What is rotator cuff syndrome?

definition

Rotator cuff syndrome is an inflammation of the bursa in the shoulder joint (bursitis subacromialis) and tendinitis of the muscles that make up the rotator cuff. The rotator cuff consists of four muscles that hold and stabilize the head of the humerus in the shoulder joint. M. supraspinatus, M. infraspinatus, M. subscapularis and M. teres minor form the rotator cuff. The tendon of the supraspinatus muscle is usually affected in rotator cuff syndrome. Treatment for the syndrome is important to prevent complications, such as a tendon tear.

Also read the article on the topic: Bursitis of the shoulder

These symptoms will help you recognize rotator cuff syndrome

• Pain in the shoulder joint, especially when the rotator muscles are moving. Here, movements such as lifting, spreading, turning the arm outwards or inwards trigger pain.

• Impingement syndrome is a typical indication of rotator cuff syndrome, where pain occurs when the arm is raised at an angle of between 60 and 120 degrees.

• There is pain that occurs when lying on the affected shoulder. This is why there are nightly complaints.

• The pain can radiate from the shoulder to the arm.

• If there is sudden, severe pain followed by restricted mobility, the cause is probably a rotator cuff tendon tear.

Nocturnal pain

Nocturnal pain is a typical symptom of rotator cuff syndrome. It is also typical that the pain increases at night compared to the daytime. The pain then mainly occurs when lying on the affected side. In order to prevent this pain and a disturbed night's sleep, the affected shoulder should be relieved while lying down.

Appointment with a shoulder specialist

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

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.

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Restriction of movement

Restriction of movement is a common symptom of rotator cuff syndrome. Above all, the restriction arises from the pain, so that certain movements are simply avoided. This includes above all lifting the arm sideways. If the shoulder has been inflamed for a long time or is recurring, it can lead to frozen shoulder, also known as frozen sholder.
The shoulder can only be moved minimally. In the case of rotator cuff syndrome, care should be taken to ensure adequate protection and early treatment in order to contain or limit the restriction of movement as quickly as possible.

Find out more about the topic: Frozen shoulder

Inflammation in the shoulder joint

Inflammation in the joint is triggered by overloading the shoulder joint structures. The bursa is particularly affected in rotator cuff syndrome and ensures that the head of the humerus does not rub against the roof of the shoulder when the arm is raised.If this is inflamed, it is trapped between the two joint partners and causes pain. The inflammation can then spread to surrounding structures and cause pain, redness, and swelling.
Since the inflammation can attack the joint structures and tendons of the rotator muscles, calcification of the shoulder or partial destruction of the structures can occur and thus trigger a tendon rupture, for example. It is therefore important that inflammation is treated as quickly as possible.

You might also be interested in this topic: Inflammation of the rotator cuff

Impingement syndrome

The impingement syndrome describes in the context of a rotator cuff syndrome pain in the shoulder joint when lifting the arm. A tendon or surrounding tissue is pinched in the joint that is narrowed due to overuse or degeneration, causing pain. The tendon of the supraspinatus muscle is most commonly affected. The pain typically occurs when the arms are raised sideways at an angle between 60 and 120 degrees. This angular distance is also known as the "painful arc". In addition to shoulder pain, there is also a restriction in movement. Complications can manifest themselves as a tendon tear, recurring bursitis or reduced strength in the shoulder joint.

Read more on the topic: Impingement Syndrome

Where does the pain occur?

The pain can mainly be felt in the shoulder joint and can usually be precisely localized by those affected. They occur especially when the affected muscle is stressed. Raising the arm forwards or sideways can cause pain. For example, if the supraspinatus muscle is affected, discomfort occurs when the arm is raised to the side. The pain can also radiate into the arm when moving.

causes

The rotator cuff syndrome usually results from excessive or incorrect loading of the shoulder joint. Athletes are often affected, but people who work overhead work can also develop rotator cuff syndrome. Overloading or incorrect loading can lead to inflammation in the shoulder joint and remodeling processes. Furthermore, people over the age of 50 are often affected by shoulder complaints, as degenerative processes can also trigger rotator cuff syndrome.

diagnosis

After a short questioning (anamnesis), an examination of the shoulder in particular provides indications of rotator cuff syndrome. For example, the doctor checks which movement causes the pain (lifting, turning the arm in or out). If, for example, there is an impingement syndrome - that is, shoulder tightness due to an inflamed bursa - pain occurs when the arm is raised sideways.
Various special physical tests can give the doctor clues about the tendon or structure affected. For imaging diagnostics, X-rays can be used to assess bones and calcifications, or ultrasound and MRI to visualize soft tissue and inflammation.

