A rotator cuff tear is a rupture of one or more tendons from the rotator cuff muscle in the shoulder. Rotator cuff 'injury' may include any type of irritation or overuse of muscles or tendons, and is one of the most common conditions affecting the shoulder.
The rotator cuff tendon, not the muscle, is most frequently involved, and of the four, supraspinatus is most commonly affected, as it passes underneath acromion. The role of supraspinatus is to hold downward movement. Supraspinatus refuses to move downward while the shoulders relax and when carrying the load. Such a tear usually occurs at the point of insertion into the humerus head in the larger tubercle. Although supraspinatus is the most commonly injured muscle of four muscles in the rotator cuff, three other muscles consisting of rotator cuff, infraspinatus, teres minor, and subscapularis, may also be injured.
The cuff is responsible for stabilizing the glenohumeral joint, kidnapping, externally rotating, and internally turning the humerus. When shoulder trauma occurs, these functions can be compromised. Because individuals rely heavily on the shoulders for many activities, overuse of muscles can cause tears, most of all in supraspinatus tendons.
Video Rotator cuff tear
Signs and symptoms
Many rotator cuff tears are asymptomatic. They are known to increase frequency with age and the most common causes are age-related degeneration and, less frequently, sports injuries or trauma. Both tears of partial and full thickness have been found in post mortem and MRI studies in those with no history of shoulder pain or symptoms. However, the most common presentation is shoulder pain or discomfort. This may occur with activity, especially shoulder activity above the horizontal position, but may also be present at rest in bed. Restrained movement of pain above the horizontal position may exist, as well as weakness with flexion and shoulder abduction.
Complications
Patients usually regain function in their shoulders, and experience less pain, after surgery. For some, however, joints continue to hurt. Weakness and limited range of motion can also survive. Those who report such symptoms are often diagnosed with the failed rotator cuff syndrome.
According to an article published by the American Academy of Orthopedic Surgeons, arthroscopic procedures produce "satisfactory results" over 90 percent of the time. Dr Eric J. Strauss and other authors wrote that 6-8 percent of patients have an "incompetent" rotator rotator, because the improved tendon does not cure or develop additional tears. In some cases, the symptoms are caused by a cervical spine disease, showing neck pain radiating to the shoulder; suprascapular neuropathy, neurological disorders; subacromial collision, common to athletes and others who perform repetitive overhead motions; or arthritis. The anterior-posterior magnetic lesion produces pain similar to rotator cuff tears.
The most vulnerable to failed rotator cuff syndrome are patients 65 years of age or older; and those with large and sustained tears. Smokers, diabetics, patients with muscle atrophy and/or fat infiltration, and those who do not follow postoperative care recommendations are also at greater risk.
The doctor examines the patient and performs an imaging test to identify the cause of the ongoing discomfort. Depending on the diagnosis, several treatment alternatives are available. They include revision repair, nonanatomic improvement, tendon transfer and arthroplasty. Whenever possible, surgeons make tensionless repairs where they use transplanted tissue rather than stitches to reconnect the tendon segment. This can result in a complete overhaul. Another option is partial repair, and reconstruction involving bridges of biological or synthetic substances. Partial repair is usually performed in patients with cuff tear retention.
Two methods to promote rotator cuff healing are to inject the patient's own stem cells (or other growth factors) into the repair site, and install scaffolding (natural or artificial support that maintains tissue contour). The results using PRP (platelet-rich plasma) to increase healing of rotator cuff improvement at the time of surgery, although intellectually exciting, did not appear to show statistically significant clinical differences. Tenotomy and tendonic biceps are an alternative treatment for patients with rotator cuff tears as well as bicep tendon lesions. Tendonesis, which can be performed as an artroscopic or open procedure, generally restores strength and function. Tenotomy is a shorter operation, requiring less rehabilitation, which doctors tend to recommend for older patients.
The transfer tendon is prescribed for young active cuff-tear patients who experience weakness and decreased range of motion, but little pain. This technique is not considered appropriate for older people, or those with preoperative stiffness or nerve injury. People who are diagnosed with glenohumeral arthritis and rotator cuff anthropathy often undergo hemiarthroplasty, which requires replacement of the humerus portion of the shoulder joint. Elderly patients with recurrent cuff tears and degenerative glenohumeral arthritis occasionally receive total shoulder arthroplasty (replacement). Another operation, total shoulder arthroplasty is reversed, effective for others.
