Most people have the perception that they may be suffering from frozen shoulder, but it is not a big problem, so they don’t need to go to the hospital and just stick a plaster on themselves and keep exercising. This is wrong. A significant number of patients with chronic shoulder pain are not suffering from frozen shoulder, but are actually diagnosed with rotator cuff injury. For patients with rotator cuff injury, insisting on exercising with rotator cuff injury will only make the ruptured rotator cuff continue to tear and aggravate the condition. Here, Ah Toob has a popularization of what rotator cuff injury is, the clinical manifestation and diagnosis of rotator cuff injury, hoping to correct some misconceptions about shoulder pain!
What is the rotator cuff structure of the body and where is it located in the shoulder joint?
The rotator cuff is a tendon complex formed by the supraspinatus, infraspinatus, subscapularis, and teres minor muscles, which wraps around the humeral head and looks like a sleeve, hence the name rotator cuff.
The function of the rotator cuff is to tighten the humeral head toward the glenoid during upper arm abduction, maintain the normal fulcrum of the humeral head and glenoid, and ensure the stability of the shoulder joint.
One of the most common injuries to the rotator cuff is to the supraspinatus, followed by the infraspinatus.
Why are the supraspinatus and infraspinatus muscles prone to injury?
1. The internal structure of the rotator cuff gradually develops cellular degeneration, necrosis, calcium salt deposition, and fiber rupture with age, which is relatively rare in adults under 40 years old and gradually worsens with age.
2.Angiography confirmed that there is a significant vascular sparing zone in the area of 1 cm where the supraspinatus muscle ends at the humeral head stop, which is called the rotator cuff tear risk zone.
3.Anatomical structure and mechanical stress analysis showed that the supraspinatus muscle was under maximum stress at the stop of the humeral head and was prone to injury.
4, There is a bony structure above the supraspinatus muscle, and the shoulder abduction and supination can easily lead to an impact between the supraspinatus muscle and the acromion, producing a rupture.
Classification of rotator cuff injury.
Partial rupture: rotator cuff articular surface rupture, rotator cuff synovial surface rupture, rotator cuff tissue internal flat type rupture, rotator cuff tissue internal longitudinal type rupture
Complete rupture: small rupture: rupture opening less than 1 cm
Moderate rupture: 1-3cm rupture
Large rupture: rupture mouth 3-5cm
Extra large rupture: rupture opening greater than 5cm
Etiology of rotator cuff injury.
1.Trauma is the main cause of rotator cuff injury in young adults.
2.Degenerative degeneration of rotator cuff tissue caused by insufficient blood supply, a common cause of rotator cuff injury in elderly patients.
3.Chronic impingement injury of the shoulder, middle-aged patients with long-term shoulder activity are prone to injury.
Typical symptoms of rotator cuff injury.
Pain occurs in the shoulder, the pain is mostly located at the top and front of the shoulder, and the pain can radiate to the outside of the shoulder.
Patients with a complete rotator cuff rupture: Most patients have a significant restriction of shoulder movement, especially in supination and abduction, and are unable to maintain supination after assisted supination.
Patients with partial rotator cuff rupture: usually the shoulder can still be moved, but the range of motion is reduced and the strength is decreased; the pain is worse at night and the patient cannot lie on the affected side.
Physical examination of rotator cuff injury.
Empty jar test (Jobe test)
Drop arm test (Drop Arm Test)
Hypoglossus test (resistance to internal rotation test)
Ancillary tests for rotator cuff injury.
Gold standard: Magnetic resonance imaging of the shoulder joint
Treatment of rotator cuff injury.
Conservative treatment: For patients with a partial rotator cuff rupture who have been injured for less than 3 months.
Conservative treatment is also available for older patients who do not have high demands on the shoulder joint or who cannot tolerate surgery.
Surgical treatment: Complete rotator cuff rupture requires surgical treatment, and currently the main treatment method is shoulder arthroscopy.
Shoulder arthroscopy
Ruptured rotator cuff (arthroscopic view of the shoulder)
Repaired rotator cuff (arthroscopic view)
Shoulder arthroscopic surgery is now more mature, and compared with traditional open repair surgery, it is less traumatic, less bleeding, faster recovery, and has less impact on the function of the shoulder joint. Depending on the degree of complete rotator cuff rupture during surgery, the rotator cuff can be repaired by direct suturing or anchor stapling with wires.