University of Occupational and Environmental Health Wakamatsu Hospital
orthopedics・Sports arthroscopy
Wakamatsu Hospital for University of Occupational and Environmental Health
Orthopedic and Sports Arthroscopy Surgery
ISAKOS approved Teaching Center
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Rotator Cuff Tear
What is a rotator cuff? What is Rotator Cuff?
The rotator cuff consists of the supraspinatus muscle (SSP), the infraspinatus muscle (ISP), the teres minor muscle (Teres Minor), and the subscapularis muscle (SSC). It is responsible for dynamic stabilization of the humeral head in the glenoid of the scapula during overhead movements (eg, pitching, swimming, weightlifting, serving in racquet sports) and movement.
Rotator cuff tears can occur in acute or chronic sports injuries, but they are often reported to occur unrelated to sports activity and in people with no history of overuse.
A rotator cuff strain is a single, acute injury to a muscle. Tendonitis usually results from chronic supraspinatus tendon friction between the head of the humerus and the coracacromial arch (acromion, acromioclavicular joint, coracoid process, and coracoaromial ligament). Exercises that require repeated movements of the arm above the head, such as pitching a baseball, lifting weights above the shoulder, serving in racquet sports, swimming crawl, butterfly, or backstroke, increase risk.
The supraspinatus tendon has a poor blood flow near the attachment of the tendon to the greater tuberosity of the humerus, and furthermore, it is located under the acromion process and covers the narrowest part. considered to be particularly susceptible.
The resulting inflammatory response and edema further narrow the subacromial space, precipitating tendon irritation and injury.
If this progression is not stopped, the inflammation can eventually lead to a partial or complete rotator cuff tear.
Degenerative rotator cuff tendonitis is common among older nonathletes (> 40) for similar reasons. Subacromial bursitis (inflammation, swelling, and fibrosis of the joint capsule above the rotator cuff) commonly results from rotator cuff tendonitis.
Symptoms and Signs Symptoms
Subacromial bursitis, rotator cuff tendonitis, and partial rotator cuff tears cause shoulder pain, especially when the arm is raised overhead.
Pain is usually aggravated with shoulder abduction or flexion (painful arcs of movement) between 60 and 120 degrees and is often very mild below 60 degrees or above 120 degrees.
However, the pain may be dull and poorly localized.
A complete rotator cuff tear results in acute pain and shoulder weakness. Weakness of external rotation is particularly prominent in large rotator cuff tears.
Up to rotator cuff tearsnight painoften accompanied by
Diagnosis
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Physical Examination Physical Examination
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Diagnosis is by history and physical examination (including provocative procedures).
The rotator cuff cannot be directly palpated but can be assessed indirectly by provocative testing of each component muscle; significant pain or weakness is considered positive.
SSP test: To assess the supraspinatus muscle, have the patient lift the arm forward with the thumb pointing down to resist a downward force on the arm. test or Jobe test).
ISP test: For evaluation of the infraspinatus and teres minor, the patient has the arm at his side with the elbow flexed to 90 degrees and is encouraged to externally rotate against resistance; from other muscle (eg, deltoid) function. Weakness detected by this test suggests rotator cuff insufficiency (eg, complete tear).
lift-off test: For subscapularis evaluation, ask the patient to wrap the affected hand behind the back and place the dorsum of the hand on the hip. The examiner takes the hand and removes it from the waist. The patient must be able to keep this hand out of contact with the skin on the back (Gerber lift-off test).
IMPINGMENT TEST
Neer testexamines the tendon impingement of the rotator cuff located below the coracoaromial arch. The patient's arm is fully pronated and forced forward (lifted arm above head).
Hawkins testBut check for impingement. The patient's arm is raised to 90 degrees, the elbow is flexed to 90 degrees, and the shoulder is forced to internally rotate.
Apley scratch testasks the patient to touch the contralateral scapula and evaluates the range of motion of the complex shoulder joint: abduction by extending the fingertips from overhead to the back of the neck to the contralateral scapula and external rotation are tested; adduction and internal rotation are tested by extending the dorsum of the hand from below, across the back of the back, to the contralateral scapula.
Other sites that can cause shoulder pain include the acromioclavicular or sternoclavicular joints, the cervical spine, the biceps tendon, and the scapula.
If there is tenderness or deformity suggestive of a problem at these sites, the site should be evaluated and examined for merging or rule-out.
The neck is examined as part of any shoulder evaluation because referral pain from the cervical spine to the shoulder joint may occur, particularly with C5 radiculopathy.
If you suspect a shoulder rotator cuff injury As a simple test There is an ultrasound test.
If still suggestive of a tear or if symptoms do not resolve with short-term conservative treatment, further MRI evaluation should be performed.
How to take physical examination of the shoulder joint
Ultrasound image of supraspinatus tendon rupture
Treatment
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NSAIDs
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exercise therapy
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Under ultrasound guidance
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Sometimes surgery (mainly endoscopic surgery)
In most cases of tendinitis and bursitis, rest, nonsteroidal anti-inflammatory drugs (NSAIDs), and rotator cuff-strengthening exercises are adequate. Injection of corticosteroids into the subacromial space is sometimes indicated (eg, when symptoms are acute and severe or if prior treatment has failed). Chronic bursitis refractory to conservative management may require surgical removal of excess bone to relieve impingement. Surgical repair may be recommended for severe rotator cuff injuries (eg, complete tears).
Arthroscopic surgery at our hospital