Maps Rotator cuff tear
Risk factors
Some risk factors for having a rotator cuff rupture are irreversible: age, body mass index, and height. Recurrent removal and overhead movements are at risk for rotator cuff tears. People who have jobs that involve the above work, such as carpenters, painters, guards and servers at risk also experience a rotator cuff tear. People who play sports that involve movements overhead, such as swimming, volleyball, baseball, tennis, and the American football midfielder, are at greater risk of rupturing the rotator cuff. In general, the incidence of rotator cuff tears or injury increases with age, while corticosteroid injection to relieve pain increases the risk of tendon tendon and delayed healing of the tendon.
Mechanism of injury
The two main causes are injury (acute) and degeneration (chronic and cumulative), and the mechanisms involved can be extrinsic or intrinsic or, perhaps most commonly, a combination of both.
Acute tears
The amount of stress required to tear off an acute rotator cuff tendon will depend on the underlying condition of the tendon before stress. In the case of a healthy tendon, the required stress will be high, such as falling on the outstretched arm. This stress can occur by chance with other injuries such as shoulder dislocation, or acromioclavicular joint splitting. In the case of a tendon with pre-existing degeneration, the force can be surprisingly simple, like a sudden lift, especially with the arm above the horizontal position. This is a common occurrence with rear seated passengers in a motor vehicle crash, regardless of speed.
Chronic tears
Chronic tears are indicative of wider use in conjunction with other factors such as poor biomechanics or muscle imbalances. Ultimately, most are the result of wear and tear that occurs slowly over time as a natural part of aging. They are more common in the dominant arm, but tears on one shoulder indicate an increased risk of tearing in the opponent's shoulder. Several factors contribute to degenerative, or chronic, tearing rotator cuffs whose repeated stress is the most significant. This stress consists of repetition of the same frequent shoulder movements, such as throwing up, rowing, and lifting weights. Many jobs that require frequent shoulder movements such as lifting and overhead movements also contribute.
Another factor in the older population is the decrease in blood supply. With age, circulation to rotator cuff tendons decreases, interfering with the natural ability to repair, which ultimately causes, or contributes to, tears.
The common end factor is the impingement syndrome, the most common non-sport related injury and that occurs when the rotator cuff muscle tendon becomes irritated and inflamed as it passes through the subacromial space under the acromion. This relatively small space becomes smaller when the arms are lifted forward or upward. Repeated imitations can inflate tendons and bursa, resulting in syndrome.
Extrinsic Factors
Well-documented anatomical factors include acromion morphological characteristics. Acromia curvy, curved, and lateral inclines are strongly associated with cuff tears and can cause damage to the tract in the tendon. In contrast, flat acromia may have an insignificant involvement in cuff disease and the consequences may best be handled conservatively. The development of these different acromial forms may be genetic and acquired. In the latter case, only age is positively correlated with development from flat to curved or hooked. The nature of mechanical activity, such as sports involving the shoulder, along with the frequency and intensity of the sport, may be responsible for adverse developments. Sports such as bowling in cricket, swimming, tennis, baseball, and kayaking, are most often involved. However, the progression to hooked acromion may be simply an adaptation to the already damaged, unbalanced rotator cuff that creates increased pressure on the korakoacromial curvature. Other anatomical factors that may have significance include os acromiale and acromial spurs. Environmental factors involved include age, shoulder overload, smoking, and any medical conditions that affect circulation or damage inflammatory and healing responses, such as diabetes mellitus.
Intrinsic factor
The intrinsic factor refers to the mechanism of injury that occurs within the rotator cuff itself. The principle is the degenerative-microtrauma model, which assumes that age-related tendon damage is aggravated by chronic microtrauma results in an eye-tearing vein which then develops into a full rotator cuff rupture. As a result of repeated microtrauma in the degenerative rotator cuff tendon setting, inflammatory mediators alter the local environment, and oxidative stress induces apoptosis of the tenocytes leading to further degeneration of rotator cuff tendons. Neural theory also exists that shows neural overstimulation leads to the recruitment of inflammatory cells and may also contribute to tendon degeneration.
