Rotator cuff rupture

Synonyms

  • Rotator cuff lesion
  • Rotator cuff tear
  • Torn supraspinatus tendon
  • Periathropathia Humeroscapularis pseudoparetica (PHS)
  • Tendon tear
  • Tendon tear

English: Rotator cuff rupture, rotator cuff injury

definition

Under one Rotator cuff rupture one understands a crack of attachment structures of the so-called Rotator cuff.
This refers to a muscle tendon hood, which is formed from several muscles of the shoulder girdle or the upper arm. These muscles of the rotator cuff have the task of fixing the position of the humerus head in the joint socket.
Associated are:

  • of the Supraspinatus muscle ("Upper bone muscle", "supra" = Latin above)
  • of the Infraspinatus muscle ("Underbone muscle", "infra" = Latin below)
  • of the Teres minor muscle ("Smaller round muscle", "teres" = Latin round, "minor" = Latin smaller)
    such as
  • of the Subscapularis muscle ("Sub shoulder blade muscle", "sub" = Latin under)

A rotator cuff rupture can in principle injury two different structures arise. On the one hand, the tendon of the supraspinatus muscle tear in the case of a rotator cuff rupture, on the other hand, tear off a bony protrusion of the upper arm bone (lat. humerus) together with the tendons anchored there. These bony protrusions include that Lesser tuberosity (Latin for "small hump") as the point of attachment of the subscapularis muscle and that Greater tuberosity (Latin for "large hump") as anchoring point for the remaining muscles of the rotator cuff.
In almost all cases of a rotator cuff tear, the supraspinatus tendon is affected.

Appointment with a shoulder specialist

I would be happy to advise you!

Who am I?
My name is Carmen Heinz. I am a specialist in orthopedics and trauma surgery in the specialist team of Dr. Gumpert.

The shoulder joint is one of the most complicated joints in the human body.

The treatment of the shoulder (rotator cuff, impingement syndrome, calcified shoulder (tendinosis calcarea, biceps tendon, etc.) therefore requires a lot of experience.
I treat a wide variety of shoulder diseases in a conservative way.
The aim of any therapy is treatment with full recovery without surgery.
Which therapy achieves the best results in the long term can only be determined after looking at all of the information (Examination, X-ray, ultrasound, MRI, etc.) be assessed.

You can find me in:

  • Lumedis - your orthopedic surgeon
    Kaiserstrasse 14
    60311 Frankfurt am Main

Directly to the online appointment arrangement
Unfortunately, it is currently only possible to make an appointment with private health insurers. I hope for your understanding!
You can find more information about myself at Carmen Heinz.

Epidemiology / incidence in the population

Rotator cuff ruptures occur frequently, with the likelihood of disease increasing with age due to degenerative changes (wear and tear) Muscles and tendons increases.
The most common cause of one Rotator cuff rupture is of a degenerative nature; in the elderly, the incidence of autopsies is around 30%.

Figure shoulder joint

  1. Rotator cuff rupture
  2. Humerus head
  3. Supraspinatus - muscle (Musculus supraspinatus)

Cause a rotator cuff tear

As The cause of a rotator cuff tear There are theoretically two different possibilities. On the one hand, a tear can be caused by trauma (accident), for example a shoulder joint dislocation (Shoulder dislocation) or with violent passive movement of the Poor. As a result of the shoulder dislocation, the rotator cuff is forcibly overstretched and the tendon, especially the supraspinatus tendon, tears. A tear after a shoulder dislocation increases with age as the elasticity of the rotator cuff decreases. On the other hand, a rotator cuff rupture can be of degenerative cause. The cause is much more common than the accident-related one. This is understood to mean an increasing fragility of the structures with age due to substance changes, which one Rotator cuff rupturer enable even minor accidents that normally do not lead to injury (minor trauma). This cause should be considered from around 50 years of age. The typical accident event for a rotator cuff rupture is the Fall on the outstretched arm.

