Damage to the rotator cuff of the shoulder joint. Rotator cuff injury. Symptoms of damage to the rotator cuff of the shoulder joint

The human shoulder joint has a very sophisticated yet elegant design. Its anatomy allows us to significantly expand the capabilities of our hand, including performing complex movements overhead. However, increasing the range of motion in the joint decreases its stability. This makes the shoulder joint vulnerable to various problems if any of its parts are damaged and not working properly.

The condition of the rotator cuff of the shoulder is the key to normal shoulder function.

The rotator cuff is a unique structure that is formed by four tendons. These four tendons attach to their respective muscles and help keep the head of the humerus in the center of the glenoid cavity, thereby stabilizing it, and allowing the arm to move in different directions. The rotator cuff may wear out gradually if the shoulder joint is subjected to prolonged stress during strenuous physical labor.

Such degenerative damage occurs mainly in middle age. But also a rupture of the cuff can occur suddenly at any age with an acute injury. Rotator cuff rupture is quite painful and manifests itself as significant weakness in the shoulder joint.

ANATOMY OF THE SHOULDER JOINT AND ROTARY CUFF

The shoulder joint is formed by the humerus, scapula, clavicle. The part of the scapula, called the acromion, forms, as it were, the roof of the shoulder joint. The upper end of the humerus is called the head. The head is placed in a small and shallow glenoid cavity.

The articular cavity is part of the scapula. Between the bony formations of the scapula, strong ligaments (coracoidacromial, acromioclavicular and coracoclavicular) are stretched, which add stability to the joint. However, in some cases, they can also damage the rotator cuff.

The rotator cuff is made of tough fibrous tissue. The rotator or rotator cuff covers the shoulder joint. The cuff is formed by four tendons, which are connected to four muscles (supraspinatus, infraspinatus, round, subscapularis). These muscles rotate the shoulder outward or inward. Along with the deltoid muscle, they also help lift the arm away from the body.

The rotator cuff slides between the head of the shoulder and the acromine as we raise our arm. There is a special bursa between the rotator cuff and acromion. Bursa provides a reduction in friction between two rubbing surfaces. It lubricates the surface of the cuff, as it were, protecting it from friction with acromine.

If the space between the acromion and the humerus narrows for various reasons, and the movement of the limb occurs again and again from day to day, the cuff may be pinched. A similar infringement occurs with impingement syndrome.

REHABILITATION AFTER OPERATION

Rehabilitation after surgery can be a slow process. Full recovery can take 3 to 6 months.

Movement in the operated shoulder joint should be started as early as possible, however, the load should be balanced so as not to disrupt the process of fusion of the fixed cuff and bone.

You will need a special orthosis bandage designed to support and protect your shoulder for several weeks after surgery. Ice, electrical stimulation, and other physiotherapy methods can be used during the first few days after surgery to reduce pain and swelling.

The development of joint movements begins gradually with passive movements. During passive exercise, your shoulder joint moves, but the muscles remain relaxed. You can do passive movements yourself or with the help of an instructor.

Active movement usually begins 6 weeks after surgery. These exercises are aimed at increasing muscle strength.

Treatment of rotator cuff injuries is a complex medical problem and requires the combined efforts of the physician and patient.

WHY YOU NEED TO TREAT WITH US

In our clinic, we widely use arthroscopy and other minimally invasive methods of treating shoulder joint pathology. Operations are carried out on ultra-modern medical equipment using high-quality and proven consumables, fixators and implants from major global manufacturers.

Ph.D. - 1500 rubles

• Study of the history of the disease and patient complaints
• Clinical examination
• Identifying symptoms of the disease
• Study and interpretation of the results of MRI, CT and radiographs, as well as blood tests
• Establishing a diagnosis
• Prescribing treatment

Repeated consultation of a traumatologist - orthopedist, Ph.D. - is free

• Analysis of the research results ordered during the initial consultation
• Establishing diagnosis
• Prescribing treatment

Arthroscopic reconstruction of the rotator cuff - from 79,000 to 109,000 rubles

• Clinic stay
• Anesthesia
• Surgery: Shoulder arthroscopy with rotator cuff reconstruction
• Expendable materials
• Implants (Smith and Nephew, Mitek)

* The analyzes for the operation are not included in the price.

PRP therapy, plasma lifting for diseases and injuries of the shoulder joint - 4000 rubles (one injection)

• Consultation with a specialist, Ph.D.
• Taking blood
• Preparation of platelet-rich plasma in a special test tube
• Injection of platelet-rich plasma into the affected area

Reception of a traumatologist - orthopedist, Ph.D. after surgery - free

• Clinical examination after surgery
• Viewing and interpreting the results of radiographs, MRI, CT after surgery
• Recommendations for further recovery and rehabilitation
• Joint puncture
• Intra-articular administration of a hyaluronic acid preparation (if necessary)
• Removal of postoperative stitches

The rotator cuff is an anatomical and functional complex consisting of the supraspinatus, infraspinatus, subscapularis, and teres minor muscles and tendons that surround the joint and help keep the head of the humerus in a physiological position. The main types of her damage:

• Stretching.
• Tear.
• The gap.

