Rotator cuff injuries

The rotator cuff is a muscle-tendon plate that is formed by the tendons of the four shoulder rotators and surrounds the shoulder joint. The muscles involved are: These muscles ensure the inward and outward rotation of the shoulder joint and stabilize it in position through the formed tendon plate. This is important because the shoulder joint has very little security through ligaments and is therefore dependent on increased muscular fixation.

Injuries to the shoulder can result in tendon ruptures in the area of the rotator cuff (rotator cuff rupture). Symptoms: If the rotator cuff is only slightly injured, e.g. ruptured, the pain may be minor and not be classified as threatening. In the case of a complete rupture, however, stronger, usually load-dependent pain occurs.

Typically, the arm can only be splayed against resistance under pain. As with the impingement syndrome, the pain is most severe when the arm is spread between 70-130° (painful arc). The inward rotation of the arm is also often accompanied by pain.

At night, patients complain of pain when they want to lie on the affected side. Depending on the extent of the tear, everyday movements can only be performed with little force or not at all. Diagnosis: In most cases, the clinical picture taken when examining affected patients is already characteristic for the diagnosis of rotator cuff rupture.

This is particularly true for complete tears. The drop-arm test, for example, is suitable for examination, in which the doctor spreads the patient’s arm at 90° from the body (abduction) and then asks the patient to hold the arm in this position. If the rotator cuff is completely torn off, the patient is unable to do this and his arm simply falls down by gravity.

In addition, the doctor checks the patient’s muscle strength and the extent to which it is reduced. This can provide information about the extent of the injury. Furthermore, an MRI or ultrasound examination can be performed to visualize the injured tendons.

In addition, an x-ray can be taken to show the shoulder joint in order to clarify possible causes for the rupture, e.g. bone protrusions that may have damaged the tendon over a longer period of time. Therapy: In the case of injuries to the rotator cuff, which only lead to a minor functional impairment, a conservative therapy can be attempted first. This consists of a combination of anti-inflammatory drugs, painkillers and intensive physiotherapy.

Initially, the shoulder usually has to be immobilized for some time, but physiotherapy should be started early. This is important in order to strengthen the functionality of the shoulder and maintain its mobility. Training must be carried out consistently over a period of several months in order to achieve an optimal result.

If these measures do not help or if the complaints are very severe from the beginning so that the affected arm can hardly be used or not at all, a surgical intervention must usually be performed. This can often be performed arthroscopically, i.e. as part of a joint endoscopy. The aim of the procedure is usually to suture the torn rotator cuff ends together.

In addition, disturbing bone protrusions that have narrowed the space under the acromion can be removed (subacromial decompression). In many cases, the bursa lying there is also removed directly, as this can also cause severe pain in the shoulder joint in the event of inflammation and additionally constricts the space under the glenohumeral joint.

Musculus supra- and infraspinatus
Musculus subscapularis and
Musculus teres minor.

Arthrosis refers to wear and tear of the joint.

In Germany, this disease occurs particularly frequently in the knee joint, as it is subject to particular stress. Approximately 2/3 of all people over the age of 65 are affected by the disease, although the severity of the condition can vary greatly and not all affected symptoms are felt. A distinction is made between primary and secondary arthrosis.Primary arthrosis is based on a cartilage defect, to which no exact cause can be assigned.

Secondary arthrosis is caused by incorrect loading, overloading, previous inflammation of the joint (arthritis) or certain metabolic diseases. The pain typically occurs when the affected joint is under stress. In the course of arthrosis, the affected joints may become deformed and joint effusions may occur.

symptoms: Shoulder joint arthrosis is usually manifested by pain in the shoulder joint that occurs during certain movements. Typically, lifting and spreading as well as turning the arm outwards is painful. Sometimes, a crunching or rubbing sound can also be heard in the joint when it is moved.

This can be caused by the rubbed off cartilage. Diagnosis: The diagnosis is usually made with an X-ray. This shows a narrowing of the joint space already in relatively early stages of the disease.

In advanced stages, the X-ray image also shows additional bony changes in the joint, e.g. bone protrusions (osteophytes) and deformities. Therapy: Osteoarthritis is initially treated with anti-inflammatory drugs and intensive physiotherapy to improve mobility. Painkillers can be used to relieve the symptoms.

If conservative measures do not help, there are some procedures that can be used alternatively. For example, there is the possibility of injecting so-called chondroprotectives into the joint. Chondroprotectives are drugs that are intended to protect the cartilage from further deterioration.

Healthy cartilage can also be taken from a less stressed cartilage zone of the joint and transplanted to the main stress points (so-called autotransplantation). A similar method is chondrocyte transplantation, in which a few cartilage cells are removed from healthy cartilage. These are cultivated for several weeks and then attached to the damaged cartilage.

By forming new cartilage, these transplanted cells can compensate for the damage to a certain extent. Surgical procedures are an alternative, especially if the arthrosis is already more advanced. The joint can either be replaced by an endoprosthesis or stiffened (arthrodesis).

An endoprosthesis is a long-term solution, but the joint usually loosens up again after about 10 years and then needs to be operated on again. For this reason one would like to avoid, if possible, the use of an endoprosthesis before the age of 60. The subsequent operations are usually much more complicated than the first operation, as bone substance is increasingly lost and the bone is less resilient due to aging processes and osteoporotic changes.

In arthrodesis (joint stiffening), the corresponding joint is fixed in one position, e.g. by screws or wires, and cannot be moved afterwards. Although this usually results in lasting freedom from pain, this procedure is also accompanied by a complete loss of function in the affected joint.

Humeral head (humerus)
Shoulder height (Acromion)
Shoulder corner joint
Collarbone (Clavicle)
Coracoid
Shoulder joint (glenohumeral joint)