Pathophysiology
Shoulder is a complex mechanism involving bones, ligaments, joints, muscles, and tendons.
Classification
Tears of rotator cuff tendon are described as partial or full thickness, and full thickness with complete detachment of tendon from bone.
- Partial-thickness tears often appear as a full-fledged tendon prick.
- Tears of full thickness are "through-and-through". These tears can be small pinpoints, larger buttonholes, or involving most of the tendons where it still attaches to the humeral head and thus retain its function.
- Tears of full thickness may also involve the complete release of the tendon from the humeral head and may cause significant movement of the shoulder and shoulder function.
Shoulder pain varies and may not be proportional to the size of the tear.
Surgical considerations
Neer promotes the concept of a three-stage rotator cuff disease. Phase I, according to Neer, occurs in those younger than 25 years and involves edema and hemorrhage in tendons and bursa. Stage II involves tendinitis and rotator cuff fibrosis at the age of 25 to 40 years. Phase III involves tearing of the rotator cuff (partial or full thickness) and occurs in those older than 40 years. For surgical purposes, tears are also described by location, size or area, and depth. Further subclasses include acromial distance, acromial form, fat infiltration or muscle degeneration, muscle atrophy, tendon retraction, vascular proliferation, chondroid metaplasia, and calcification. Again, in surgical planning, age-related degenerations of thinning and disorganation of collagen fibers, myxoid degeneration, and hyaline degeneration are considered.
However, for simplicity, tears are sometimes classified based on injury-causing trauma:
- Intellect, as a result of sudden strong movements that may include falling into the outstretched hand with speed, making a sudden boost with a paddle in the kayak, or following a strong throw
- Subacute, arises in a similar situation but occurs in one of the five layers of anatomic shoulder
- Chronic, develops over time, and usually occurs on or near the tendon (as a result of tendons rubbing against the bone above it), and is usually associated with an outlet syndrome
Diagnosis
The diagnosis is based on a physical and historical assessment, including a description of previous activity and acute or chronic symptoms. Systematic physical examination of the shoulder consists of inspection, palpation, range of motion, provocative tests for reproducing symptoms, neurological examination, and strength testing. Shoulders should also be checked for tenderness and deformity. Because the pain that arises from the neck is often 'referred' to the shoulder, examination should include assessment of the cervical spine seeking evidence suggestive of a pinched nerve, osteoarthritis, or rheumatoid arthritis.
Diagnostic modalities, depending on the circumstances, include X-rays, MRI, MR arthrography, double-contrast arthrography, and ultrasound. Although MR arthrography is currently considered a gold standard, ultrasound may be the most cost-effective. Typically, tears will not be detected by X-rays, although bone spurs, which can affect rotator cuff tendons, may be seen. Such spurs suggest chronic severe rotator cuff disease. Multiple contrast arthrography involves injections of contrast dye into the shoulder joint to detect leakage out of the injured rotator cuff and its value is influenced by operator experience. The most common diagnostic tool is magnetic resonance imaging (MRI), which can sometimes indicate the size of the tear, and its location within the tendon. Furthermore, MRI allows detection or exclusion of complete rotator cuff rips with reasonable accuracy and is also suitable for diagnosing other pathologies of the shoulder joint.
The logical use of diagnostic tests is an essential component of effective clinical practice.
Clinical assessment, rather than being overly dependent on MRI or other modalities, is highly recommended in determining the cause of shoulder pain, or planning its treatment, since rotator cuff tears are also found in some people without pain or symptoms. The role of X-ray, MRI, and ultrasound, is in addition to clinical judgment and serves to confirm the temporary diagnosis made by a thorough history and physical examination. Excessive reliance on imaging has the potential to cause overtreatment or disruption of the actual underlying problem.
Symptoms
Symptoms can occur immediately after trauma (acute) or develop over time (chronic).