Symptoms

A distinction must be made with regard to the complaints between:

  • traumatic / accident-related Rotator cuff ruptures
    and
  • degenerative / age-related rotator cuff ruptures.

After an accident, the person concerned complains of acute pain and limited mobility of the arm as a symptom.
Either a painful lateral lifting (abduction) of the arm occurs as a result of the rotator cuff rupture, or this movement is completely eliminated. In the latter case one speaks of a so-called Pseudoparesis. A paresis is a paralysis caused by nerve damage; Pseudoparesis, on the other hand, includes paralysis that does not result from an injury to nervous structures.
In the case of a rotator cuff rupture, it is caused by a tendon tear or tear. The person concerned feels pain not only when moving, but also when palpating the supraspinatus tendon or the Greater tuberosity - depending on which structure is affected.
In addition, as part of a rotator cuff rupture, a bruise (hematoma) can form in the shoulder area as a symptom, causing swelling to form there. In the case of degenerative rotator cuff ruptures, on the other hand, there are no acute symptoms. Rather, complaints develop slowly. Sometimes there are even no symptoms at all. Degenerative pain Rotator cuff rupture gradually increase, as do limitations in mobility and strength.

Alternative causes / differential diagnosis

Must be distinguished from one Rotator cuff rupture a narrowing of the space through which the Supraspinatus tendon runs below the shoulder roof (Subacromial recess).
This can be caused by calcification (Lime shoulder) or swelling of the tendon (Impingement syndrome) arise and manifest as a common clinical picture. The calcified shoulder and the impingement syndrome must therefore always be excluded.

therapy

Treating a Rotator cuff rupture can be done in two different ways, viz conservative or operational.
Conservative therapy one Rotator cuff rupture is carried out as an early functional treatment, especially in elderly patients or in Partial tears of the rotator cuff.
This includes on the one hand pain relief (analgesia), on the other hand movement training, especially strength and coordination. The pain of a rotator cuff rupture can be combated with tablets (non-steroidal anti-inflammatory drugs, NSAIDs, NSAIDs, e.g. Voltaren Ibuprofen or Arcoxia) or through local procedures.
The latter methods include injecting (local infiltration) pain relievers (anesthetics) and Cortisone in the shoulder as well as application of cold (cryotherapy) or electricity (Electrotherapy). When the Greater tuberosity Conservative therapy can also be initiated as the cause of the rotator cuff rupture if there is no displacement of the structures (dislocation).
Those affected receive a special bandage (Gilchrist bandage) to immobilize the shoulder. Movement exercises of the shoulder are then started, which should be performed without pain.
An alternative for rotator cuff ruptures is the early functional treatment the operative therapy opposite, which is carried out on younger people, on active older people and on complete rotator cuff ruptures.
The torn tendon (Rotator cuff tear) is fixed again on the humerus. First a so-called string is attached to the string Braid seam created. Then two channels are drilled through the humerus on the greater tuberosity, through which the ends of the suture are passed and knotted. Alternatively, the tendon can be over man-made bone anchors attached to the bone.
If the greater tuberosity is torn off and the structures are displaced (dislocation), it is attached to its old location on the bone with a lag screw or tension strap. These surgical procedures can be used as "Keyhole surgery" arthroscopically or as "mini open construction"(English about" small opening reconstruction procedure ") can be carried out.
Arthroscopic accesses only a few centimeters wide are required and under camera control (analogous to the Arthroscopy) operated. During the “mini open reconstruction”, an approx. 5cm skin incision is made.
The shoulder must be immobilized after the rotator cuff rupture operation. For this purpose, the shoulder is placed on special positioning rails to relieve the tendon (Shoulder pillow, postman pillow) stored in the abduction position (spreading the arm) so that the eyes can heal quickly without tension.
After about three weeks, the Usually started with physiotherapy exercises. Active movements are only allowed after about six weeks, but without the use of force. This is only possible after about three months. Full function after a rotator cuff rupture is usually regained after about six months.