuff of the shoulder to the shoulder. Lockers are called anchors. During the procedure, the surgeon makes small holes in the shoulder.

Open operation

In some cases, when for technical reasons arthroscopy can not be performed, perform an open operation.

Through a small incision, all tendons of the rotational cuff are clearly visible. This makes it easy to sew the seam of all damaged structures.

Plastic tendon of the rotator cuff of the shoulder

Sometimes it is not easy to make a suture of tendons.

When the damage is a long time (several months), the muscles contract, and they can not be stretched to the original length.

In these cases, a tendon graft can be used to perform a full restoration of the torn portion of the rotator cuff of the shoulder.

Rehabilitation

Rehabilitation after conservative treatment

Even if the operation is not needed, then, you will need to perform special exercises. Probably, the help of the doctor of physical training will be necessary, which will develop an individual rehabilitation program to restore the function of the shoulder.

The program includes tips and exercises for the cervical spine, improving posture and restoring the shoulder joint. Especially important exercises to restore the tone and coordination of the muscles of the rotator cuff of the shoulder and the muscles of the shoulder blade.

The doctor or instructor of the exercise therapy will check the correctness of the exercises.

Rehabilitation after surgery

Rehabilitation after surgery on the rotator cuff of the shoulder can be a slow process. Most likely, it will take two to three months, and a full recovery can take up to six months.

Getting the full amplitude of movements in the shoulder joint as soon as possible is of paramount importance. Nevertheless, these exercises need to be done, gradually complicating them and increasing the load. Your doctor may recommend a bandage to immobilize the shoulder joint.

Depending on the intervention, immobilization can last from a few days to five to six weeks. To control pain and swelling after surgery, local application of cold may be recommended.

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It is also possible to use massage and physiotherapy to alleviate muscle spasms and pain. The procedures are applied only under the supervision of the attending physician. After the application of arthroscopy, rehabilitation is usually faster than after open surgery, where access was through the muscles of the shoulder.

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Treatment begins with passive exercises, when the movements are performed by the instructor, and your muscles are completely relaxed. Then you can learn to perform passive exercises yourself and perform them at home.

Later, they move to performing exercises with active movements, when the exercises involve their own muscles. Begin with isometric exercises. When performing these exercises, the muscles work in such a way that no movements occur in the adjacent joints.

Especially important are the exercises aimed at improving the tone and coordination of the muscles of the rotator cuff of the shoulder and the muscle around the scapula. These are the key muscles in the operation of the shoulder joint. They hold the head of the shoulder in the center of the articular cavity of the scapula, allowing the joint to function at any position of the shoulder.

Many exercises will simulate those actions that are performed in everyday life and sports. At the end of the rehabilitation course, be sure to find out what to do and what to avoid so that there are no problems with the shoulder joint in the future.

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A source: http://orto.house/index.php/cufftear

Signs of damage to the rotator cuff of the shoulder

The rupture of the cuff of the shoulder joint arises from injury or degenerative changes. This area of ​​the musculoskeletal system has the greatest mobility.

It allows a person to raise his hand and take her behind his back. An increase in the volume of joint movements contributes to a decrease in its stability and a high risk of damage to its tissues.

Because of what happens a gap?

Tendons of the muscles of the rotator cuff are characterized by weak blood supply. This leads to a rapid development of degenerative changes. Not only this cause contributes to the onset of tenopathy.

Genetic pathologies of connective tissues can be included here. Bundles and tendons contain collagen of 4 types. With the prevalence of types 3 and 4, the disease develops more often. Tenopathy can affect any part of the rotator cuff.

This contributes to the appearance of pain during movement.

Full or partial rupture of the cuff occurs with permanent damage to the tendons.

Damage can occur under the influence of excessive physical exertion.

The space between the bony surfaces in some cases is anomalously narrow, which contributes to the constant friction of the rotator cuff.

Such conditions develop as a result of fractures of the humerus, which is not properly fused. In some people, the end of the acromial bone has a curved shape, resulting in friction on the tendon.

There may be an extra process, which also damages the soft tissues of the rotator cuff.

With age, degenerative processes begin to develop more rapidly:

• tenopathy acquires a pronounced character;
• tendon loses its elasticity;
• can break.

The most common damage to the rotator cuff is found in people of mature age. If the effect is strong - a fracture of the humerus of the humerus, a dislocation of the shoulder joint or a stroke - the trauma can occur in the young person.

Symptoms and Diagnosis

Damage to the rotator cuff with previous degenerative changes in tissues is characterized by increased pain syndrome and impaired function of the upper limbs.