Causes

Traumatization can occur both of individual components and of the entire complex as a whole. Most often, people whose professional activity is associated with a high static or dynamic load on the shoulder is susceptible to this type of injury. As an example, we can cite artists, painters, carpenters, baseball players, tennis players, etc. Given these points, what risk factors should be highlighted:

1. Age. According to statistics, it occurs more often in people over 40 years old.


2. Certain sports. It has been found that athletes who perform frequently repetitive arm movements are more at risk of developing severe rotator cuff problems.
3. Construction specialties. The explanation is similar to the previous point.
4. Genetic predisposition. Features of the structure of muscles and joints, which are hereditary in nature, can predispose to stretching or tearing of the rotator complex.

Both acute trauma and chronic microtraumatization can provoke the development of damage to the rotator cuff of the shoulder joint.

Clinical picture

In most cases, a detailed clinical picture is observed almost immediately after injury. What symptoms will be typical:

• Often, patients complain of a dull pain that is felt in the depths of the shoulder.
• Painful sensations intensify when moving the hand.
• The intensity of the pain syndrome depends on the severity of the injury.
• The functionality of the injured upper limb is somewhat limited. The patient notes that it is difficult to perform simple movements (for example, combing hair, placing an arm behind the back, etc.).
• There is weakness in the arm.
• Even with a fairly mild injury, it is usually impossible to fully rest on the side of the affected side.
• If severe damage is noted, subcutaneous hemorrhage and noticeable swelling of the upper arm may occur.

A ruptured rotator cuff of the shoulder joint cannot be healed without surgery.

Diagnostics

During the clinical examination, the physician can determine the nature and severity of the injury. To clarify the degree of damage, one has to resort to additional diagnostic methods. Most often, the following types of instrumental studies are used:

1. Radiography. It will not be possible to determine pathological changes in the musculo-ligamentous apparatus with X-ray, but it is quite realistic to assess the condition of the bones and joints.
2. Ultrasound examination. Modern ultrasound machines make it possible to study well the state of any soft tissues of the upper limb.
3. Research on. Today the resolution of MRI is second to none. The quality of the images is an order of magnitude superior to the images obtained during ultrasound examination.

A sharp rotational movement of the hand without preparation can lead to trauma to the musculo-ligamentous apparatus of the shoulder.

Treatment

Mild injuries of the rotator cuff of the shoulder joint (for example, sprains) can be successfully treated with conservative treatments. In case of partial or complete rupture of muscles and tendons, surgical operation is indispensable. At the same time, what measures can be taken in case of a rotator cuff injury while at home:

• We try not to move the injured limb once again. A scarf can be used. Many patients report pain relief when the arm is bent at the elbow and pressed against the chest.
• For the first day, it is recommended to put a cold compress on the shoulder area. You can use ice or refrigerated items (for example, a bottle with input, food, etc.). The duration of applying cold is 15–20 minutes every 2 hours.
• From 2-3 days we switch to warm compresses. A heating pad is usually recommended.

Drug therapy

To relieve pain, you will need analgesics and non-steroidal anti-inflammatory drugs.

Physiotherapy

In almost all cases, many physiotherapy procedures are involved in the treatment of the rotator cuff of the shoulder joint. As clinical practice shows, physiotherapy helps to reduce pain, restore peripheral circulation, normalize microcirculation, and accelerate reparative processes in damaged tissues. Usually, the procedures are prescribed 2 days after the injury. In addition, a course of physiotherapy is also provided after surgery. What methods are used most often:

• Cryotherapy.
• Electrophoresis with pain medication.
• Ultrahigh frequency therapy.
• Laser therapy.
• Balneotherapy.
• Magnetotherapy.
• Healing mud.

If pain or severe discomfort in the shoulder is observed for more than a week, it is recommended to visit an orthopedic traumatologist.

Massage

Many years of experience have shown that therapeutic massage is a very effective physiotherapeutic method for various injuries and injuries of the musculo-ligamentous apparatus, in particular, the rotator cuff of the shoulder. What are the main tasks of massage:

1. Improving local blood circulation.
2. Removal of painful sensations in damaged parts of the body.
3. Prevention of the progression of pathology.
4. Restoration of shoulder functionality.
5. Prevention of atrophic changes in muscles.

When massaging, most of the basic techniques are involved, such as stroking, kneading, etc. They process not only the rotator cuff area, but also the cervical spine, the broadest muscle, the peri-scapular area and the entire surface of the upper limb. Areas of greatest pain are tried to be spared. At the final stage, passive and active movements are performed with the affected hand.

Today, periodic massage sessions are actively used as a prophylaxis for various kinds of injuries and injuries of the musculoskeletal system.

Physiotherapy

The most effective method of restoring the functionality of the damaged upper limb is. The attending physician is responsible for the selection of a special set of exercises. During exercise therapy, small dumbbells and a rubber expander are very useful. What exercises to strengthen the rotator cuff can be recommended:

• Stand in the doorway. Bend the injured arm at the elbow and touch the wall with your palm. Place a towel rolled several times between your elbow and your body. Hold the towel with your elbow and rest your palm against the wall. At the same time, the body does not move. Hold this position for a few seconds. Then take your hand away from the wall and rest a little. The number of repetitions is 10 times.


