How can you identify a rotator cuff injury. What are the common symptoms of rotator cuff problems. When should you seek medical attention for shoulder pain. What treatment options are available for rotator cuff injuries.

Understanding Rotator Cuff Anatomy and Function

The rotator cuff is a crucial component of the shoulder joint, consisting of four muscles and their associated tendons. These muscles work together to stabilize the shoulder and enable a wide range of arm movements. To fully grasp the impact of rotator cuff injuries, it’s essential to understand the basic anatomy and function of this complex structure.

The Four Muscles of the Rotator Cuff

• Supraspinatus
• Infraspinatus
• Subscapularis
• Teres minor

Each of these muscles plays a specific role in shoulder movement and stability. The tendons of these muscles attach to the upper arm bone (humerus), forming a cuff-like structure around the shoulder joint. This arrangement allows for the diverse range of motion we enjoy in our shoulders while providing crucial support to the joint.

Recognizing the Signs of a Rotator Cuff Injury

Identifying a rotator cuff injury early can be crucial for effective treatment and recovery. While symptoms may vary depending on the severity and type of injury, there are several common signs to watch for:

Key Symptoms of Rotator Cuff Problems

• Shoulder weakness
• Pain when lifting or rotating the arm
• Difficulty sleeping on the affected side
• Clicking or popping sensation during arm movement
• Reduced range of motion

Dr. Christopher Kim, an orthopedic surgeon specializing in sports medicine, emphasizes that shoulder weakness is the primary indicator of a rotator cuff injury. If you find it challenging to raise your arm above your head or notice a significant difference in strength between your shoulders, it’s time to consider the possibility of a rotator cuff problem.

Types of Rotator Cuff Injuries: From Tendonitis to Tears

Rotator cuff injuries can range from mild inflammation to complete tendon tears. Understanding the different types of injuries can help you better communicate with your healthcare provider and make informed decisions about treatment.

Rotator Cuff Tendonitis

Tendonitis occurs when the tendons of the rotator cuff become irritated and inflamed. This condition often develops over time due to repetitive motions or prolonged pressure on the shoulder, such as sleeping on the same side every night. Symptoms of tendonitis may include:

• Pain when lifting the arm overhead
• Tenderness in the shoulder area
• Mild swelling
• Stiffness in the shoulder joint

Rotator Cuff Tears

Tears in the rotator cuff can be partial or complete, and they may result from acute injury or gradual degeneration. Dr. Kim explains that tears can be categorized as follows:

1. Partial tears: Some tendon fibers are damaged, but the tendon remains partially attached to the bone.
2. Full-thickness tears: The tendon is completely detached from the bone, creating a hole in the rotator cuff.

Symptoms of rotator cuff tears may include:

• Sudden, sharp pain with certain arm movements
• Weakness when lifting or rotating the arm
• Inability to sleep on the affected side
• Cracking or popping sounds when moving the shoulder

Risk Factors and Causes of Rotator Cuff Injuries

Understanding the factors that contribute to rotator cuff injuries can help you take preventive measures and recognize when you might be at increased risk. Several elements can influence the likelihood of developing a rotator cuff problem:

Age-Related Degeneration

As we age, our tissues naturally become less resilient and more prone to injury. Dr. Kim notes that individuals over 40 are at higher risk for rotator cuff tears, with the risk increasing significantly in people in their 60s, 70s, and 80s. Many older adults may have asymptomatic rotator cuff tears without even realizing it.

Occupational and Recreational Activities

Certain jobs and hobbies that involve repetitive overhead arm movements can increase the risk of rotator cuff injuries. Examples include:

• Painters
• Carpenters
• Athletes (especially swimmers, tennis players, and baseball pitchers)
• Weightlifters

Traumatic Injuries

While less common than degenerative tears, acute injuries can cause rotator cuff damage. Falls, especially those where you try to break your fall with an outstretched arm, can lead to rotator cuff tears. These traumatic injuries are more frequently seen in younger adults.

Diagnosing Rotator Cuff Injuries: The Importance of Professional Assessment

Accurately diagnosing a rotator cuff injury requires the expertise of a healthcare professional, particularly a sports medicine physician or orthopedic specialist. These experts employ a variety of diagnostic techniques to pinpoint the exact nature and extent of the injury.

