Rotator cuff tears are a common cause of shoulder pain, limited motion and dysfunction. A rotator cuff tear will cause a range of shoulder symptoms and affect the quality of daily life, such as shoulder pain, especially at night so that you cannot sleep; inability to brush your hair; and inability to remove a bra in female patients. 2008 statistics show that nearly 2,000,000 people in the United States were seen for rotator cuff disease. Now that the diagnosis of frozen shoulder has been eliminated, we find that about 60% of outpatients with shoulder pain have rotator cuff impingement and rotator cuff injuries.
To understand rotator cuff tears, the first place to start is to understand the anatomy of the rotator cuff. The shoulder joint is made up of 3 bones: the upper arm (humerus), the scapula and the clavicle. The shoulder joint is a ball-socket joint: the ball of the upper arm, or head, and the fossa of the scapula match. The rotator cuff is the structure that maintains the correct position of the upper arm in the articular fossa. The rotator cuff has four parts, all of which become tendinous at their distal ends attached to the head of the humerus. The rotator cuff allows the shoulder joint to be lifted and rotated by the action of the rotator cuff. There is a lubricating tissue (bursa) between the rotator cuff and the bone at the top of the shoulder joint (acromion), which allows the rotator cuff to move freely during shoulder movement. When the rotator cuff is injured, the bursa can become inflamed, causing pain
Etiology
There are two main causes of rotator cuff tears: injury and degeneration. In many cases, both factors are present and work together to cause the disease.
I. Injury: A rotator cuff tear may result if the arm is fallen with the arm extended or when a heavy object is lifted very sharply. This injury may be accompanied by other shoulder injuries, such as a dislocation of the shoulder joint.
Second, degeneration: Most tears are the result of rotator cuff wear and tear that occurs with age. Degenerative tears are most common in the dominant shoulder joint. When one rotator cuff tear occurs on one side, the likelihood of rotator cuff injury on the other side increases. Factors that affect degenerative or chronic rotator cuff tears are
1. Repeated impingement: Sports such as tennis, rowing, and weightlifting can lead to over-applied injuries. Some other jobs such as window cleaning and mopping can also lead to repeated impingement of the rotator cuff and rotator crest, eventually leading to rotator cuff tears.
2.Reduced blood supply: There is a non-vascular area in the rotator cuff at 10-20mm close to the humeral stop, and as we age, the blood supply to the rotator cuff is further reduced, which accelerates the degeneration and tearing of the rotator cuff.
3.Bone superfluous: When the age increases, bone superfluous (bone spur) is often formed on the lower surface of the acromion. When the shoulder joint is raised, the bone spur can wear out the rotator cuff, and the repeated wear leads to rotator cuff tear.
4. Local anatomical abnormalities: oversized humeral tuberosity, subacromial bursa thickening and fibrosis, rostral shoulder ligament hypertrophy, and hooked rotator cuff will increase rotator cuff wear.
Studies have shown that patients with the following risk factors are more likely to cause rotator cuff tears.
1. Age: Patients over the age of 40 are more likely to develop tears;
2. Exercise patterns: prolonged repetitive heavy lifting or overhead movements, such as tennis, painters, carpenters, etc.
Symptoms
1.After rotator cuff tear, it often causes a series of symptoms, common symptoms include
2. Anterolateral/diffuse acute or chronic pain in the anterolateral shoulder joint;
3, Pain at rest and at night, especially when sleeping on the side;
4. Pain that is triggered or aggravated by overhead movements;
5. There may be weakness in lifting or rotating the arm;
6.Sometimes there is a ringing sound when moving the shoulder joint;
7. There may be secondary limitation of shoulder joint mobility.
Imaging examination
In addition to symptoms and physical examination by a clinician, the diagnosis of rotator cuff tears also requires the cooperation of imaging examinations. A complete imaging examination should include the following parts.
I. X-ray: It can be used to initially evaluate whether the rotator cuff is calcified, whether there is acromion, bony deformity, arthritis, fracture, dislocation, bone tumor, etc.;
MRI: Non-invasive and can clearly show the muscles, tendons, glenoid lips, joint capsule, cartilage and surrounding soft tissues, easy and fast, but expensive;
Ultrasound: Highly accurate in diagnosing rotator cuff tears, and inexpensive compared to MRI. However, it requires the operating physician to have rich clinical experience and meticulous examination techniques.
Treatment.
Rotator cuff tears, if not repaired, will gradually become larger and can go from a small rotator cuff tear of less than 1cm to a large rotator cuff tear of greater than 3cm in as little as 1 year. Therefore, for diagnosed rotator cuff tears, if you are too old (>75 years old) or physically unable to tolerate surgery, you can consider conservative treatment such as oral anti-inflammatory and analgesic drugs, physical therapy, and intra-articular local seal. Otherwise, surgical treatment is recommended to repair the rotator cuff.
In the past, open surgery was used to repair the rotator cuff, but in the past 20 years, with the development of arthroscopic technology, the technique of total rotator cuff repair has matured. Numerous clinical studies have shown that total arthroscopic repair of the rotator cuff can achieve the same results as open surgery. The results of clinical follow-up show that total arthroscopic rotator cuff repair has the advantages of less trauma, faster recovery and better prognosis.