Partial rupture does not contribute to complete lack of mobility. The intensity of unpleasant sensations depends on the number of broken fibers.

The localization of pain depends on the type of damaged tendon.

To identify the type of injury, the doctor should find out the mechanism of its occurrence, the time of appearance and the nature of the unpleasant sensations. Next, an examination is performed, during which functional tests are used. The patient is asked to move his arm and lift it up.

Emerging symptoms help the doctor determine the type of injury and its localization. A complete rupture of the tendon prevents the performance of actions for which the muscle attached to it interferes.

At partial damage of movement are kept, however they are accompanied by painful sensations.

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Obligatory is an x-ray study, with which you can find a sign of rupture of the tendon - subchondral sclerosis. It is formed due to the friction of the head of the humerus on the lower part of the acromion.

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In case of a dubious diagnosis and to clarify the nature and severity of the trauma, ultrasound or MRI is performed, which allows to inspect soft tissues.

How is cuff damage treated?

In the early stages of treatment is aimed at eliminating pain and signs of inflammation. For this, NSAIDs and analgesics are used: Diclofenac, Voltaren, Ibuprofen.

In an acute period, limb immobilization is required with the help of a bandage bandage or a tire. To relieve pain and puffiness, apply a cold compress. With degenerative changes and tears, conservative treatment is indicated.

After the disappearance of pain, you can proceed to perform special exercises. At a later stage, physiotherapy and strength training are added. The duration of the therapeutic course is 6-10 weeks. During this time, the mobility of the joint is restored.

The severity of injury is not considered the main criterion in deciding whether to require surgery. Even with complete ruptures, the mobility of the joint can not be disturbed.

This is due to the fact that the neighboring tendons begin to perform the functions of damaged tissues.

The operation is indicated for severe pain syndrome, inefficiency of conservative therapy. The broken bundle is pulled back to its previous position and fixed.

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To anchor the severed tendon, anchor hooks are used. Before closing the operating wound, it is cleaned of the dead and pathologically altered parts of the cuff.

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The same procedure applies to a portion of the humerus, to which the tendon is attached.

With old traumas there is a shortening of the muscle, because of which it is problematic to return the tendon to its former place. The most effective are surgical interventions performed within the first 2 months after the injury.

After the operation, the hand is fixed in the retracted position by means of a special tire. This relieves tension in muscles and tendons and prevents re-occurrence of trauma. The duration of immobilization depends on the complexity and the result of the intervention. The tire usually wear 4-5 weeks.

Recovery

After this, you can move on to rehabilitation activities. The recovery period is divided into 3 stages:

• immobilization of limbs to protect ligaments;
• return of joint mobility;
• build-up of strength.

When rupture of the rotator cuff of the shoulder, special exercises will have to be performed for at least 3 months. Functions of the affected department are completely restored in six months.

A source: https://OrtoCure.ru/travma/rastyazhenie-i-razryv/manzhety-plechevogo-sustava.html

Rupture of the rotator cuff of the shoulder

Definition of the term "rotator cuff of the shoulder joint".

Most of the pathological conditions of the shoulder joint is associated with a lesion of the rotator cuff of the shoulder-complex muscular-tendon-capsular structures functioning as a single whole and providing stability and normal function the shoulder joint. It consists of tendons of short shoulder rotators - subscapular, supraspinous, subacute, small round muscles, the intraarticular part of the tendon of the long head of the biceps arm muscle, connected together and with the capsule of the joint fibrous crosspieces.

The rupture of the rotator cuff of the shoulder is characterized by the following features:

1) Sudden onset (connection with trauma)

2) Progressive pain in the shoulder, weakness and loss of active movements

3) The pain in the shoulder is disturbed at night and can be irradiated to the area of ​​attachment of the deltoid muscle on the shoulder

Passive movements initially remain in full, further joint contracture develops.

Clinical symptoms:

1) a symptom of a puzzled shrug by the shoulder (Leclerc's symptom is an involuntary lifting of the upper armpit)

2) Fur test

3) local malnutrition of the supraspinatus

Classification of rupture cuff rotators.

Traumatic or degenerative

Partial:

- Intraarticular, lower (from the side of the joint)

-Vnosuspositive, upper (from the side of the bag)

Full (for the entire thickness):

-Minimum (3 cm)

Methods of objective diagnosis of the rupture of the rotator cuff of the shoulder can be considered arthrography (with cuff ruptures, contrast agent introduced into the subacromial space into the joint cavity), ultrasound sonography and magnetic resonance imaging the shoulder joint.

1) Subacromial sclerosis of the acromial process

2) Upper subluxation of the head of the humerus

Treatment of rupture cuff rotators.