• We turn to the wall. The arm is bent, the elbow touches the wall. We rest our elbows against the wall, feeling the tension of the muscles of the shoulder girdle. The number of repetitions is 10 times.
• We stand in the doorway. Both hands are spread apart and we rest our palms on the walls. Without taking your hands off the walls, we take a small step forward and feel a slight stretch of the muscles of the shoulder girdle. The back is straight. Stretching is performed neatly without sudden movements.
• We lie on our side. Damaged hand on top. We take a dumbbell in this hand. Then it is necessary to bend it 90 °, and press the elbow to the body. Remaining lying on your side, we lift the dumbbell up without lifting the elbow from the body. The number of repetitions is individual. Over time, you can increase the weight of the dumbbell and the number of approaches.
• Working with an expander. Press one end of the expander with your right foot. With our left hand we take another part of it. As if "starting the engine on the boat", we perform the movement with the left hand up. After taking several approaches, we change the arm and leg. Also, the expander can be fixed to the wall at shoulder level. Take both ends, slightly spread your arms to the sides. Then, with both hands, pull the expander towards you. We straighten our arms without letting go of the inventory.

It is strongly not recommended to treat any damage to the rotator cuff of the shoulder joint without consulting a specialist. As a rule, with self-treatment, the recovery period may not only be delayed, but various complications may develop.

Surgical intervention

In case of partial or complete rupture of the rotator cuff of the shoulder joint, it is indicated. The operation will be more effective if it is performed almost immediately after injury. Therefore, it is better not to delay the visit to the doctor in case of severe damage to the rotator cuff. Modern surgical techniques make it possible to successfully restore torn tissue. The recovery period can last from several months to a year. Basically, rehabilitation after surgery includes physiotherapy, therapeutic exercises and massage sessions.

Only a highly qualified physician can determine whether you need surgical treatment or sufficient conservative therapies.

Prevention

If you are at risk of rotator cuff injury or have experienced similar trauma in the past, it is recommended that you do a daily set of exercises that will help strengthen the musculo-ligamentous apparatus of the shoulder. Most people focus on the muscles of the chest and the front of the shoulder. However, it is equally important to do exercises to strengthen all the muscles in the shoulder girdle. Talk to your doctor or a highly trained physiotherapist to find the optimal exercise program to prevent injury to the rotator cuff of the shoulder joint.

The clavicular-shoulder joint in the human body is a very complex structure of the musculoskeletal system. Its main stabilizer is the rotator cuff. Its integrity provides the shoulder joint with an adequate range of movements and functions. However, rotator cuff rupture is one of the most common sports injuries.

Why the rotator cuff of the shoulder is so important in the variety of rotational and motor dynamics of the upper limb, anatomy explains quite specifically. Shoulder rotator consists of tendons connecting the surrounding muscles of the shoulder (supraspinatus, infraspinatus, small round and subscapularis muscles).

This strong connection helps with the most difficult movements (rotation, abduction, adduction of the hand).

Thus, the shoulder rotators "hug" the musculoskeletal humeral joint from all sides, preventing it from disengaging.

Shoulder cuff injury

The causes of degenerative phenomena in the shoulder joint can be either natural wear and tear of tissues, or the consequences of acute organ trauma. Both factors lead to an imbalance in the work of the shoulder joint and further limitation or absolute absence of motor capabilities of the upper limb in this joint.

Attempts to perform any kinesthetic action will cause an attack of acute pain due to infringement of the cuff by the acromion (lateral end of the scapula) and the head of the shoulder joint.

The main reason for the most frequent injuries of this particular tendon apparatus is the peculiarity of its anatomical structure. In the human body, the most elastic structures are those with good blood supply. The rotator cuff has virtually no vascular network. Because of this, the elasticity of the organ is extremely low.

For these reasons, rupture of the cuff occurs due to sudden movements in the shoulder joint, excessive lifting loads with heavy weight or impacts.

The danger of natural wear of the cuff occurs in people after 40 years. They should be especially careful about the shoulder joint, without overloading it.

Excessive and premature wear of the rotator shoulder cuff, not associated with age-related changes and acute injuries, can occur due to specific work activities with monotonous movements. Among athletes, these are javelin throwers, tennis players, badminton players, and among blue-collar workers - painters, plasterers, and finishers.

Symptoms

The most important symptom of the development of acute damage to the rotator cuff of the shoulder joint is severe pain. The pain is localized within the injured joint, but can be felt in the neck and hand. Any movement of the hand will increase the pain.

Severe pain syndrome is the most important symptom of pathology

With age-related or functional wear of the cuff, the nature of the pain will increase, arthralgia as a symptom fades into the background. The defining clinical indicator in this case will be joint weakness and noticeable contracture (restriction of movement). It will become more difficult for the patient to perform actions such as scratching each time.

Another concomitant symptom of degenerative disorders of the shoulder cuff is crepitus (crunch).

