A rotator cuff tear is a common condition in the shoulder joint area. The rotator cuff is a group of muscles and tendons that are susceptible to wear and tear and accidents. If parts of the rotator cuff tear, this is known as a rotator cuff tear. Older people are usually affected.
Here you will find further information and selected doctors for shoulder injuries.
The shoulder joint enables arm movements in several directions. This makes it a very complex joint. The rotator cuff is responsible for many of these movements.
The rotator cuff is a group of four muscles, the so-called rotators. The rotators extend from the shoulder blade to the upper arm bone. Their attachments wrap around the head of the humerus like a cuff. This allows them to turn or rotate the arm.
At the same time, tensing these muscles together can press the head of the humerus into the socket and stabilize the joint. In addition to movement in different directions, the rotator cuff is also responsible for shoulder stability.
Naturally, this dual role places high stress on the tissue. The following are harmful to the rotator cuff
A rotator cuff tear is a common condition in the shoulder area. It describes a tear in the area of the rotator cuff (ICD code: S46/M75.1).
Typically, injuries affect the tendon that transmits the force of the moving muscle to the static bone.
These problems range
Illustration of the rotator cuff on the shoulder © logo3in1 | AdobeStock
Wear and tear and ruptures of the rotator cuff are therefore common reasons for shoulder surgery.
As many rotator cuff ruptures do not cause any symptoms, they are often not recognized. It is therefore not possible to say with absolute certainty how frequently such tears occur.
Rotator cuff tears are extremely rare before the age of 40. The frequency increases with age. One study identified a rotator cuff tear in over 80% of people over 80 years of age.
Wear and tear and accidents are the most common causes of rotator cuff tears.
The rotator cuff often tears after a fall on the arm extended backwards. Such accidents are the most common cause of ruptures without signs of wear and tear, accounting for 70% of cases.
However, rotator cuff ruptures due to previous degenerative damage are more common overall. Degenerative changes are understood to be signs of wear and tear.
There are also mixed forms in which patients with previous degenerative damage experience a minor accident. This enlarges the existing defect and triggers symptoms.
A shoulder joint dislocation in a patient over the age of 40 leads to a rotator cuff tear in 40 to 70 percent of cases.
Although the symptoms of a rotator cuff tear are quite clear, the level of pain varies greatly. A large proportion of rotator cuff tears do not cause any symptoms, especially smaller degenerative tears. In these slowly developing tears, the shoulder has had enough time to adapt to the problem.
Acute mass tears, on the other hand, cause very clear symptoms.
The most common shoulder complaint in rotator cuff lesions is pain, especially when working overhead. However, the main symptoms of a torn tendon are night pain and limited strength.
The diagnosis of a rotator cuff tear consists of
together.
The clinical examination includes
There are also special functional tests. These allow the individual muscles of the rotator cuff to be tested in isolation. However, the validity of all rotator cuff function tests can be significantly impaired by pain during the examination.
X-rays in three planes are the basic diagnostic method for pathological changes in the rotator cuff. These include
Changes in the bony joint can be assessed on the basis of these images.
The ultrasound examination enables the rotator cuff to be diagnosed quickly and cost-effectively. This allows simple degenerations and complete rotator cuff tears to be diagnosed with a high degree of accuracy. At the same time, it is possible to assess the long biceps tendon with regard to stability and concomitant inflammation.
In recent years, magnetic resonance imaging (MRI) has established itself as extremely helpful in shoulder diagnostics. Its accuracy is further increased by the administration of contrast agents on the joint side in so-called contrast MR arthrography.
Computed tomography (CT), on the other hand, no longer plays a significant role in rotator cuff diagnostics. MRI has largely replaced it. CT is still occasionally used to assess fatty degeneration of the muscle.
The therapeutic options depend on a variety of influencing factors. They are analyzed in detail and depend on the findings. There is no standardized therapeutic procedure.
The criteria for deciding on treatment are
These criteria result in numerous treatment options that can be used depending on the individual case.
In many cases, conservative, non-surgical therapy is a good choice and can produce good results. This can be supported by biological methods such as ACP. Degenerative rotator cuff defects that occur slowly are initially treated conservatively.
However, if there is no significant improvement within three months, surgery may be necessary.
The tears in the rotator cuff have a tendency to enlarge. The success of conservative treatment therefore does not usually last forever. Half of patients develop new symptoms over 3-5 years and then require surgery.
The treatment of choice for rotator cuff tears today is anatomical reconstruction. This can be achieved by
be performed.
The purely arthroscopic procedure is becoming increasingly popular due to better mobilization and tissue protection.
The healing prospects of a tendon suture depend on the size of the tear. Small tears heal with a high degree of certainty. Medium and large rotator cuff tears have lower healing rates of 70 to 80 percent.
However, there are a number of surgical options available today to stimulate biological healing.
Below you can see the procedure for a minimally invasive procedure to treat a rotator cuff tear:
For tears that cannot be closed anatomically, so-called irreparable ruptures, there are numerous treatment alternatives. These include
The last option is an inverse shoulder joint prosthesis.
The prognosis of the treated rotator cuff defect is highly dependent on
However, the symptoms usually improve after tendon suturing. An improvement also occurs if not everything heals firmly.
The follow-up treatment of a rotator cuff tear depends on the type of treatment. After an anatomical reconstruction, the arm must be immobilized for 2-5 weeks. During this time, the tendon can grow onto the bone. A simple sling may be sufficient for immobilization. During this time, passive movement exercises are permitted under physiotherapeutic guidance.
From the 7th week after the operation, active movement exercises and movement exercises in the pool are possible. Extensive humeral head centering exercises are also required. The total rehabilitation period is around 12 to 16 weeks.
The recovery of the ability to work after a rotator cuff tear depends heavily on the occupational strain and activity. Light physical activities without overhead work are possible from the 5th to 7th week after the operation. Overhead activities are not permitted before the 13th postoperative week. The rehabilitation phase is prolonged overall.
Overhead sports activities should not be resumed until at least 6 months after the operation.
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