Treatment should begin with conservative measures (as with impingment syndrome) and the use of a discharge line for 2-3 weeks.

For the planning of surgical intervention, it is extremely important to conduct differential diagnosis between different types of rupture cuff ruptures.

With partial or complete ruptures up to 1 cm, patients are shown:

1) subacromial decompression

2) arthroscopic resection of damaged fibers

Full gaps in the rotator cuff are not compatible with the normal function of the shoulder joint. They show surgical interventions:

1) Cuff seam

2) Cuff plastic surgery

Technique of operation:

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Initially, subacromial decompression is performed according to the procedure described above (see Fig. impijment-a syndrome of a humeral joint).

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After that, the integrity of the rotator cuff of the arm is evaluated (as a rule, the discontinuities are localized at the attachment site supraspinatus to the large tubercle of the humerus, the central end of the tendon is displaced under the acromioclavicular joint). Most discontinuities have both transverse and longitudinal components. The task of surgical intervention is to restore the anatomical integrity and length (tone) of the tendon. It should be borne in mind that as the rupture is more than 3 cm, the tendon of the subacute muscle is usually damaged. Further, the proximal end of the damaged tendons is mobilized, during which it is necessary to avoid the continuation of the incision below the small round muscles, so as not to damage the branches of the axillary nerve in the place of their exit through the foramen quadrilaterum, as well as the suprascapal nerve in the zone of inzisura scapule.

After isolation and stitching of the proximal ends, damaged tendons with an osteotome, a bone flap is created on the large tubercle of the humeral bones and an awl or by means of a drill, channels for transosseous carrying out of threads are formed, which are then tied in pairs and between by yourself.

3) hemiarthroplasty (endoprosthetics)

Rehabilitation.

Immobilization on the outgoing bus within 3-6 weeks (depending on the extent of the rupture) followed by connection of isometric contractions of the muscles of the shoulder girdle, passive movements in the joint, exercise therapy, electromyostimulation.

Methods of plastic replacement of the damaged tendon of the supraspinatus with extensive defects of the rotator cuff of the shoulder (5 cm and more):

1) using the tendon part of the subscapular muscle

2) with the help of the deltoid muscle (transposition of the acromion)

3) in cases where it is not possible to restore the integrity of the tendons even in the position of the arm, surgical intervention is reduced to decompression and surgical treatment of cuff damage performed to reduce the intensity of pain syndrome.

Arthropathy of the shoulder joint - as a complication of extensive chronic ruptures of the rotator cuff of the shoulder.

Loss of tonus of the supraspinous muscle leads to the formation of a firm upper subluxation of the head of the shoulder, the pressure of the latter on articular cartilage of the scapula cavity, not adapted to this kind of stress and the development of degenerative changes in the humeral the joint.

Surgical treatment of this condition consists in hemiarthroplasty (endoprosthetics) of the shoulder joint.

A source: http://narod-trauma.ru/povrezhdeniya-i-zabolevaniya-plechevogo-sustava/razryv-vrashhayushhej-manzhety-plecha

Damage to the rotator cuff of the shoulder

The rotator cuff is located inside the shoulder and consists of tendons and muscles.

These elements firmly connect the upper part of the humerus with the scapula and their task is to help keep the head of the humerus right in the articular cavity.

It is such a biological system of elements and functions in a well-coordinated work that provides the widest range of movements of the human shoulder joint.

Damage to the rotator cuff of the shoulder is very common and is associated with exposure to damaging factors: for example, falling, stretching, repeatedly repeated overloads of the ligament of the rotator cuff shoulder. The risk of such damage increases with age.

Rotational (rotator) cuff of the shoulder can be damaged in 3 different ways:

• Tendonitis - occurs as a result of inflammation of the rotator cuff due to overload. Athletes engaged in sports that load the upper body (tennis, volleyball), especially often face tendenitis because of the specifics of these activities.

Tendonitis of the rotator cuff refers to inflammatory damage and is a consequence of physical renal arthritis

• Bursitis is a condition that occurs with inflammation of the bursa located between the joint of the shoulder and the shoulder blade. At the same time, the rotator cuff suffers. This can also be a consequence of muscle overload.

• Stretch or break the rotator cuff of the shoulder

Symptoms of damage to the rotational (rotator) cuff of the shoulder

The most common symptoms of damage to the rotator cuff are severe pain and weakness in the shoulder.

The simplest everyday activities, for example, combing and dressing, lying on the affected side and lifting even light objects are accompanied by pain.

The patient also feels a general weakness in the hand and this weakness, along with pain, reminds us that it is better to keep the hand at rest.