Physical Examination

The diagnostic process typically begins with a thorough physical examination. The physician will assess your shoulder’s range of motion, strength, and any areas of tenderness. They may also perform specific tests designed to evaluate the function of individual rotator cuff muscles.

Imaging Studies

To confirm the diagnosis and determine the severity of the injury, your doctor may order one or more imaging studies:

• X-rays: While they don’t show soft tissue injuries, X-rays can rule out other conditions like arthritis or bone spurs.
• Ultrasound: This non-invasive test can reveal tendon tears and inflammation in real-time.
• MRI (Magnetic Resonance Imaging): Provides detailed images of soft tissues, allowing for precise evaluation of rotator cuff tears.

It’s important to note that a comprehensive diagnosis is crucial for developing an effective treatment plan. Dr. Kim emphasizes that sports medicine physicians are uniquely trained to differentiate rotator cuff injuries from other shoulder problems, such as cervical spine issues or biceps tendon injuries.

Treatment Options for Rotator Cuff Injuries

The appropriate treatment for a rotator cuff injury depends on several factors, including the type and severity of the injury, the patient’s age, activity level, and overall health. Treatment options range from conservative approaches to surgical interventions.

Conservative Treatment

For many rotator cuff injuries, especially those caught early, non-surgical treatments can be highly effective. These may include:

• Rest and activity modification
• Ice or heat therapy
• Non-steroidal anti-inflammatory drugs (NSAIDs)
• Physical therapy to improve strength and flexibility
• Corticosteroid injections for pain relief

Surgical Intervention

In cases of severe tears or when conservative treatments fail to provide relief, surgery may be necessary. Surgical options include:

• Arthroscopic repair: Minimally invasive procedure using small incisions and a camera
• Open repair: Traditional surgery for larger or more complex tears
• Tendon transfer: Used when the torn tendon is too damaged to be reattached

The choice of surgical technique depends on the specific characteristics of the tear and the surgeon’s expertise. Recovery from rotator cuff surgery typically involves a period of immobilization followed by progressive rehabilitation exercises.

Preventing Rotator Cuff Injuries: Strategies for Shoulder Health

While not all rotator cuff injuries can be prevented, there are steps you can take to reduce your risk and maintain shoulder health. Implementing these strategies can help protect your rotator cuff from both acute injuries and long-term wear and tear.

Proper Exercise Technique

Whether you’re an athlete or someone who exercises regularly, using proper form during shoulder-intensive activities is crucial. This includes:

• Maintaining good posture during overhead movements
• Avoiding sudden, jerky motions that can strain the shoulder
• Gradually increasing the intensity and duration of shoulder exercises

Strengthening and Stretching Routines

Incorporating specific exercises to strengthen the rotator cuff muscles and improve shoulder flexibility can help prevent injuries. Consider including the following in your fitness routine:

• External and internal rotation exercises
• Shoulder blade squeezes
• Wall slides
• Gentle shoulder stretches

It’s advisable to consult with a physical therapist or certified trainer to ensure you’re performing these exercises correctly and targeting the appropriate muscle groups.

Workplace Ergonomics

If your job involves repetitive shoulder movements or prolonged periods in positions that stress the rotator cuff, making ergonomic adjustments can help reduce your risk of injury. Consider:

• Adjusting your workstation to minimize overhead reaching
• Taking regular breaks to stretch and change positions
• Using assistive devices to reduce shoulder strain when possible

When to Seek Medical Attention for Shoulder Pain

Knowing when to consult a healthcare professional about shoulder pain is crucial for preventing long-term damage and ensuring proper treatment. While some minor aches and pains may resolve on their own, certain signs warrant immediate medical attention.

Red Flags for Immediate Consultation

Seek medical care promptly if you experience any of the following:

• Sudden, severe pain following an injury or fall
• Inability to move your arm or shoulder
• Visible deformity in the shoulder area
• Pain that persists even when the arm is at rest
• Weakness that interferes with daily activities

Ongoing Symptoms Requiring Evaluation

Even if your symptoms are less severe, it’s important to consult a healthcare provider if you experience:

• Persistent pain lasting more than a few weeks
• Gradual loss of shoulder motion or strength
• Pain that interferes with sleep or daily activities
• Recurrent shoulder pain or weakness

Remember, early intervention can often lead to more effective treatment and faster recovery. Don’t hesitate to reach out to a sports medicine physician or orthopedic specialist if you have concerns about your shoulder health.