Diagnostics

If there is a subacute rotator cuff injury, the first diagnostic step is history. The doctor will ask questions about lifestyle, nature of work, sports.

The next stage is an objective examination to reveal the range of motion, the nature and level of pain.

More about that how to treat a tendon rupture in a finger .

Clinical tests and instrumental diagnostics will finally establish or refute the diagnosis - damage to the rotator cuff of the shoulder joint (right or left). The X-ray will show signs of secondary pathologies: bone spurs, osteophytes and narrowing of the joint spaces.

The most modern and informative method for diagnosing tendon ruptures is MRI. In layered images, tendon fibers are clearly visible, and a violation of their structures can be easily diagnosed.

Treatment

Therapeutic measures for rupture of the shoulder cuff are aimed at:

• relief of pain syndrome;
• elimination of inflammation in the lesion focus;
• regeneration of damaged fibers.

In addition to complete immobilization and wearing an orthosis, one or more methods of therapeutic measures are prescribed.

Drug therapy

For drug therapy, patients are prescribed:

• non-steroidal anti-inflammatory drugs in tablets and / or intramuscular injections;
• intra-articular injections of platelet masses and corticosteroids;
• chondroprotectors;
• vitamin complexes.

Physiotherapy

Physiotherapy has a beneficial effect on the restoration of joint mobility

In almost all cases of damage to the shoulder cuff, physiotherapy is prescribed to the patient after a certain time after the removal of orthopedic fixators and getting rid of pain. This method of treatment has a beneficial effect on the restoration of joint mobility and microcirculation of the surrounding tissues. Most often, the following procedures are prescribed:

• cryotherapy;
• magnetic treatment;
• with medications;
• balneotherapy;
• compresses with therapeutic mud.

Massage

Wellness massage is also a very good method of treatment and rehabilitation after a rotator cuff injury. This method has an excellent effect on stagnation in muscles and joints, contributes to the development of a stiff shoulder after immobilization.

After the massage session, the specialist conducts a number of passive and active therapeutic and restorative movement techniques with the patient.

Physiotherapy

One of the most highly effective methods of conservative treatment and restoration of a damaged upper limb is. Useful gymnastic movements, developed by a rehabilitation therapist, will help to restore mobility to the shoulder as soon as possible.

This includes elements of gymnastics without apparatus, and exercises with various accessories (expander, crossbar), and classes on special simulators.

Physical activity is calculated and carried out strictly under medical supervision. Self-selection of exercises can lead to incorrect calculation of the load and secondary damage to the ligamentous apparatus.

Surgical intervention

In case of ineffectiveness of conservative treatment or according to medical indications (complete rupture of the rotator cuff), the patient is prescribed surgery.

Surgical treatment of a ruptured rotator cuff of the shoulder joint should be performed no later than 3 months after injury.

Shoulder arthroscopy

There are two types of rotator cuff refixing surgeries:

1. Open joint surgery.
2. Arthroscopy.

In the first case extensive surgery is performed on the fully open clavicular-humeral joint. This technique is used for combined lesions in order to restore the loss of soft tissue through transplantation.

Second technique is the most common and modern way of surgical treatment of this upper limb lesion. The operation is performed through several small incisions (4-5) with the placement of an arthroscope and microsurgical instruments in them.

The purpose of the operation is to clean the problem area from bone growths and destroyed non-viable tissues and fix the damaged tendons using special devices: anchors or suture anchors.

Prevention

The basis for the prevention of the health of the rotator cuff is a well-chosen physical activity. It is necessary to avoid sudden movements of the hands back and up. But this does not mean that the shoulder does not need to be loaded at all. On the contrary, constant but gradual strengthening of the joint with useful loads will help to avoid problems.

Conclusion

A healthy shoulder joint is an integral part of a person's active and efficient life. Without the full functioning of the upper limbs, it is impossible to perform any of the usual elementary actions.

It is necessary to constantly strengthen the tendon apparatus of the shoulder since childhood, so that in old age you do not limit yourself in full-fledged activity.

A ruptured rotator cuff tendon suggests that one or more of these tendons have lost some or all of their connection to the head of the shoulder.

The supraspinatus tendon is most commonly injured, but other muscles can also be damaged.

In many cases, tendon ruptures begin with dissection and loss of normal anatomical structure. As these changes progress, the tendon may rupture completely, sometimes when lifting something heavy.

Most rotator cuff ruptures tear off the tendon from the point of attachment to the bone.

Rotator cuff of the shoulder - includes the supraspinatus, infraspinatus, small round and subscapularis muscles. These muscles are needed to stabilize the head of the humerus and prevent it from shifting when moving in the joint.

In addition, these muscles allow rotational movements in the shoulder in all directions.

The subscapularis muscle rotates the arm inward, the supraspinatus muscle raises the shoulder and "anchors" it, ie. presses the head of the humerus into the glenoid cavity of the scapula while abducting the shoulder to the side.

In this case, the main abduction force is determined by the deltoid muscle, and the supraspinatus muscle works as a commander, directing the efforts of the deltoid muscle. The infraspinatus muscle rotates the shoulder outward, and the small round muscle rotates outward and brings the arm to the body.