Acute injuries are less common than chronic illness, but can follow the attack by forcibly lifting the arm against resistance, as happens in weightlifting, for example. In addition, falling hard on the shoulder can cause acute symptoms. This traumatic injury primarily affects the supraspinatus tendon or rotator intervals and symptoms including severe pain radiating through the arm, and limited range of motion, especially during shoulder abduction. Chronic tears occur among individuals who are constantly participating in overhead activities, such as throwing or swimming, but can also develop from shoulder tendinitis or rotator cuff disease. Symptoms arising from chronic tears include worsening of pain, weakness, and sporadic muscular atrophy, visible pain during rest, cracking sensations (crepitations) when moving the shoulders, and inability to move or lift the arms sufficiently, especially during kidnapping and movement flexion.
Pain on the anterolateral aspect of the shoulder is not specific to the shoulder, and may arise from, and is referred from, the neck, the heart or the intestine.
The patient's history will often include pain or pain in the front and outside of the shoulder, the pain gets worse by leaning on the elbow and pushing upward on the shoulder (like leaning on the armrest of the reclining chair), activity intolerance overhead, pain at night when lying directly on the affected shoulder, pain reaching forwards (eg unable to lift a gallon of milk from the refrigerator). Weakness can be reported, but often covered by pain and usually only found through examination. With longer pains, the shoulders are favored and gradually loss of movement and weakness may develop, which, due to pain and preservation, are often not recognized by the patient and are only brought to attention during the examination.
A major shoulder problem can cause pain in the deltoid muscle that is intensified by kidnapping of resistance - a sign of impact. This signifies the pain arising from the rotator cuff, but can not distinguish between inflammation, strain, or tearing. Patients can report that they can not reach upwards to comb their hair or lifting food cans off the shelf above the head.
Alerts
It has been suggested that there is no single physical examination test that can distinguish between bursitis, partial thickness, and full thickness tear. In contrast, the combination of tests seems to provide the most accurate diagnosis. For impingement, this test includes the signature Hawkins-Kennedy impulse in which the medial examiner rotates the patient's flex arm, forcing the supraspinatus tendon against the korakoacromial ligaments and thus producing pain if positive tests for positive painful bow marks, and weakness beyond rotation with the arms on the side. For the diagnosis of a full thickness rotator cuff, the best combination appears to include once again painful bow and weakness in external rotation, and in addition, the sign of the arm falls. This test is also known as the Codman test. The arms are lifted to the side up to 90 Â ° by the testers. The patient then attempts to lower the arm back to neutral, palms down. If the arm drops suddenly or pain is experienced, the test is considered positive.
MRI
Magnetic resonance imaging (MRI) and ultrasound are comparable in efficacy and assist in diagnosis although both have a false positive rate of 15-20%. MRI is believed to detect the most tear thickness even though very small tears may be missed. In such situations, MRI combined with contrast material injections, MR-arthrogram, may help to confirm the diagnosis. It should be realized that a normal MRI can not completely rule out small tears (false negatives) while some tear-thickness is not reliably detected. While MRI is sensitive in identifying tendonic degeneration (tendinopathy), MRI may not be able to distinguish between degenerative tendons and partially torn tendons. Again, magnetic resonance arthrography can improve differentiation. Overall sensitivity of 91% (9% false negative rate) has been reported to indicate that magnetic resonance arthrography is reliable in detecting tear rotator cuffs of partial thickness. However, routine use is not recommended, as it involves inserting a joint with a needle with a potential risk of infection. As a result, tests are reserved for cases where the diagnosis remains unclear.
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Musculoskeletal ultrasound has been advocated by experienced practitioners, avoiding X-ray radiation and MRI costs while showing accuracy comparable to MRI to identify and measure full-thickness size and partial thickness-rotator cuff tears. This modality may also reveal other conditions that may mimic rotator cuff rupture in clinical examination, including tendinosis, calcific tendinitis, subacromial submucoid bursitis, greater tuberosity fracture, and adhesive capsulitis. However, MRI provides more information about adjacent structures on the shoulder such as capsules, glenoid and bone labrum muscles and these factors should be considered in each case when choosing the appropriate study.