Living with a Rotator Cuff Injury: Adapting and Recovering

Coping with a rotator cuff injury can be challenging, but with the right approach, many individuals can maintain an active lifestyle and achieve a successful recovery. Understanding how to adapt your daily activities and approach rehabilitation can make a significant difference in your outcome.

Modifying Daily Activities

While recovering from a rotator cuff injury, you may need to adjust how you perform certain tasks to avoid exacerbating your condition. Consider these strategies:

• Use your unaffected arm for activities that require reaching or lifting
• Keep frequently used items at waist level to minimize overhead reaching
• Use assistive devices like long-handled reachers or shower chairs
• Ask for help with tasks that may strain your injured shoulder

Rehabilitation and Physical Therapy

A structured rehabilitation program is often crucial for recovering from a rotator cuff injury. Physical therapy typically focuses on:

1. Restoring range of motion
2. Strengthening the rotator cuff and surrounding muscles
3. Improving shoulder blade stability
4. Correcting any movement patterns that may have contributed to the injury

Consistency with your prescribed exercises and attending all scheduled therapy sessions can significantly impact your recovery time and overall outcome.

Managing Pain and Discomfort

During the recovery process, you may experience varying levels of pain and discomfort. Work with your healthcare provider to develop a pain management strategy, which may include:

• Appropriate use of over-the-counter or prescription pain medications
• Application of ice or heat therapy
• Gentle stretching exercises
• Modifying activities to avoid pain triggers

Remember that while some discomfort during rehabilitation is normal, sharp or severe pain should be reported to your healthcare provider immediately.

Emotional and Mental Well-being

Dealing with a rotator cuff injury can be mentally and emotionally challenging, especially if it impacts your ability to work or participate in activities you enjoy. Consider these strategies for maintaining your mental health:

• Stay connected with friends and family for support
• Explore new hobbies or activities that don’t strain your shoulder
• Practice stress-reduction techniques like meditation or deep breathing exercises
• Join a support group for individuals with similar injuries

By taking a holistic approach to your recovery, addressing both the physical and emotional aspects of living with a rotator cuff injury, you can improve your chances of a successful outcome and maintain a positive outlook throughout the healing process.

How to Tell When You’ve Torn or Injured Your Rotator Cuff

There’s a fine line between normal wear and tear and an actual tear of your rotator cuff.

Posted
by Featured Provider Christopher Kim on Friday, March 26, 2021

Raise your hand if you’ve experienced shoulder pain.

If your hand isn’t stretched high above your head, there’s a decent chance you have a damaged rotator cuff.

Shoulder weakness is the No. 1 sign of a rotator cuff injury, says Christopher Kim, MD, an orthopaedic surgeon who specializes in sports medicine. So if you struggle to lift your arm above your head, it’s likely that there’s something wrong in this part of the shoulder.

Shoulder weakness is the common symptom across a range of rotator cuff injuries.

Like the shoulder itself, the rotator cuff is a complex set of working parts that allow you to lift and rotate your arms (hence the name). The rotator cuff is made up of four different muscles (the supraspinatus, infraspinatus, subscapularis and teres minor) and the tendons that attach them to the bone to help stabilize your shoulder joint. So you can have a problem with one or many of the muscles and suffer from the same weakness.

“People come in with similar kinds of pain and often complain of the same thing,” Dr. Kim says. “We sort out where the weakness is really coming from to figure out which part of the rotator cuff it is, and how bad it is.”

You may not easily notice the weakness yourself if, say, you can still raise up your arm. But you might feel a pain, pop or click when you move your arm a certain way or sleep on it in bed. Other times, you don’t notice it until one shoulder gives out or is noticeably weaker when you try to lift something you normally have no problems with.

Uniquely Trained to Identify Your Shoulder Issues 

Only a sports medicine physician can pinpoint your shoulder problem. Meet with Dr. Kim to improve your strength and overcome your injury. 

Make an Appointment 

Sports medicine physicians like Dr. Kim run you through a battery of tests to first identify that it’s a rotator cuff injury and not something wrong with cervical vertebra, neck, biceps or AC joint. Then they sort out the severity of the damage.