When do you need an MRI?

An MRI is only used if there is no improvement due to conservative (non-surgical) therapeutic measures or if inflammation occurs again and again. Since an MRI is a very expensive examination, it should only be carried out when indicated. An MRI is also performed if the rotator cuff has ruptured. Acute pain and an acute loss of strength indicate a rupture. The MRI is used to localize the rupture and assess the extent.

therapy

The treatment of rotator cuff syndrome is mainly conservative. Surgery will only be considered if the non-surgical treatment measures fail. The following options are available to treat rotator cuff syndrome:

• Pain therapy using tablets, creams or gels,

• Physiotherapy (manual therapy, exercise therapy),

• Cortisone injection into the shoulder joint (intra-articular infiltration),

• Stretching and strengthening the rotator cuff,

• Surgical therapy by means of a joint specimen (arthroscopy) or open surgery.

Medication

Medicines are used to reduce inflammation and relieve pain. NSAIDs (non-steroidal anti-inflammatory drugs) such as ibuprofen are used for this. Regular consumption should be ensured for sufficient effect. The tablets are taken three times a day. Since these pain medication can often attack the mucous membrane of the stomach, additional gastric protection such as pantoprazole should be given in the event of prolonged use or in patients with a history of gastric mucosal disease.

Exercises

Stretching and strengthening the rotator cuff muscles should be done to treat and prevent the syndrome. Before doing exercises, you should ensure that the shoulder is adequately heated, for example using shoulder circles. In order to strengthen the muscles, exercises with light weights can be carried out at a cable pulling station (for example in the gym). The muscles that are responsible for internal and external rotation and for lifting the arm should be trained. It is also important to stretch the shoulder sufficiently in all directions after the exercises.

Cortisone injection

The cortisone injection is used to reduce inflammation and relieve pain in the shoulder joint. This therapy is also known as intra-articular infiltration, where the cortisone is injected directly into the joint. For example, the cortisone preparation triamcinolone is used here. This therapy usually has an immediate pain-relieving effect, but should not be used too often, as cortisone can lead to degeneration of the tendons, for example, and a tendon tear can be provoked.

Find out more about the topic: Cortion therapy for joint diseases

Taping

Taping provides additional support for conservative therapy during the healing phase and stabilizes the shoulder and relieves the muscles. In order to tape the shoulder, this should be done according to previous, correct instructions, for example from a physiotherapist or doctor. Since it is also difficult to put a tape on the shoulder yourself, it is necessary that the tape is attached by someone else.

When do you need an operation?

An operation is necessary if conservative measures are not effective and, for example, pain and restricted mobility persist over a longer period of time. Another indication for an operation is if the shoulder problems increasingly restrict the person concerned in the continuation of their accustomed life and the quality of life is reduced. By means of a joint reflection, disruptive structures that restrict movement can then be removed (decompression).

Duration / forecast

The duration of rotator cuff syndrome depends on how quickly therapy is given. If the shoulder continues to be stressed, the healing time can be delayed and even lead to the fact that an operation is necessary. It is therefore important to seek medical advice if there are signs of rotator cuff syndrome and to start therapy early. If the syndrome is caused by degenerative processes in the shoulder, complaints often arise again and again.

Rotator cuff tear

A rotator cuff tear is a complete or partial tear in one or more tendons. The cause can be brought about by degenerative processes of the tendons. Accident-related trauma or repeated minor injuries (for example due to excessive strain) can also cause the tendons to rupture. If the tendons tear as a result of rotator cuff syndrome, this is usually the result of the inflammation that accompanies the syndrome.

The tear is noticeable through spontaneous, severe pain and sudden loss of strength in the shoulder. There are also movement restrictions, which are also noticeable during the physical examination by the doctor. In addition, an x-ray of the shoulder should be carried out, whereby the upper arm head is often noticeable. An ultrasound or an MRI can be performed to further assess the crack.

The therapy is carried out, especially in older and inactive patients, with conservative means and is only switched to surgical therapy if the conservative therapy is unsuccessful. In young and active patients in particular, an operation should be performed as soon as possible, during which the tendon is sutured again. After the operation, the arm must be lifted to the side for six weeks to relieve the strain on the tendon suture.

Read more on the topic: Rotator cuff tear