Radiographic projection
X-ray projection radiographs can not directly reveal rotator cuff tears, 'soft tissue', and consequently, normal X-rays can not exclude defective cuffs. However, indirect evidence from pathology can be seen in examples where one or more of the tendons have degenerative calcification (calcific tendinitis). The humeral head can migrate upward (the head of the humerus head high) secondary to the tears of infraspinatus, or a teardrop of supraspinatus and infraspinatus. Migration can be measured by the distance between:
- A line that crosses the center line between the superior and inferior rim of the glenoid articular surface (blue in the image).
- The "best fit" circle center is positioned on the articular surface of humery (green image)
Usually, the first is positioned inferior to the last, and the reversal therefore shows the rotator cuff tear. Prolonged contact between the high-legged humerus head and the acromion above it may cause the X-ray findings from wear on the humeral head and the secondary degenerative acromion and arthritis of the glenohumeral joint (spherical and shoulder socket joints), called cuff arthropathy, may follow. The X-ray incidence of bone spurs findings at adjacent acromioclavicular joints may indicate a spurt of bone that grows from the outer edge of the clavicle downward to the rotator cuff. Spurs can also be seen at the bottom of the acromion, once thought to cause a direct crack from the rotator cuff of contact friction, a concept that is currently considered controversial.
Testing in the office
As part of clinical decision making, simple, minimally invasive, in-office procedures can be performed, a rotator cuff impingement test. A small number of local anesthetics and injectable corticosteroids are injected into the subacromial space to block pain and to provide anti-inflammatory relief. If the pain is gone and the function of the shoulder remains good, no further tests are being pursued. The test helps to confirm that pain arises from the shoulder especially than the so-called neck, heart, or intestine.
If the pain relief, the test is considered positive for rotator-cuff impulses, where tendinitis and bursitis are the main causes. However, partial rotator-cuff tears can also show good pain, so a positive response can not rule out some rotator-cuff tear. However, by showing good function, pain-free, treatment will not change, so this test is useful to help avoid excessive or unnecessary surgery.
Prevention
Overuse of long-term/shoulder joint abuse is generally considered to limit the range of motion and productivity due to everyday wear and tearing of muscles, and many public websites offer preventive advice. (See external links) Recommendations typically include:
- regular shoulder training to maintain strength and flexibility
- use the right shape when lifting or moving heavy loads
- resting shoulders while experiencing pain
- application of cold pack and hot bearing to sick and inflamed shoulder Strengthening program
- to insert the muscles of the bodice of the back and shoulders and chest, shoulders and upper arms
- sufficient rest periods in jobs requiring repeated appointments and reaching
Size
According to a study that measured the length of the tendon against injured rotator cuff size, the researchers learned that when the rotator cuff tendons decrease in length, the mean rotator cuff tearity curve decreases proportionally, also indicating that larger individuals are more likely to suffer. from a severe rotator cuff tear if they do not "tighten the shoulder muscles around the joint".
Position
Another study looked at 12 different motion positions and their relative correlation with injuries occurred during the movement. The evidence shows that putting the arm in a neutral position eases the tension on all the ligaments and tendons.
Stretching
One article looked at the effect of stretching techniques on shoulder injury prevention methods. Increased exercise speeds increase injuries, but starting fast movement exercises with slow stretching can cause muscle/tendon attachment to be more resistant to tearing.
Muscle Group
When exercising, training the shoulders as a whole and not one or two muscle groups are also found to be a necessity. When shoulder muscles are performed in all directions, such as external rotation, flexion, and extension, or vertical abduction, it is unlikely to suffer a tendon rupture.
Treatment
Those suspected of having a rotator cuff tear are potential candidates for operative or non-operative treatment. However, individuals can move from one group to another based on clinical responses and findings on repeated examination.
No evidence of the benefits seen from initial surgery rather than delayed, and many with partial tears and some with complete tears will respond to nonoperative management. As a result, many recommend early non-surgical management. However, early surgical treatment may be considered in significant acute tears (& gt; 1Ã, cm-1.5Ã,® cm) or in young patients with full-thickness tears that have significant risks for the development of irreversible rotator cuff changes.
Finally, a review of more than 150 papers published in 2010 concluded that there is no strong evidence to suggest that rotator-cuff surgery benefits patients more than nonoperative management, adding to management and treatment controversy.