“There’s a very broad spectrum. On one end, you have impingement, bursitis and rotator cuff tendonitis. On the other end of the spectrum, there’s a full thickness rotator cuff tear. And then you have a whole bunch in between and partial tears that range from low-grade or high-grade.”

Rotator Cuff Tendonitis

The tendons of your rotator cuff can become irritated and inflamed, leading to tendonitis. It’s something that usually occurs over time, whether from sleeping on the same side of your body every night or performing repetitive motions that require you to raise your arm above your head.

“This is what some refer to as impingement or bursitis,” Dr. Kim says. “We have a bursa, which is a little fluid-filled sac around the rotator cuff that allows things to glide over each other. Inflammation can cause it to swell with more fluid, which leads to pain.”

And as you move, the space around your rotator cuff narrows. The tendons rub against other parts of the shoulder, causing more irritation and pain.

Rotator Cuff Tears

The tendons that attach the rotator cuff can also start to fray or lose their connection to the bone.

“We characterize rotator cuff tears in lots of different ways. We can define it as more the wear-and-tear, degenerative tear that happens as we get older, which is common. There are also the traumatic tears, where you have a fall or an injury. Either of these can be partial or full,” Dr. Kim says.

Partial rotator cuff tears are when there is damage, but some of the tendon is still connected. Full-thickness, or complete rotator cuff tears, are completely disconnected and look like there is a hole where the muscle should attach to the bone.

Age and repetition both wear on your rotator cuff muscles and tendons.

Traumatic tears are more common in young adults, as the result of a fall. But the majority of rotator cuff tears are of the degenerative type — the normal wear and tear your body faces over time. You’re more likely to suffer a rotator cuff tear after the age of 40. People in their 60s, 70s and 80s have a good chance of tearing a rotator cuff without even knowing it, Dr. Kim says.

With age, comes the repetition that causes these degenerative tears. By the time you’re 40, you’ve simply moved your shoulder a lot more times than through age 20. But there are other risk factors for developing a degenerative tear or even rotator cuff tendonitis.

“The non-traumatic type of tear typically happens in people who had a lot of repetitive motions with their shoulders. And that repetitive motion could be lifting heavy objects or performing manual labor where you’re constantly lifting and pulling,” Dr. Kim says. “It can actually even be repetitive desk work, like using a mouse or keyboard all day. People complain about shoulder pain with that, too.”

There are also biological, internal risk factors, he says. A history of shoulder trauma or surgery puts you at risk of a tear. So does smoking. Smokers tend to have more rotator cuff problems and more pain.

Rotator cuff pain is easy to overcome with stretches and exercises.

There’s no specific shoulder stretch, exercise or routine for you to prevent a rotator cuff injury. But that’s typically the prescription for rotator cuff problems, even up to partial tears.

“Rotator cuff treatment is so variable. Not all rotator cuff injuries are treated the same. One full-thickness tear is different from another. Partial tears are different from full tears,” Dr. Kim says. “There are a lot of factors involved, but almost always our recommendations are non-surgical. You undergo therapy with a physical therapist or do your own home exercises. And then we discuss whether a steroid injection is beneficial or not in managing your pain.”

When these more conservative treatments aren’t effective, or you suffered a complete tear, rotator cuff repair surgery is needed.

“The majority of rotator cuff surgeries are all arthroscopic. It’s a less invasive surgery but recovery from a rotator cuff repair is actually quite long. It takes much longer for soft tissue to heal back onto bone,” Dr. Kim says.

“You’re typically in a sling for about six weeks. During that time, you come out of the sling two or three times a week for physical therapy. It’s usually three months before you start any strengthening exercises — light bands and things like that. And you typically go to therapy for five to six months before continuing to improve on your own at home. It’s usually about nine to 12 months total before it’s the best you’re rotator cuff is going to get.”

Nobody wants to hear that their shoulder weakness is going to take a year of treatment and effort to heal. That’s why it’s so important to get evaluated early, Dr. Kim says.

“The longer you have symptoms, the harder it often is to treat. And the injury has progressed,” he says, “Treating a rotator cuff problem when it’s at the early stages of bursitis or tendonitis is best. People respond pretty well with non-surgical, conservative measures like injections and physical therapy.”

