Rotator cuff tear

Rotator cuff is a structure composed of the tendons – a tight tissue that connects muscles to the bone with which they interact. In the case of the shoulder, the tendons of four muscles form a ring that surrounds the head of the humerus – supraspinatus, infraspinatus, teres minor and subscapularis (SITS). They are responsible for the lifting and rotation of the shoulder and are necessary to maintain the stability of the joint.

Causes

Rotator cuff tear can occur at any age as a result of severe trauma (lifting a weight, trying to catch a heavy object, falling down onto an extended limb) or repeated micro-injuries (during playing tennis, golf, practicing crossfit). Most often, damage occurs gradually and is related to the natural process of weakening of the fibres that form the tendon. It is estimated that over 30% of people over the age of 65 may have damaged tendons and most of them do not feel any discomfort.

Symptoms

Partial or full-thickness rotator cuff tear may not only lead to a weakening of the abduction force but can also reduce rotation of the arm. A characteristic symptom is shoulder pain which makes it impossible to sleep and is aggravated when trying to exercise. It is not uncommon to experience a painful clank when moving the joint.

In English, from the left: Unbroken rotator cuff; Partial-thickness tear; Full-thickness tear

Diagnosis

An initial diagnosis can be given on the basis of the consultation and clinical examination. However, imaging tests – magnetic resonance imaging (MRI) or ultrasound are necessary to confirm the type and degree of tear.

Treatment of rotator cuff tear

Treatment of a rotator cuff tear depends on the patient’s age, activity, degree of injury (partial or full-thickness tear) and the type of injury (acute / chronic).

Conservative treatment is successfully applied in the case of chronic and partial-thickness tears and in people over 70 years of age. It involves modification of activity and rehabilitation aimed at restoring functions of the joint.

An important element of treatment is the periodic administration of oral anti-inflammatory drugs and intra-articular injections:

  • corticosteroids – temporarily reducing pain, allowing for gradual rehabilitation exercises;
  • platelet-rich plasma – PRP (blood taken from the patient is subjected to a special process, resulting in a concentrated mixture of proteins and growth factors) – it modulates the inflammatory and analgesic process.

Surgical treatment of rotator cuff tear is indicated in acute injuries and for patients who underwent conservative treatment and it did not bring the expected results or for people under 60 years of age.

The surgery is performed with the arthroscopic technique (several 5-10 mm skin incisions through which the camera and surgical instruments are inserted) under general anesthesia. During the procedure, the inflamed bursa and adhesions are removed and the tendons are stitched to the anatomical site of attachment with special medical materials (screws affixed into the bone). This operation takes 1 to 2 hours and gives very good clinical results. Patient satisfaction is over 90%, and the risk of complications (including infection, frozen shoulder, recurrent tear) is low..

The return to full function of the damaged rotator cuff tendon takes a long time and requires an extensive effort from the patient, who is referred for rehabilitation. Repaired tendons fuse with the bone over many months. Therefore, after the operation, partial immobilization in the orthosis is required for 4-6 weeks. Already during this period, shoulder exercises are implemented under the supervision of physiotherapists. Returning to office work takes approx. 3 weeks, the car can be driven after approx. 6 weeks, and physical activity can be undertaken 3 to 6 months after the procedure. The full period of treatment and rehabilitation depends on the degree of damage and lasts between 6-12 months.

In English: Repaired rotator cuff

In a small percentage of cases, it can be concluded on the basis of preoperative imaging tests that repairing the tear will not be possible due to the poor quality of the tendon combined with the atrophy of the rotator cuff muscles. In such cases, the following surgical methods are used: arthroscopic reconstructive methods with a donor tissue transplant (the so-called reconstruction of the upper joint capsule), transfer of tendons from other areas of the shoulder girdle, interposition arthroplasty or inverted arthroplasty of the shoulder joint

dr n. med. Tomasz Kowalski

Specjalista ortopedii i traumatologii narządu ruchu

Jestem Zastępcą Ordynatora Oddziału Ortopedii i Traumatologii Narządu Ruchu w Carolina Medical Center oraz pełnię funkcję Kierownika Medycznego Bloku Operacyjnego. Specjalizuję się w leczeniu schorzeń stawu barkowego, łokciowego oraz kolanowego. Wykonuję pełen zakres zabiegów operacyjnych włączając operacje artroskopowe, rekonstrukcje pourazowe oraz endoprotezoplastyki. Zajmuję się również leczeniem urazów narządu ruchu (złamań, zwichnięć, zerwań mięśni i ścięgien) u dzieci i dorosłych.