Non-operative treatment
They are painless but the functions maintained are appropriate for nonoperative management. These include oral medications that provide pain relievers such as anti-inflammatory agents, topical pain relievers such as cold compresses, and if necessary, subacromial corticosteroids/local anesthetic injections. The alternative to injections is iontophoresis, a battery-powered patch that "pushes" the drug into the target tissue. A sling can be offered for short-term comfort, with the understanding that unwanted shoulder stiffness can develop with prolonged immobilization. Early physical therapy can provide pain relief with modalities (eg iontoforesis) and help maintain movement. Ultrasound treatment does not work. When pain decreases, deficiencies in strength and biomechanical error can be corrected.
Conservative physical therapy programs begin with early rest and restrictions from engaging in symptomatic activities. Usually, inflammation can usually be controlled within one to two weeks, using nonsteroidal anti-inflammatory drugs and subacromial steroid injections to reduce inflammation, to the point that the pain has decreased significantly to make stretching tolerable. After this brief period, rapid hardening and increased pain can occur if sufficient stretching has not been implemented.
A gentle and passive range of motion programs must be initiated to help prevent stiffness and maintain range of motion during this break period. Exercises, for the anterior, inferior, and posterior shoulders, should be part of the program. The codman's exercise (gigantic, pudding-stirring), to "allow the patient to kidnap the arm with gravity, supraspinatus remains relaxed, and no pivot point required" is widely used. The use of NSAIDs, hot and cold packs, and modalities of physical therapy, such as ultrasound, phonophoresis, or ionophthalysis, can be performed during this stretch period, if effective. Corticosteroid injections are recommended two to three months apart with a maximum of three injections. Several injections (four or more) have been shown to compromise with the rotator cuff results resulting in a weakening of the tendon. However, before the cuff rotator strengthening can begin, the shoulder should have full range of motion.
Once the full range of motion and painlessness is reached, the patient can progress to a gentle reinforcement program. Rockwood coined the term orthotherapy to describe this program which aims to create exercises that initially increase movement gently, then gradually increase the strength on the corset's shoulders. Each patient is given a home-based therapy kit, which includes an elastic band of six colors and different strengths, a set of pulleys, and a three-piece stick, one meter long. The program is customized, adjust individual needs and change as necessary. Participants are required to use their training program whether at home, work, or traveling.
Some cases occur where nonoperative treatment is not recommended:
- 20 to 30 years of active patients with acute tear and severe functional deficit of a particular event
- Patients aged 30 to 50 years with acute rotator cuff cuffs secondary to certain events
- a highly competitive athlete who is primarily involved in overhead or throwing a sport
These patients may need to be treated surgically because rotator cuff repairs are required for normal strength recovery needed to return to preoperative and competitive levels of function. Finally, those who do not respond, or are dissatisfied with, conservative treatment should seek surgical opinion.
Surgery
Three general surgical approaches are arthroscopy, open surgery, and open surgery. In the past, small tears were treated arthroscopically, while larger tears would usually require an open procedure. Advances in arthroscopy now allow for even the greatest tear artroscopic repairs, and arthroscopic techniques are now required to mobilize many tears that are withdrawn. The results match the open surgical technique, while allowing a more thorough evaluation of the shoulder during surgery, increasing the diagnostic value of the procedure, as other conditions may cause shoulder pain simultaneously. Arthroscopic surgery also allows for a shorter recovery time despite significant differences in postoperative pain or the use of pain medication apparently not seen between arthroscopic patients and open surgery.
Even for full-thickness rotator cuff tears, conservative treatments (ie, nonsurgical treatments) results are usually quite good. However, many patients still suffer from disability and pain despite non-surgical therapy. For large ruptures in the rotator cuff, surgery has shown persistent results in 10 years of follow-up. However, the same study showed progressive and progressive fat atrophy and repeated rotator cuff tears. MRI fatty atrophy evidence on the rotator cuff before surgery is predictive of poor operating outcome. If the rotator cuff is completely torn, surgery is usually required to reattach the tendon to the bone.