Damage to at least one of the four muscles leads to severe limitation of movement and loss of function of the shoulder joint.

Rotator cuff injury can result from acute trauma. In this case, patients often describe a specific injury that resulted in pain and impaired shoulder function.

For example, athletes in sports such as baseball, tennis, weightlifting and rowing. Constant microtraumatization of the rotator cuff tendons when hitting the ball, serving, throwing can lead to micro tears of muscle fibers, the muscles gradually become thinner and over time, even with a minor injury, can easily break.

A predisposition to overextension of the rotator cuff tendons is present in teachers who write with chalk on a blackboard, raising their hand up, in painters painting walls, in builders, etc.

Due to the reason that caused the rupture - traumatic or degenerative ruptures. By the nature of the damage, partial and complete ruptures are distinguished.

Partial tears do not extend through the entire thickness of the tendon; full tears extend to the entire thickness of the cuff layers. Traumatic injuries are classified as fresh, stale, and old.

physiotherapeutic procedures, the use of anti-inflammatory and analgesic drugs, with severe pain - blockade with long-acting glucocorticoids.

A very good clinical effect is given by intra-articular injections of platelet-rich plasma into the shoulder joint ("growth factors", PRP).

Repairing a ruptured rotator cuff tendon is a complex operation. Rotator cuff reconstruction can be performed either openly, through an incision in the shoulder, or arthroscopically.

In our Medical Center, surgical treatment of a rotator cuff injury is performed in a modern way, without a joint incision - under arthroscopic control.

Instead of an incision, local mini-punctures are performed, into one of which an arthroscope with a video camera is inserted, and into the other instruments for the operation.

An enlarged image from a video camera is transmitted to a video monitor, which allows the doctor to examine in detail all structures of the joint and identify the localization of damage.

At the first stage of the operation, the joint is cleaned - all non-viable, degeneratively altered rotator cuff tissues are removed. Then, the area of ​​the humerus, where the rotator cuff was torn or torn off, is cleaned of soft tissue residues so that the tendon can grow to it better.

The anchor is attached to the bone, and the tendon is stitched with threads.

When the tendon of the rotator cuff is torn, the ligaments cease to hold the head of the humerus. Most tears occur in the supraspinatus muscle and tendon, but other ligaments can also be damaged. Most often, a tendon rupture is caused by wear and tear. The higher the load, the greater the likelihood of a complete rupture. There are several types of tendon ruptures:

• A tear is an incomplete injury to soft tissue.
• A complete tear is the separation of soft tissue in two. In most cases, the tendons break away from the attachment point to the head of the humerus.
• Rotator cuff rupture - tendon rupture.

Sharp break

A fall on an outstretched arm or sudden lifting of weights leads to a rupture of the rotator cuff of the shoulder. This injury can accompany other injuries, such as a fracture of the clavicle or dislocation of the shoulder joint.

Degenerative rupture

Most tears are caused by age-related changes in the tendon. The most common rotator cuff rupture occurs in the dominant arm.

If you have a degenerative rupture of one shoulder joint, there is a high chance of a ruptured rotator cuff in the other joint. Factors affecting degenerative rupture of the rotator cuff of the shoulder joint.

Rotator cuff of the shoulder - includes the supraspinatus, infraspinatus, small round and subscapularis muscles. These muscles are needed to stabilize the head of the humerus and prevent it from shifting when moving in the joint. In addition, these muscles allow rotational movements in the shoulder in all directions.

The subscapularis muscle rotates the arm inward, the supraspinatus muscle raises the shoulder and "anchors" it, ie. presses the head of the humerus into the glenoid cavity of the scapula while abducting the shoulder to the side. In this case, the main abduction force is determined by the deltoid muscle, and the supraspinatus muscle acts as a commander, directing the efforts of the deltoid muscle.

The infraspinatus muscle rotates the shoulder outward, and the small round muscle rotates outward and brings the arm to the body. Damage to at least one of the four muscles leads to severe limitation of movement and loss of function of the shoulder joint.

Rotator cuff injury can result from acute trauma. In this case, patients often describe a specific injury that resulted in pain and impaired shoulder function.

In some cases, rotator cuff rupture is the result of chronic muscle microtraumatization. Most often this occurs in persons whose professional activities are associated with frequent elevated position of the hand or throwing movements.

For example, athletes in sports such as baseball, tennis, weightlifting and rowing. Constant microtraumatization of the rotator cuff tendons when hitting the ball, serving, throwing can lead to micro tears of muscle fibers, the muscles gradually become thinner and over time, even with a minor injury, can easily break.

A predisposition to overextension of the rotator cuff tendons is present in teachers who write with chalk on a blackboard, raising their hand up, in painters painting walls, in builders, etc.

In some patients, the rupture of the rotator cuff may be a consequence of the development of degenerative-dystrophic changes in the muscles associated with aging of the body, for example, in the elderly or a genetic predisposition.

Due to the reason that caused the rupture - traumatic or degenerative ruptures. By the nature of the damage, partial and complete ruptures are distinguished. Partial tears do not extend through the entire thickness of the tendon; full tears extend to the entire thickness of the cuff layers. Traumatic injuries are classified as fresh, stale, and old.