Treatment of damage to the rotational (rotator) cuff of the shoulder

Conservative

Injuries to the rotator cuff of the shoulder are very common and can be cured in a conservative way. If the patient has an easy trauma, it is important to keep the affected shoulder inactive, at rest.

Daily apply ice and use anti-inflammatory drugs to relieve pain and swelling.

If the condition of the shoulder will require surgery, it is recommended to use minimally invasive methods, for example, arthroscopy of the shoulder joint, which gives excellent results at more severe degrees of cuff damage shoulder. In more serious cases, a classical operation with a cut is recommended.

Surgical

Arthroscopic operation "Double suture" for restoration of the rotator cuff

For patients who have significant damage to the rotator cuff of the shoulder, or those who encounter recurring problems with the shoulder and defects, the arthroscopic operation "Double seam" for restoration of the rotary cuffs.

This technique usually improves the overall quality of restoring the cuff of the shoulder. The name "Double seam" refers to how the tendons are restored-the double seam of a surgical thread.

More information about the technique can be found in the section Treatment of the rotator cuff of the shoulder

The technique of restoring the rotator cuff of the shoulder "Healing Response" (Healing Response)

The technique of restoring the rotary cuff "Healing Response" is the newest procedure using its own stem cells of the body and bone marrow in order to help repair the damaged tendon of the rotator cuff shoulder. This arthroscopic procedure involves the making of small micro-holes; a clot of blood from the bone that released as a result of the formation of formed holes, strengthens the tendon itself and its attachment to bones. For the procedure, no surgical thread is needed, so patients recover very quickly. More information about the recovery technique can be found in the section Treatment of the rotator cuff of the shoulder ...

Transplantation of the tendon to the damaged rotator cuff of the shoulder

Sometimes classical or arthroscopic surgery does not give the expected results. With a serious rupture of the rotator cuff of the shoulder, good results are achieved by transplantation of the tendon.

Tendon transplant is a surgical operation, in which the tendon and muscle are transferred from one position to another.

This is a full procedure, in which the lost function of the shoulder can be restored. The procedure requires the surgeon to have serious technical skills and is the last step in saving the rotator cuff.

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More information about the shoulder tendon transplantation can be found in the section Treatment of the rotator cuff of the shoulder ...

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A source: http://drblokov.ru/travma-plecha/povrezhdeniya-rotatornoy-manzhetyi/

Structure and pathology of the rotator cuff of the shoulder joint

Rotator cuff is a functional combination of four muscles and tendons. They cover the humerus from above. These include supraspinatus, subacute, subscapular and small round muscles.

Functions

The rotator cuff determines the position of the head of the humerus in the articular fovea of ​​the scapula, so that these elements fit tightly to each other and are not displaced. In addition, it, as a muscular complex, ensures the rotation of the shoulder outward and inward.

Each muscle has its own function:

1. The muscle of the muscle, when contracted, lifts the limb and squeezes the brachium head into the joint capsule in the case of shoulder detachment. In this movement, the force is exerted by the deltoid muscle, and the supernumerary directs the movement.
2. The subordinate muscle has the function of rotating the arm outward.
3. The subshrub provides the rotation of the shoulder inside.
4. A small round turns the limb outwards and leads it to the trunk.

Surface in the rotator cuff is the supraspinatus, and its tendon passes in a small narrow gap near the acromial process of the scapula and the head of the shoulder. This fact also causes a high frequency of damage to the said tendon.

Causes of damage

Concerning other organs and tissues of the human body, tendons are worse than blood. This feature often leads to the development of dystrophic disorders of the rotational cuff. This condition is called tendopathy.

A negative role is also played by genetic disorders in connective tissue, that is, in collagen. It is a protein that includes 4 types.

It is with a relatively large content of connective tissue of types 3 and 4 that the likelihood of developing tendonopathy increases.

If the supragastric muscle is damaged, the pain will appear during the withdrawal of the limb to the side, if the subscapular muscle - then the symptoms will be manifested during movements, accompanying, for example, combing hair, eating with meals devices.

The group of tendopathies includes also tendon ruptures of the rotational cuff. Most often they are promoted by chronic microtraumatism. The reasons for this phenomenon in young and old people are different:

• At a young age, this is due to the high position of the hands or movements during the throw. Microtravmatization of tendons affects people of certain professions. This affects athletes involved in baseball, volleyball, tennis, powerlifting. Permanent damage to the tendons of the rotator cuff, in particular, the supraspinatus, during strokes ball, feed and throws leads to microscopic tearing of tendon fibers, muscles become Thinner. In the future, even with minimal action on the cuff, it can easily tear. In addition to athletes, such a load of muscles experienced by people such professions, as teachers, writing on the board and many others.
• In the elderly, dodger-dystrophic processes in the tendons, which are manifested in connection with the aging of the organism, contribute to the development of tendonitis. The probability of rupture of the rotational cuff is quite high.