If there are significant bone spurs, one approach may include acromioplasty, subacromial decompression, as part of the procedure. Subacromial decompression, removal of a small portion of the acromion that covers the rotator cuff, aims to reduce pressure on the rotator cuff under certain conditions and promote healing and recovery. Although subakromial decompression may be beneficial in the management of partial tear repairs and full thickness, it does not improve the tear itself and recent artroscopic decompression combined with improved "mini-open" rotator cuff, enables uninterrupted cuff removal of deltoid origin. Decompression results alone tend to decrease with time, but the combination of improvements and decompression seems to last longer.
Tough and thick tear repair involves network stitching. The method that currently supports is placing anchor in the bone in place of natural attachment, with a torn tendon resuture to anchor. If poor network quality, mesh (collagen, Artelon, or other degradable materials) can be used to strengthen the repair. Improvements can be made through an open incision, again requiring partial deltoid release, while an open mini-technique approaches the tear through the deltoid cleavage approach. The latter can cause less muscle injury and produce better results. Contemporary techniques now use the arthroscopic approach. Recovery can take up to three-six months, with a sling used for the first one-six weeks.
In a small minority of cases where extensive arthritis has been developed, the choice is the replacement of the shoulder joint (arthroplasty). In particular, this is an upside-down shoulder shrug, a more restrictive shoulder arthroplasty shoulder that allows the shoulder to function properly even in the presence of a full-fledged rotator cuff tear.
Rehabilitation
After surgery rehabilitation consists of three stages. First, the arm can not move so the muscles can recover. Secondly, when appropriate, a therapist helps with passive exercises to regain the range of motion. Third, the arms are gradually carried out actively, with the aim of regaining and increasing strength. Yoshitsugu Takeda and his team recently studied rotator cuff injuries and rehabilitation exercises targeting supraspinatus. As mentioned earlier, supraspinatus muscle is the muscle and tendon in the rotator cuff most often injured. To rehabilitate supraspinatus and fight future injuries on rotator cuff, Takeda's team has concluded that empty cans and the most effective exercises are most effective at isolating and strengthening supraspinatus.
After surgical repair of arthroscopic cuffs, patients undergo rehabilitation to regain shoulder function. Orthopedic surgeons stress that physical therapy is essential for healing. Exercises reduce shoulder pain, strengthen joints, and increase arm range. The therapist, along with the surgeon, designs the exercise regimen according to individual needs and risk factors.
Traditionally, patients are advised to paralyze their shoulders for six weeks prior to rehabilitation. However, the timing and intensity of appropriate therapy will be debated. Regardless, most surgeons advise to stay in the sling for at least six weeks. Some experts advocate aggressive early rehabilitation. They like the use of passive movement, which allows the patient to move the shoulder without physical effort. Alternatively, some experts argue that therapy should begin later and be done more carefully. Theoretically, it gives time to the network to heal; although there are conflicting data about the benefits of early immobilization. A study of rats suggested that it increased the strength of surgical repair, while research on rabbits produced conflicting evidence. Patients, especially those recovering from large rotator cuff tears, tend to develop new tears. Rehabbing too fast or too hard may increase the risk of retention or failure to heal. However, no studies have shown a link between early treatment and tearing events. In some studies, patients who received earlier and more aggressive therapy reported reduced shoulder pain, reduced stiffness and better range of motion. Other studies have shown that accelerated rehabilitation results in better shoulder function. Ross et al. note that, despite the findings, "there is no definitive consensus that supports clinical differences" between the two methods of rehabilitation.
There is a consensus between orthopedic surgeons and physical therapists regarding the rehabilitation protocol of rotator cuff repair. The time and duration of care and exercise are based on biological and biomedical factors involving rotator cuff. For about two to three weeks after surgery, a patient has shoulder pain and swelling; no major therapeutic action is performed in this window other than oral and ice sore medications. Overall, patients at risk of failure, should undergo a more conservative approach to rehabilitation.