To diagnose damage to the rotator cuff of the shoulder, special tests are used in which the doctor, bringing the patient's arms to a certain position, assesses the motor ability of the injured arm, observes the patient's response to his actions.

The most informative tests are abduction weakness and shoulder external rotation weakness. With extensive damage to the rotator cuff, symptoms of a falling arm are also characteristic (the patient cannot hold the passively abducted arm) and lifting of the shoulder girdle when trying to withdraw the arm (Leclerc's symptom).

physiotherapeutic procedures, the use of anti-inflammatory and analgesic drugs, with severe pain - blockade with long-acting glucocorticoids. A very good clinical effect is given by intra-articular injections of platelet-rich plasma into the shoulder joint ("growth factors", PRP).

If the duration of unsuccessful conservative treatment exceeds 2-3 months, it is necessary to raise the question of surgery.

Repairing a ruptured rotator cuff tendon is a complex operation. Rotator cuff reconstruction can be performed either openly, through an incision in the shoulder, or arthroscopically.

The disadvantages of open surgery are the need for large, traumatic incisions in the shoulder to provide access to the damaged tendons, which carries a high risk of side effects and long-term recovery from surgery.

In our Medical Center, surgical treatment of a rotator cuff injury is performed in a modern way, without a joint incision - under arthroscopic control. Instead of an incision, local mini-punctures are performed, into one of which an arthroscope with a video camera is inserted, and into the other instruments for the operation.

An enlarged image from a video camera is transmitted to a video monitor, which allows the doctor to examine in detail all structures of the joint and identify the localization of damage.

The essence of arthroscopic surgery is that the rupture is sutured, and if the tendon is detached from the place of fixation, then the suture is performed using special "anchor" clamps.

At the first stage of the operation, the joint is cleaned - all non-viable, degeneratively altered rotator cuff tissues are removed. Then the area of ​​the humerus, where the rotator cuff was torn or torn off, is cleaned of soft tissue residues so that the tendon can grow to it better.

Usually, 2-3 anchor anchors are required to fix the torn tendon. The latch consists of an anchor and threads.

The anchor is attached to the bone, and the tendon is stitched with threads.

The choice of a specific type of anchor fixture is carried out by the operating surgeon, but in general, the patient should also be informed about which fixture is planned to be used in his case. We recommend using clamps from world-renowned companies that have proven themselves for a long time.

The rotational "cuff" of the shoulder is understood to mean the antero-outer part of the capsule of the shoulder joint, into which the tendons of the supraspinatus, infraspinatus and small round muscles are woven. The latter are attached to the adjacent facets of the greater tubercle of the humerus.

Such anatomical closeness of the fixation of the muscles allowed traumatologists to combine them into one group (rotator cuff of the shoulder), although they are different in function: the supraspinatus muscle retracts the shoulder anteriorly and outward, the infraspinatus and small round muscles are pure rotators of the shoulder outward.

Pathogenesis (What Happens?) During Rotator Cuff Ruptures

Rupture of the tendons that make up the rotator cuff is usually a complication of shoulder dislocation. The tendons of all three muscles are most often damaged at the same time, but isolated ruptures of the tendons of the supraspinatus muscle or only the infraspinatus and the small round are possible.

Symptoms of Rotator Cuff Rupture

When the body is tilted forward, the patient actively removes the shoulder anteriorly and outward to 90 ° or more. Normally, when a person is upright, the abduction of the shoulder is done as follows: contracting, the supraspinatus muscle presses the head of the humerus to the glenoid cavity, creating support, and then the deltoid muscle acts on the long arm of the humerus.

When the tendon of the infraspinatus muscle is ruptured, the shoulder joint does not close and contraction of the deltoid muscle leads to an upward displacement of the shoulder head, i.e. in the subluxation position, since the axes of the humerus and glenoid cavity do not coincide.

When the trunk is tilted, these axes are aligned and the contraction of the deltoid muscle can close the shoulder joint and keep the limb in a horizontal position.

In the later stages of trauma, a symptom of "frozen shoulder" may appear, when passive abduction becomes impossible due to obliteration of Riedel's pocket.

A symptom typical for a ruptured rotator cuff of the shoulder is a symptom of a "falling checkerboard flag". Check it as follows: take the hand in the middle position between supination and pronation anteriorly to a horizontal level.

Then they ask to bend the arm at the elbow joint to 90 °. In this position, the forearm is not held and falls to the medial side (like the flag of a chess clock in time trouble), rotating the shoulder inward.

The reasons for this are in the absence of antagonists to the internal rotators and the inability to hold the shoulder, weighted by the bent forearm, in a position average between supination and pronation.

Rotator cuff rupture should be differentiated from axillary nerve damage, which is indicated by atony and atrophy of the deltoid muscle and loss of skin sensitivity along the outer surface of the upper third of the shoulder.

In contrast arthrography of the shoulder joint for rupture of the "cuff" is characterized by the filling of the subacromial bursa with a contrast agent, which normally does not communicate with the joint, reduction or disappearance of the subacromial space.

