In a recently concluded NBA regular season game against the Pelicans, Lakers star Kobe had to withdraw from the rest of the season due to a shoulder injury. After the Achilles tendon and knee, it was another shoulder injury that once again caused the superstar to leave the game. During the game Kobe accidentally strained his shoulder during a dunk and left the game early because of shoulder pain. And in the subsequent MRI, it was found to be a torn tendon in the shoulder. Many media translated Kobe’s shoulder injury into a torn rotator cuff, so what exactly is a rotator cuff? And what exactly caused Kobe to get hurt again and again? Will he still be able to make it to the game? Can rotator cuff tears occur in the general population?
The rotator cuff is a direct translation of the English term rotator cuff, which is the real medical term for the rotator cuff. It is a very important part of the shoulder joint, and the four tendons that wrap around the head of the humerus like a cuff are collectively referred to as the rotator cuff. It consists of the supraspinatus tendon at the top, the supraspinatus and teres minor tendons at the bottom, and the subscapularis tendon at the front (diagram). The rotator cuff, as the name implies, has a rotational function that allows rotation of all sides of the shoulder joint, including internal and external rotation, and abduction and supination, and serves as a stabilizing structure for the shoulder joint, helping to depress the humeral head and prevent it from colliding with the acromion.
Rotator cuff tears are a very common sports injury of the shoulder joint, especially in sports with many overhead movements of the upper extremity. Heavy use of the shoulder joint can lead to rotator cuff wear and tear, which may be the direct cause of the eventual injury.
Rotator cuff tears are also a common degenerative disease in middle-aged and elderly people, and their incidence increases with age. According to statistics, the incidence of rotator cuff tears in people aged 50-59 years old is 13%, while the incidence of rotator cuff tears in people aged 60-80 years old can reach 20-30%, and up to 50% in people over 80 years old. In addition to direct traumatic violence, rotator cuff tears can also be caused by repetitive strain, including prolonged upper extremity work and repeated lifting of heavy objects. Some patients may also rupture spontaneously, so some patients with shoulder pain may not have experienced significant traumatic violence but may still have a rotator cuff tear.
Rotator cuff tears are often misdiagnosed as “frozen shoulder”, resulting in delays in treatment and turning the rotator cuff tear into a massive tear. Rotator cuff tears are mainly painful when the shoulder joint is moved, mostly during activity in the early stages, but in severe cases, the pain may occur at night while sleeping. At a certain level of progression, there will be a decrease in joint mobility, weakness in supination, and even secondary shoulder joint adhesions. Because of the complex structure of the shoulder joint, general orthopedic surgeons are not familiar with the anatomy and mechanics of the shoulder joint, so it is very easy to misdiagnose the problem; X-rays and CTs are not able to determine this, and MRI or ultrasound is usually needed to know if there is a rotator cuff injury.
What should I do if I have a rotator cuff tear? Usually the injury will be goodbye. If you want to return to play, Kobe will most likely have to undergo surgery. For the general population, surgery is the best option to restore function once it is clear that the rotator cuff is torn. Sports medicine specialists currently use minimally invasive shoulder arthroscopy surgical techniques to re-sew the torn rotator cuff back onto the bone with a few small incisions, reshaping the function and stability of the rotator cuff. After the surgery, as long as you actively cooperate with the rehabilitation, you can fully resume your daily function and sports. This is different from Yao Ming’s fatigue fracture. Kobe’s shoulder injury is a relatively common soft tissue injury, and as long as the right specialist and treatment is chosen, he is fully capable of repairing the torn tendon and returning to play.
If the symptoms do not subside after rest, you need to seek immediate medical attention. A sports medicine specialist can help clarify the diagnosis and implement minimally invasive treatment.
Finally, we have attached a shoulder function self-assessment form to help you understand the functional status of the shoulder joint.
Shoulder function self-assessment method.
1.Do you feel pain in the shoulder joint? (Score 0-10, 0 being no pain, 10 being extreme pain)
2.Do you feel shoulder pain when you sleep at night? (0-10 points, 0 is never, 10 is very often affects sleep)
3.The painful side can help to put on pants and belt (3 points for being able to do it, 0 points for not being able to do it)
4.After toileting, the painful side of the limb can take care of personal hygiene and touch the back pocket of the pants, etc. (3 points for completion, 0 points for failure to complete)
5.When taking a bath, the upper limb on the painful side does back rubbing (3 points for completion, 0 points for inability to complete)
6.The painful side of the hand holds a cup to drink, take dishes to eat, brush teeth and wash face, etc. (3 points for completion, 0 points for failure to complete)
7.Wearing outer clothes and shirts on the painful side (3 points for completion, 0 points for inability to complete)
8.Sleeping on the side of the painful limb (3 points for completion, 0 points for inability to complete)
9.Wash the armpit and body on the opposite side with the painful side when bathing (3 points for completion, 0 points for failure to complete)
10.Wash and comb hair with the hand on the painful side (3 points for completion, 0 points for failure to complete)
11.The painful side of the limb to reach beyond the top of the head (3 points if you can do it, 0 points if you can’t)
12.Overall evaluation of your satisfaction with your current shoulder joint status (0-7 points, very satisfied with 7 points, very dissatisfied with 0 points)
Score calculation: (1) Subtract the scores of items 1 and 2 from 20; (2) Add up the scores of items 3 to 11; (3) Multiply the score of item 12 by 2 and add the scores of the first two parts (1) and (2), that is, the final total score.
A. 61 – 50 points, fair function, continue to observe
B. 49-30 points, function is affected, recommend hospital consultation
C. 29 points or less, the function is more serious, seek medical attention as soon as possible