Damage to the rotator cuff of the shoulder joint
Last reviewed: 23.04.2024
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The damages of the rotator cuff of the shoulder joint are divided into tension, tendonitis and partial or complete rupture.
The rotator cuff, consisting of the supraspinous, subacute, small circular, subscapular muscles, helps to stabilize the humerus in the articular cavity of the scapula during a variety of athletic movements of the arm upwards (for example, throwing, swimming, lifting weights and playing tennis). Damage includes stretching, tendonitis, partial or complete rupture.
Tendonitis usually develops as a result of squeezing the tendon of the supraspinatus between the head of the humerus and the beak-acromial arch (acromion, acromioclavicular joint, beak-like process and beak-acromial ligament). This tendon is considered especially vulnerable, because it has a weakly vascularized area near the place of its attachment to the large tubercle. Developed as a result of inflammatory reaction and edema, further narrow the podkromialnoe space, thereby speeding up the process. If the process does not stop, tendonitis can go to fibrosis, or a complete or partial rupture may occur. Degenerative inflammation of the rotator cuff is common among people> 40 years of age who do not engage in sports. Subacromial (fake) bursitis is the most frequent manifestation of damage to the rotator cuff.
[Symptoms and diagnosis of damage to the rotator cuff of the shoulder joint
Symptoms of bursitis include pain in the shoulder, especially with upper body movements, and muscle weakness. The pain usually increases between 80-120 ° (especially strong when moving) with shoulder retraction or flexion and is usually minimal or absent within <80 ° and> 120 °. Symptoms can be of varying degrees. Incomplete rupture of the tendon and its inflammation give the same symptoms.
The state of the supraspinatus is evaluated by the patient's resistance to the pressure exerted on the arms from above, the patient holds hands in the front flexion, with the thumbs pointing downwards ("empty can" test).
Subacute and small round muscles are evaluated by the patient's resistance to pressure with external rotation, arms are lowered along the trunk with elbows bent at right angles. This position isolates the function of the muscles of the rotational cuff from other muscles, such as deltoid. Weakness during this test suggests a significant dysfunction of the rotator cuff (for example, a complete rupture).
The subscapular muscle is evaluated by the patient's resistance to pressure with internal rotation, or by setting the rear of the patient's hand on his back, ask him to try to raise his hand.
Other tests include Epley scratching test, Nir test, Hawkins test. The test of scratching Epley checks the range of movements in the shoulder joint, retraction and external rotation: the patient tries to touch the tips of the fingers of the opposite shoulder, holding his arm above the head behind the neck; Checking the reduction and internal rotation: an attempt to touch the opposite blade from below behind and back diagonally with the back surface of the brush. Nir's test reveals a disruption in the function of the rotator cuff tendon under the beak-acromial arch, this test is performed by placing the patient's arms in the position of forced flexion (arms raised above the head) with full pronation of hands. The Hawkins test also determines the presence of compression of the tendon of the supraspinatus; is carried out by raising the patient's arm at a right angle with a strong rotation of the shoulder to the inside.
The acromioclavicular and sternoclavicular joints, cervical vertebrae, biceps tendon and scapula should be palpated to identify areas of pain or defect and to exclude pathological conditions associated with damage to these areas.
The neck should always be inspected when examining the shoulder, because the pain from the cervical vertebrae can irradiate to the shoulder (especially with radiculopathy C5).
If a rotational cuff injury is suspected, MRI, arthroscopy, or both should be performed.
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Treatment of damage to the rotator cuff of the shoulder joint
In most cases, enough peace and strengthening exercises. Surgical treatment may be necessary in case of severe damage (eg, complete rupture), especially in young patients.