Diagnostics of the Rupture of the rotator cuff of the shoulder

In the early stages, diagnosis is complicated by the clinical symptoms of shoulder dislocation and subsequent immobilization with a plaster cast. Usually, patients come after long-term rehabilitation treatment, which is not effective.

Development mechanism

The shoulder joint has a spherical shape, which provides a significant range of motion. It consists of the glenoid cavity formed by the clavicle and acromion.

The head of the humerus, which has a spherical shape, is located in the glenoid cavity. Due to the contraction of muscle structures, the tendons of which are attached to the tubercle of the humerus, the arm moves in any direction.

An increase in the stability of the joint with the prevention of its dislocation is ensured by the presence of cartilaginous lips (the depth of the articular cavity is increased), a capsule, ligamentous apparatus, as well as a rotational (rotator) muscle cuff.

It is represented by the supraspinatus, infraspinatus, subscapularis and small round muscles, as well as their tendons ..

Trauma (stretching, breaking of fibers) of one or more muscles disturbs the stability of the shoulder joint.

Causes

Injury to the shoulder cuff can be triggered by the following factors:

• excessive physical exertion that falls on the upper limbs, in particular, the articulation of the shoulder;
• systematic overstrain of the tendons;
• frequent injuries to the elements of the shoulder;
• fracture of the humeral joint;
• circulatory disorders.

There are two main mechanisms of damage to the rotator cuff: trauma and degeneration.

Traumatic rupture

Damage to the rotator cuff of the shoulder joint is a polyetiological condition, the development of which is possible under the influence of several provoking factors. Among them:

• Acute trauma resulting from excessive mechanical force and leading to complete (dislocation) or partial (subluxation) exit of the head of the humerus from the glenoid cavity with stretching or rupture of tendons and muscles.
• Chronic traumatization of connective tissue structures or muscle fibers against the background of systematic stress and the performance of the same type of hand movements. This reason is most often realized in athletes who are engaged in shot put, javelin throwing, rowing, weightlifting, tennis. Also, chronic trauma occurs in representatives of some professions, whose activities are associated with the same type of movements of the hand raised up (teachers writing with chalk, painters, plasterers).
• Congenital or acquired change in the anatomical ratio of various structures of the shoulder joint, leading to an increase in the load on the ligamentous apparatus, capsule and muscles.
• Decrease in the strength of the ligamentous apparatus, which is of hereditary origin, realized at the genetic level (a decrease in the number of collagen fibers in the connective tissue).
• The development of degenerative-dystrophic processes leading to a weakening of various joint structures due to age-related involution, insufficient blood supply. They provoke a ligament pathology called tenopathy.

Clarification of the provoking factors due to which the damage to the rotator cuff of the right shoulder joint occurred is required to prevent this violation of anatomical integrity in the future.

A person can rotate his hand in 3 planes. This is due to the fact that the shoulder joint has a large range of motion.

However, the joint is prone to frequent injury and damage of various kinds. In this case, there is a violation of the stability of the shoulder joint, and the inability to fully perform movements in it.

In addition to injuries, the cause of pathologies is insufficient blood supply and, as a result, a change in the trophism of the joint. This entails thinning and changes in the structure of the cartilage tissue, disruption of tendon joints, and in severe cases, it causes destruction of bones.

Factors that can cause a ruptured rotator cuff include:

• Age - over 45 years old.
• Professions that involve the same type of movement and constant shoulder tension:
• Sports activities causing chronic cuff injury.
• Congenital features of the anatomy of the shoulder joint, representing a narrow distance between the acromial process, which causes constant friction and tendon injury.

Compared to other organs and tissues of the human body, tendons are less well supplied with blood. This feature often leads to the development of dystrophic disorders of the rotator cuff.

This condition is called tendopathy. Genetic disorders in connective tissue, that is, in collagen, also play a negative role.

It is a protein that includes 4 types. It is with a relatively high content of connective tissue of types 3 and 4 that the likelihood of developing tendopathy increases.

One of the most common joint pathologies is bursitis - irritation or inflammation of the bursal sac. There are more than 140 bursae in the human body, and such a disease can develop in any of them. However, most often doctors diagnose lesions of the elbow, knee and shoulder joints.

Usually, this pathology is accompanied by tendon inflammation.

Bursitis refers to diseases of the musculoskeletal system and is most often diagnosed in people whose work is directly related to constant stress on the joints. This pathology is especially common in athletes.

As a rule, with adequate treatment, the disorder disappears within a couple of weeks and does not pose a serious danger to human health and life.

The reasons for the development of bursitis

Shoulder injury is a common injury that can occur for a variety of reasons. During contact sports, weightlifting exercises (lifting the barbell), etc. Possible injury to the shoulder when falling on the arm, a direct blow to the shoulder.

Effects

All tendons in the body are deficient in blood supply. Therefore, the shoulder cuff is prone to degeneration - tenopathies.

A lack of blood supply is not the only cause of tenopathies. They are promoted by heredity: connective tissue pathology.

