1.What is rotator cuff and what is its function?
A: The rotator cuff is a cuff-like structure formed by the tendons of the subscapularis, supraspinatus, infraspinatus, and teres minor in front of, on, and behind the humeral head, which plays a large role in the stability and activity of the glenohumeral joint and maintains various postures of the upper arm and accomplishes various motor functions.
Its functions are.
(1) Confining the humeral head to the glenohumeral joint through the concave compression effect of the rotator cuff muscles, counteracting the upward force of the deltoid muscle.
(2) Compressing the humeral head during shoulder supination beyond 90°, thus reducing the impact of the humeral head.
(3) The role of the subscapularis is to internally rotate the shoulder joint.
(4) The supraspinatus, infraspinatus and teres minor are involved in the abduction and external rotation of the shoulder joint.
2.What are the clinical manifestations of rotator cuff injury?
A: Rotator cuff injuries are common in older people and are often associated with impingement symptoms. Rotator cuff injuries are also common in young people who engage in repetitive overhead motion. The most common manifestations are painful arc of the shoulder joint (60°-140° of abduction) during overtopping activities, which can be radiated to the deltoid muscle and the middle of the upper arm, and weakness of shoulder abduction, flexion and external rotation. Imaging: X-rays, MR and joint ultrasound support the diagnosis.
3.The etiology of rotator cuff injury?
A: There are both intrinsic and extrinsic factors in the etiology. The intrinsic factors include: imbalance of rotator cuff muscle strength, poor flexibility of rotator cuff muscle, excessive intrinsic elastic load, poor blood supply, and tissue degeneration; the extrinsic factors include: subacromial impingement, shape of the acromioclavicular joint and trauma, bone redundancy, abnormal scapular motion, imbalance of surrounding muscles, intra-articular injury or lesion, excessive elastic load, and repetitive stress, etc.
4.What are the indications for surgery of rotator cuff injury?
Answer.
(1) Age greater than 60 years old, it is best to repair within 6 weeks for those who rupture due to a special event;
(2) Chronic tears that have been treated conservatively for 6 months or more and still have symptoms should be considered for surgery;
(3) Significant shoulder joint pain, and conventional pain relief and other treatments are not effective;
(4) Shoulder joint weakness, which affects the quality of life.
a. Rotator cuff injury b. After rotator cuff suture repair
5.How to treat irreparable giant rotator cuff injury?
A: Irreparable giant rotator cuff injury refers to multiple rotator cuff (more than 3) ruptures or single rotator cuff rupture with retraction of more than 75px or rotator cuff degeneration of Goutallier grade 3 or 4 at the ruptured end. Its treatment is clinically challenging and conservative treatment is the main management modality. In appropriately selected cases, debridement can be performed. Dr. Gondeneche’s surgical approach in the treatment of repairable massive rotator cuff injuries is mainly:
(1) long head biceps tendonotomy or tendon fixation;
(2) combined latissimus dorsi and rhomboid tendon transposition;
(3) Reverse artificial shoulder arthroplasty.
6.What are the complications of rotator cuff surgery?
Answer.
(1) Chronic pain in the shoulder joint;
(2) Progression of rotator cuff lesion and re-tear;
(3) Adhesions of the joint capsule
(4) degeneration of the joint
(5) Damage to blood vessels and nerves when establishing working channels or repairing the rotator cuff;
(6) Incomplete or excessive resection of the rotator cuff;
(7) Fracture of the rotator cuff;
(8) Rotator cuff repair failure;
(9) Loose fixation or detachment.
7.How to rehabilitate after rotator cuff surgery?
A: The basis of post-operative rehabilitation of rotator cuff injury is to re-establish normal muscle balance and force coupling around the shoulder joint scapula to ensure the enhancement of the entire motor chain. It is important to follow the basic principles, but it also depends on the individual. Early exercise or delayed exercise can be implemented. The purpose of early exercise is to avoid postoperative shoulder stiffness, and the purpose of delayed exercise is to avoid repair failure. Specific measures include.
(1) Protecting the rotator cuff for 4-6 weeks after surgery, allowing passive movement of the wrist and elbow joints;
(2)Doing hot packs before exercises cold packs after exercises can improve the patient’s comfort;
(3) Staged exercises.
(1) Phase I: pain control, passive extension exercises to restore or maintain the range of motion of the joint, requiring a period of 4-6 weeks.
(2) Phase II: After restoring pain-free range of motion, exercises to enhance muscle strength, including scapular stabilizing muscle groups and deltoid muscles, are started. This period lasts for at least 3 months until full recovery.
③ Phase 3: Return the patient to the pre-injury state of strength and function.