So as soon as you feel a twinge of shoulder pain or weakness, schedule a shoulder evaluation or visit the Bone & Joint Center to start a much shorter road to recovery.

Are You Suffering With These Symptoms of a Rotator Cuff Tear?: Dr. Matthew Pifer: Orthopedic Shoulder Surgeon

Rotator cuff tears are painful shoulder injuries that occur when there’s damage to the rotator cuff — a collection of muscles and tendons that contribute to shoulder mobility and stability. While there are numerous techniques to treat a small rotator cuff tear, a significant tear usually requires surgery for a full recovery.

Board-certified orthopedic surgeon Matthew Pifer, MD specializes in minimally invasive shoulder surgery and has extensive experience performing rotator cuff repairs. 

Most rotator cuff tears are the result of a single incident, like a sports injury. Occasionally, a bone spur in the shoulder might cause a tear. Hobbies or sports that involve repeat shoulder movements, such as baseball, tennis, and construction work, raise the risk of rotator cuff injuries.

Telltale signs of a rotator cuff tear

Shoulder pain is one of the main signs of a rotator cuff tear, but there are other signs that make it more likely. Where in the shoulder the pain occurs and how your shoulder moves provide helpful clues to the source of your shoulder issues.

In rotator cuff injuries, the pain is felt at the front of the shoulder. Because the rotator cuff enables shoulder mobility and provides stability, problems in these areas suggest a rotator cuff tear. Patients with rotator cuff tears have trouble raising their arms and reaching behind them. When you try to make these movements, your pain may worsen.

Because the shoulder is unstable, patients often notice a popping or clicking sound in the shoulder when moving the arm. This happens when the rotator cuff is unable to keep the upper arm bone in the shoulder socket. 

Some individuals report pain all the way to their elbow because nerves from the rotator cuff flow down the arm. Here are the main signs that suggest you have a rotator cuff tear. 

Movement restriction

It will be difficult to move your arm and shoulder normally if the rotator cuff is torn. Simple tasks like brushing your hair, dressing, and cooking will be excruciatingly painful. You may find it challenging to carry even small objects due to the lack of range of motion. Reaching overhead is particularly problematic when the rotator cuff is torn. 

Shoulder stiffness

If your rotator cuff is injured, your shoulder will become painful and stiff. Your arm will become much more rigid if you stop moving it. You may feel like your shoulder is frozen at times. 

Shoulder weakness

Your shoulder can’t hold as much weight as it usually can when your rotator cuff is damaged. Even something as small as a book may feel too heavy and your arm may become fatigued quickly. 

Repairing a rotator cuff

Dr. Pifer has experience repairing partial and full rotator cuff tears. The following are common approaches. 

Partial rotator cuff tear repair

When the rotator cuff tendon is ripped but hasn’t completely separated from the underlying bone, a partial repair can restore mobility and relieve pain. Surgery typically involves removing a portion of the acromion bone, which is situated on the shoulder blade. 

The ragged ends of the torn tendon are smoothed, and the inflamed bursa sac is removed. Damaged ligaments are removed in the process. 

Full rotator cuff tear repair

If the tendon has entirely torn or is completely separated from the upper arm bone, a comprehensive rotator cuff repair procedure is required. Depending on the degree of the damage, there are a few different procedures to complete a full rotator cuff repair.

Dr. Pifer specializes in minimally invasive arthroscopic shoulder surgery. With arthroscopic surgery, small incisions are created in the shoulder’s side and back, and Dr. Pifer removes any damage, such as bone spurs. He then reconnects the tendon to the humerus using suture anchors.

Only in cases of severe joint deterioration or serious injury is open surgery performed. Bone, cartilage, and tendons that have been injured are replaced using bone and tissue grafts from other parts of the body. The humerus bone’s head is then used to reconnect the tendon.

Dr. Pifer may use mini open surgery, which involves making a wider incision than is necessary for arthroscopic surgery but doesn’t involve opening the entire shoulder joint or using grafts.

Rotator cuff tears are serious business. Not only is a rotator cuff tear unlikely to get better on its own, but left untreated, it can progress into a chronic issue that causes more problems down the line.  