The structure of the tendons is collagen. The high content of the third and fourth types of collagen causes tenopathies.

They can affect any tendon of the rotator cuff, which is characterized by pain when the corresponding movement in the shoulder is made. So, when the tendon of the supraspinatus muscle suffers, pain appears when the limb is abducted to the side, and in the pathology of the subscapularis muscle, the pain syndrome increases during scratching or when the hand moves behind the back.

Clinical picture

In most cases, a detailed clinical picture is observed almost immediately after injury. What symptoms will be typical:

• Often, patients complain of a dull pain that is felt in the depths of the shoulder.
• Painful sensations intensify when moving the hand.
• The intensity of the pain syndrome depends on the severity of the injury.
• The functionality of the injured upper limb is somewhat limited. The patient notes that it is difficult to perform simple movements (for example, combing hair, placing an arm behind the back, etc.).
• There is weakness in the arm.
• Even with a fairly mild injury, it is usually impossible to fully rest on the side of the affected side.
• If severe damage is noted, subcutaneous hemorrhage and noticeable swelling of the upper arm may occur.

A ruptured rotator cuff of the shoulder joint cannot be healed without surgery.

Varieties

• Partial tears. Breaks of this type are also called incomplete. As the name suggests, these tears do not completely damage the tendon.
• Full layer breaks. These breaks are also called complete. In this case, the tendon completely loses its connection with the bone. A defect is formed in the rotator cuff with these tendons.

(Left) The four tendons that form the rotator cuff of the upper arm (top view). (Right) Full-thickness supraspinatus tendon rupture.

(Left) Normal rotator cuff, front view. (Right) Full-thickness supraspinatus tendon rupture.

Depending on the nature and severity, damage to the rotator cuff of the shoulder joint is divided into two main types, which include:

• Complete violation of anatomical integrity, which extends to all layers of the cuff.
• Partial violation of the anatomical integrity, in which only individual layers of the cuff are affected.

Based on the duration of the pathological condition, damage to the rotator cuff is fresh and old. It is considered old if more than six months have passed since the violation of integrity, while no therapeutic measures have been taken.

Also, this pathological condition is divided into 2 types according to the etiological principle - traumatic (the result of an injury) and degenerative-dystrophic damage to the rotator cuff of the shoulder.

Treatment is selected by a doctor with the obligatory consideration of this classification after an objective diagnosis has been carried out.

Separately, there is a partial damage to the rotator cuff, which is a pronounced violation of the anatomical integrity that develops as a result of excessive abduction of the arm up and back.

Rotator cuff injuries are usually classified for the cause of rupture - traumatic and degenerative. According to the degree of rupture, they are divided into partial, when only part of the tendon fibers are damaged, and full, in which case the entire thickness of the cuff is torn. By the time of appearance, fresh, stale and old breaks are distinguished.

Sprains of the muscles and ligaments of the shoulder joint: symptoms, signs and treatment of shoulder ruptures

Subacromial bursitis, tendonitis, and partial rupture of the rotator cuff result in shoulder pain, especially when the arms are raised above the head. The pain usually increases in the range from 60 ° to 120 ° (painful arc of motion) of abduction or flexion of the shoulder joint and its manifestations are minimal or absent in the range of

megan92 2 weeks ago

Tell me, who is how to deal with joint pain? My knees hurt terribly ((I drink painkillers, but I understand that I am struggling with the investigation, not the cause ... Nifiga does not help!

Daria 2 weeks ago

For several years I fought with my aching joints until I read this article by some Chinese doctor. And I have long forgotten about the "incurable" joints. Such are the things

megan92 12 days ago

Daria 12 days ago

megan92, so I wrote in my first comment) Well, I'll duplicate it, it's not difficult for me, catch it - link to professor's article.

Sonya 10 days ago

Isn't this a divorce? Why are the Internet selling ah?

yulek26 10 days ago

Sonya, what country do you live in? .. They sell it on the Internet, because shops and pharmacies charge a brutal markup. In addition, payment only after receipt, that is, first looked, checked and only then paid. Yes, and now everything is sold on the Internet - from clothes to TVs, furniture and cars.

Editorial response 10 days ago

Sonia, hello. This drug for the treatment of joints is not really sold through the pharmacy chain in order to avoid an overpriced. To date, you can order only on Official site... Be healthy!

Sonya 10 days ago

I apologize, I did not notice the information about cash on delivery at first. Then, it's OK! Everything is in order - for sure, if the payment is on receipt. Thank you very much!!))

Margo 8 days ago

Has anyone tried alternative methods of treating joints? The grandmother does not trust pills, the poor one has been suffering from pain for many years ...

Andrey 1 week ago

What folk remedies have I tried, nothing helped, it only got worse ...

Ekaterina 1 week ago

I tried to drink a decoction of bay leaves, no sense, only ruined my stomach !! I no longer believe in these folk methods - complete nonsense !!

Maria 5 days ago

Recently I watched a program on the first channel, there is also about this Federal Program for Combating Joint Diseases spoke. It is also headed by some famous Chinese professor. They say that they have found a way to permanently cure joints and back, and the state fully funds the treatment for each patient.