We should not forget about the violation of the integrity of muscles and tendons with a strong impact of the traumatizing agent. Often the rupture of the rotator cuff accompanies fractures of the humerus, dislocations of the joint. That is, such damage can be obtained without previous microtraction of tissues.

Classification

Damage to the rotator cuff is usually classified for a reason that causes a rupture - traumatic and degenerative.

By the degree of rupture divide into partial, when only a part of the fibers of the tendons are damaged, and complete, in which case the entire thickness of the cuff is torn.

By the time of appearance, fresh, stale and old breaks are distinguished.

Symptoms

The trauma of the rotator cuff of the shoulder joint is characterized, above all, by pain, which is amplified at certain positions.

The limb is weakened, at the extreme - hand movements are impossible.

The strength of pain depends on the extent of the injury, that is, the larger the gap, the more intense and sharper the pain.

Depending on which tendon is injured, a person indicates a specific localization of pain. The most common, as already mentioned, is the rupture of the tendon of the supraspinatus.

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This trauma is characterized by the inability to take the hand to the side, if there has been a complete rupture, or an increase in the intensity of painful sensations when trying to withdraw the limb in the shoulder joint at an angle of 40 to 65 degrees.

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The doctor at the reception clarifies information about the circumstances of the injury, about her prescription, and questions about the nature and intensity of pain.

It should be remembered that as a result of long and constant microtraction of the rotator cuff, its tissues can rupture without previous damage.

Functional tests

In order to diagnose the trauma of the rotator cuff, certain tests are used. During their holding the doctor, giving the limb a certain position, gives an assessment of the motor function of the hand and the pain sensations of the patient.

The most commonly used and informative diagnostic tests are tests on the weakness of withdrawal and rotation to the outside. They diagnose damages of the tendon of the supraspinatus.

On examination, the symptom of a falling arm is often met, when a person is unable to keep his position while keeping his arm in the shoulder joint.

Radiography

At the examination, it is necessary to make an X-ray examination, first of all, to exclude fracture of the bone. But, in addition, when the rotator cuff rupture is very often revealed a characteristic syndrome - subchondral sclerosis of the acromial process.

It occurs as a result of constant friction of the head of the shoulder and acromion. This leads to traumatization of tendons and tendopathy, and, in the final analysis, to rupture. This phenomenon is called impingement syndrome.

Not in all cases it is detected on the x-ray, but this does not speak of the absence of damage to the rotator cuff.

Ultrasound and MRI

Ultrasound and magnetic resonance imaging are more accurate diagnostic methods, since soft tissues, tendons and cartilages are well visualized. They can finally determine the nature and severity of the damage.

Treatment

There are 2 ways to restore the rotator cuff of the shoulder: conservative and operative. The first option is acceptable in case of incomplete breaks, when there is a real possibility of recovery without surgery.

Conservative treatment

This method of recovery includes immobilization of the shoulder joint, that is, rest and its complete immobility with the help of a special bandage. In addition, a wide range of anti-inflammatory and analgesic drugs is used.

With severe pain, blockages with glucocorticosteroids are used. Assign after a certain period of time special exercises and physiotherapy.

If there is no effect in the course of a long period of time (3 months), treatment by surgery is indicated.

Operative treatment

The type of operation that will be used depends on the size, shape and location of the damage. The options are:

1. With a partial break, the best choice is cutting or leveling, this is called deburring.
2. At full rupture, the stitching of parts of the torn tendon is effective.

For such operations, several types of accesses are used: arthroscopic, mini-access, open surgery. During arthroscopy use special video equipment, which is introduced into small punctures, without producing large incisions. Images are displayed on the monitor.

Mini-accesses are also small in volume operations. In this case, a small incision is made to treat the rotator cuff, a width of 4 to 6 cm. Traditional open access is necessary for severe, extensive and complex injuries.

If this does not give an effect, you have to resort to prosthetics.

Rehabilitation

To restore the rotational cuff after surgery, limb is immobilized using a tire.

This allows the tendons to grow together, prevents repeated rupture. The time at which the tire is worn is determined by the doctor.

He conducts periodic examinations to assess the condition after surgery. Usually the time of wearing the tire is about 3-5 weeks.

A source: http://MedOtvet.com/stroenie-sustavov/stroenie-i-patologiya-rotatornoi-manzhety-plechevogo-sustava.html