Which is followed by the "maturation and maturation" and healing phase, which lasts for the next six to ten weeks.The influence of active or passive movement during any phase is unclear, due to conflicting information and lack of clinical evidence.moving motion of gentle physical therapy instituted in this phase, only to prevent shoulder stiffness, rotator cuff remains fragile.At three months after surgery, physical therapy intervention changes substantially to focus on mobilization of the skapular and glenohumeral joint stretching.After full passive movement is recovered (usually about four to four half a month after surgery) reinforcement exercises are the focus.Employment focuses on rotator cuffs and upper back/scapula stabilizers.Usually about six months after surgery, most patients have made the most of the benefits.
The purpose in improving rotator cuff is to enable the patient to regain full function. Surgeons and therapists analyze the results in several ways. Based on their patient examination, they collect the score on the test; some examples are made by the University of California in Los Angeles and the American Shoulder and Elbow Surgeons. Other result sizes include Constant scores; Simple Shoulder Test; and Disability score of Arms, Shoulders and Hands. These tests assess the range of patient movement and the level of shoulder function.
Because conflicting information about the relative benefits of rehab is done early or later, an individual approach is required. The timing and nature of therapeutic activities are adjusted according to patient age, tissue integrity of rotator cuff repair and other factors. Special considerations are appropriate for those suffering many tears.
Prognosis
While people with rotator cuff tears may not have any apparent symptoms, studies show that, those who have age associated with tears, over time 40% will experience tear enlargement over a five-year period. Of those whose tears are enlarged, 20% have no symptoms while 80% end up experiencing symptoms.
There is no indisputable evidence that rotator cuff surgery benefits patients more than non-surgical management and the percentage of patients never regains various movements after surgery.
Epidemiological studies strongly support the relationship between age and cuff tear prevalence. In recent studies the frequency of tears increased from 13% in the youngest group (age 50-59 years) to 20% (age 60-69 years), 31% (age 70-79 years), and 51% in the oldest group (age 80 -89 years). High rates of tear prevalence in asymptomatic individuals show that rotator cuff tears can be considered as a "normal" aging process rather than the result of a clear pathological process.
Epidemiology
Incident
Rotator cuff damage may be caused by weakening of the rotator cuff tendon. This attenuation can be caused by age or how often rotator cuff is used. Adults over the age of 60 are more susceptible to rotator cuff tears. According to a study in the Journal of Orthopedic Surgery and Traumatology the frequency of rotator cuff ruptures can increase with age. This study shows that participants aged 70-90 years have a rotator cuff level of 1 to 5. Participants 90 years old rotator cuff tear frequency jumps to 1 to 3. This study shows that with increasing age there is also an increased probability of rotator cuff tear.
Prevalence
According to a study in the Journal of Orthopedics, the prevalence of rotator cuff tear is much greater in men than in women aged 50-60 years, in the age of 70-80 years there is not much difference in prevalence. Data from this study indicate that the prevalence of rotator cuff rotal in the general population is 22.1% Yamamoto et al. conducting medical checks on 683 people living in mountain villages. The purpose of this study was to determine the prevalence of rotator cuff tear among populations. Yamamoto found that among mountain village populations, rotator cuff tears were present in 20.7% of the villagers. In both studies we see that the percentage of the prevalence of rotator cuff rupture is so close in numbers that these figures show us the prevalence of rotator cuff tears in the general population.
In an autopsy study of a rotator cuff rupture, the incidence of partial tears was 28%, and of the complete rupture of membranes 30%. Often, tears occur on both sides and the frequency increases with age. Frequency is also higher in women. Other cadaveric studies have recorded intratendinous tears becoming more frequent (7.2%) than the bursal-side (2.4%) or articular tears (3.6%). However, clinically, articular tears are found 2 to 3 times more common than bursal-sided tears and among the young athlete population, articular tears constitute 91% of all partial tear-thickness.
References
- This article contains the text of the public domain document "Questions and Answers on Shoulder Problems", Publication NIH No. 01-4865, available from URL http://www.niams.nih.gov/hi/topics/shoulderprobs/shoulderqa.htm
External links
- Rotator Cuff. Arend CF. Ultrasound Bahu. Master Medical Books, 2013.
- Rotator Air Mata Manset. Wheeless 'Textbook of Orthopaedics . Penjelasan tentang rotator cuff tears dari Wheeless '
Source of the article : Wikipedia
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