Trust an experienced shoulder surgeon to provide exceptional shoulder care when you need it most. Give us a call to schedule a visit with Dr. Pifer at our Santa Barbara, California office. A team member can assist you in scheduling an in-person or telemedicine appointment with Dr. Pifer.

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Pushing your limits on the field shouldn’t mean risking your well-being. Teaming up with a sports medicine professional can be a game-changer. Uncover how this partnership helps you stay healthy and in the game.

Are You Experiencing These Telltale Signs of a Rotator Cuff Tear?

Shoulder pain can be a warning sign of a common but potentially serious injury: a rotator cuff tear. Don’t let this condition go unnoticed; learn the telltale signs and take action to protect your shoulder health.

Here’s When Arthroscopy Is the Right Course of Action

Your age and other factors play a role in whether arthroscopy is the right treatment option for your joint injury. It’s wise to meet with a specialist for a thorough evaluation and to discuss your options.

Is PRP Right for Me?

For anyone looking to speed up their recovery, platelet-rich plasma (PRP) therapy is a game-changing option. Find out how this cutting-edge treatment can help you get back to your daily activities pain-free.

How to Tell If You Have Shoulder Instability

Shoulder instability is not only painful but risky if left untreated. Having a specialist examine your shoulder is the first step to diagnosing shoulder instability. Once diagnosed, treatment eases pain and restores function.

Why You Should Consider Sports Medicine If You’re Not an Athlete

Sports medicine offers a range of benefits, and you don’t have to be an athlete to reap them. Patients with a range of issues can take advantage of sports medicine programs for preventing and treating injuries.

Treatment of impingement syndrome (rotator cuff injury) in Yaroslavl

Description

The main complaint in this disease is diffuse dull pain in the shoulder, aggravated by raising the arm up. Many note that it interferes with sleep, especially if you lie on the side of the affected shoulder joint.

A characteristic symptom is the occurrence of acute pain when trying to reach the back pocket of the trousers. Later stages are characterized by increased pain, stiffness of the joint. Sometimes when lowering the arms, a clicking in the joint is possible.

Difficulty or impossibility of raising the arm up, weakness are possible with a rupture of the tendons of the rotator cuff – a tendon formation from the tendons of the infraspinatus, supraspinatus and subscapularis muscles. The main function of the tendon formation is the stabilization of the head of the shoulder during the abduction of the upper limb in the glenoid cavity of the scapula and its retention.

The most frequent patients with impingement syndrome are middle-aged and older people . Due to post-traumatic or age-related changes, the acromial process of the scapula becomes sharpened, osteophyte spikes form on it, which leads to abrasion of the rotator cuff – which is impingement syndrome.

Treatment

If the rotator cuff is intact, conservative treatment can be started

It is necessary to limit the patient’s activity, anti-inflammatory therapy, physiotherapy, local administration of steroid drugs, it is desirable to wear a scarf. Therapeutic treatment takes from several weeks to several months, and the listed methods are usually sufficient if the disease is not advanced.

If the therapeutic treatment of impingement syndrome does not give results, then surgical treatment is performed.

It is also indicated for acute pain or damage to the dominant hand, when the quality of life of the patient decreases. Surgical treatment consists in arthroscopic subacromial decompression: through skin punctures with a special instrument, bone spikes from the acromial process of the scapula, compressing the rotator cuff and causing pain, are removed under the control of an arthroscope, while the joint is simultaneously washed with a large amount of isotonic solution.

In case of damage to the rotator cuff, surgical treatment is indicated in almost 100% of cases. The operation is performed arthroscopically through punctures or through a small incision. The choice of operation method depends on the location of the gap and its size. If the gap is partial, then during the operation only smoothing of the edges of the damage is required. Complete ruptures involving the entire thickness of the ligamentous apparatus require suturing, and ruptures at the site of attachment of the tendon to the bone require the tendon to be “sutured” to the bone with absorbable anchors.

If you have any questions or sign up for a consultation with a specialist, please call:
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Daily from 8:00 to 20:00

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Restoration of the rotator cuff of the shoulder

Restoration of the rotator cuff of the shoulder.

A ruptured rotator cuff is a serious injury with limited upper limb function. Usually complicated by subluxation of the head of the humerus.

