The rotator cuff is made up of four tendons that lie on the joint capsule which surrounds the shoulder joint. These tendons are called: Sub-scapular (front), supraspinous (top) and infraspinous and small round at the back. By acting on their muscles, the tendons act together to control shoulder movement (see article on conflict syndrome).
By external (trauma) and / or internal actions these tendons undergo changes in their structure and quality. Thus a fall can lead to a rupture of one of these tendons, but also the process of tendon aging coupled with daily exertion can wear out the tendon that causes a rupture. Also a worn, though not ruptured tendon on the occasion of a low energy trauma can rupture more easily. Although these situations lead to breakages, they have different characteristics and as such should be viewed in different ways.
In the consultation, we tried to find out if there were any complaints on the shoulder, whether or not you hear any trauma and what is the intensity, if the onset of the complaints was immediate, what intensity and type of pain you have and your inability to perform movements with the shoulder. . During medical observation we look for signs of muscle atrophy and decreased strength so that we can appreciate what we will find in the complementary exams.
Radiography shows bone changes and gives indirect signs of tendon injury and is therefore an important examination. Ultrasound is the only exam that can show the action of the moving tendons, however its quality is very dependent on who does it and does not give information about the quality of the tendon and muscle. Computed Axial Tomography (CT) has very little interest in this pathology. Magnetic resonance imaging may show the size of the tear, its location, the quality of the tendon and muscle, being the most important examination in a suspected rotator cuff tear.
In analyzing the situation consultation with your doctor is critical. Together with the complementary exams, the doctor will be able to give you the various types of treatment and advise which one is most likely to lessen / end your pain and improve your function in a lasting way.
When the pain is very severe, for example preventing you from sleeping at night, your doctor may indicate that you have an infiltration. In addition to lessening your pain, it also helps you to understand if your difficulty with shoulder movement is largely due to the pain or mainly due to tendon rupture.
In ruptures that occur in diseased tendons and in tears of part of the tendon thickness or complete but small (less than 1cm), physical therapy may be a good solution. The goals are, at an early stage, to lessen pain and then to optimize the functioning of all muscles and tendons of the shoulder girdle, to explore the possibility of mechanically balancing your shoulder and allowing it a quality life.
There are, however, situations where we know beforehand, through statistical analysis of treated patients, that physical therapy is not the best solution. In traumatic rupture of a good quality tendon, the surgical option is the best. Surgical repair of the rotator cuff is now done by arthroscopy. In experienced hands this technique has allowed to know the characteristics of the rupture and according to them choose the best and most stable way to repair it. This allows for earlier and safer physiotherapy and according to various comparative studies leads to better results even on lower quality tendons.
When the quality of tendons and muscles prevents repair of the rupture leading to a good result, other options become necessary. In patients under 55 years of age muscle transfers may be a good option. They are technically very complex surgeries that consist of placing a tendon in an anatomical position that allows it to have an action similar to that of the irreparable tendon. Results for supraspinatus and infraspinatus tears are good and consistent. The association of two tendon transfers gives less consistent results.
In older patients with massive tears, the solution most likely to lessen pain and provide a compatible function with independent, quality life is a special (inverted) prosthesis that allows you to raise your arm without the cuff tendons. It is a solution that was designed for patients in the seventh decade of life, and the prosthesis was designed specifically to solve this problem. The vast majority of patients, although not fully mobile, have acquired comfort and autonomy that makes them very happy with the outcome.
In short, the rupture of the hood is a multifaceted entity. Shoulder and elbow specialists are able, through medical observation and follow-up examinations, to offer you the treatment protocol that in our experience is most likely to help you. This text aims to inform you so that you can participate more clearly and actively in your treatment.
The surgical procedure consists in the reinsertion of the injured structures by a minimally invasive procedure (arthroscopy) or open (arthrotomy).