Types of tendon rupture:
Depending on which ligaments are damaged, there are:
– Torn rotator cuff – it consists of the tendons of the subscapularis, teres minor, supraspinatus and infraspinatus muscles. All of them are interconnected and with the joint capsule, provide its mobility and integrity.
– Rupture of the tendon of the biceps of the shoulder
• long head
• short head
Depending on the degree of damage, they distinguish:
– Partial rupture of the ligament – not all fibers are damaged, but only part of them. This condition is called a “sprain” of the ligament.

The causes of damage to the rotator cuff can be different:
– Acute injury. Most often, this fall on the shoulder or elbow joint, as well as a blow to the shoulder joint area, can be accompanied by damage to the tendons.
– Chronic traumatization of connective tissue structures or muscle fibers against the background of systematic loads and performance of the same type of hand movements. This reason is most often realized in athletes who are engaged in shot put, javelin throwing, rowing, weightlifting, tennis. Also, premature cuff wear occurs in people whose professions are associated with the same type of hand movements raised up: teachers writing with chalk, painters, plasterers.
– Age-related changes. Age-related changes can lead to rupture of the rotator cuff. Over time, the tendons become weaker and more easily injured.
– Congenital or acquired change in the anatomical ratio of various structures of the shoulder joint, leading to an increase in the load on the ligamentous apparatus, capsule and muscles.
– Decrease in the strength of the ligamentous apparatus, which is of a hereditary origin, realized at the genetic level (decrease in the number of collagen fibers in the connective tissue).

The symptoms of rotator cuff injuries depend on the degree of tear (complete or partial). With a partial tear, the patient can move the shoulder through the pain and often not fully. If the tendon is completely torn, a certain movement is almost impossible, and attempts to move it are painful. For example, if the tendon of the supraspinatus muscle is damaged, the abduction of the arm to the side suffers, while the subscapularis – its introduction to the opposite scapula. The patient complains of the inability to sleep on the affected shoulder. With an acute injury, severe pain occurs in the shoulder joint.

In a chronic process, pain first occurs occasionally, associated with raising the arm up. Over time, this unpleasant symptom appears more often, intensifies at night. As a result, the pain becomes constant, and the patient cannot perform the usual hand movements: comb or take off clothes without outside help. In the absence of proper timely treatment, arthrosis of the shoulder joint is formed.

Diagnosis

Reliable determination of the localization, as well as the severity of the violation of the anatomical integrity of the muscles, ligaments and tendons of the joint, is carried out with the help of additional objective diagnostics.
X-ray examination is mandatory, with the help of which it is possible to detect a sign of tendon rupture – subchondral sclerosis. It is formed due to friction of the head of the humerus against the lower part of the acromion.
If the diagnosis is doubtful and to clarify the nature and severity of the injury, ultrasound or MRI is performed, which allows you to examine the soft tissues, and arthroscopy can also be performed arthroscopy.

The choice of a diagnostic examination method is carried out by a doctor on the basis of a clinical examination (includes a survey, examination of the patient, performance of diagnostic tests), as well as the technical capabilities of the medical institution, providing it with the necessary equipment for performing diagnostic procedures.

Treatment:
Conservative treatment.

If the damage is not significant (partial damage), you will be offered conservative treatment.
Treatment involves ultrasound-guided injection of platelet-rich plasma into the site of injury. If necessary, radiofrequency ablation of the suprascapular and axillary nerves is performed to eliminate pain and facilitate the performance of special exercises, as well as blockades during the recovery period.

Surgical treatment.
With a complete rupture, conservative treatment is futile. Torn ligaments will not heal on their own. To repair the rotator cuff, the operation can be performed by open access or with the help of arthroscopy.

•During a surgical operation (open approach), reconstruction of the rotator cuff in our clinic is performed through a small, 5 cm long incision on the skin. Quite often, 2-3 so-called “anchor fixators” are required to fix a torn tendon. This retainer consists of an anchor and threads. The anchor is attached to the bone, and the tendon is stitched with threads. The choice of a specific type of anchor fixator is carried out by the operating orthopedic traumatologist, however, the patient is informed in detail about which fixator is planned to be used in his case. At the Anesta clinic, we use fixators from world-famous companies that have long established themselves: HEALIX ™ by DePuyMitek (a division of Johnson & Johnson) and TWINFIX ™ by Smith & Nephew.