Symptoms
A distinction must be made with regard to the complaints between: After an accident, the affected person complains of acute pain and limited mobility of the arm as a symptom. Either a painful lateral lifting (abduction) of the arm occurs as a result of the rotator cuff rupture or this movement is completely eliminated. In the latter case, one speaks of a so-called pseudoparesis.
Paresis refers to a paralysis that results from nerve damage; pseudoparesis, on the other hand, includes paralysis that does not result from injury to nerve structures. In the case of a rotator cuff rupture, this is caused by a rupture or rupture of the tendon attachment. The affected person feels pain not only during movement, but also during palpation of the supraspinatus tendon or the tuberculum majus – depending on which structure is affected.
In addition, a rotator cuff rupture can lead to the formation of a hematoma in the shoulder area, resulting in swelling. Degenerative rotator cuff ruptures, on the other hand, do not cause acute symptoms. Instead, symptoms develop slowly.In some cases there are even no symptoms at all. Pain in degenerative rotator cuff rupture gradually increases, as do restrictions in mobility and strength.
- Traumatic accident-related rotator cuff rupturesand
- Degenerative age-related rotator cuff tears.
Alternative causesDifferential diagnosis
The space through which the supraspinatus tendon runs below the acromion (subacromial recessus) must be distinguished from a rotator cuff rupture. This can be caused by calcification (calcified shoulder) or swelling of the tendon (impingement syndrome) and manifests itself as a common clinical picture. The calcified shoulder and the impingement syndrome must therefore always be excluded.
Therapy
Treatment of a rotator cuff rupture can be done in two different ways, conservatively or surgically. Conservative therapy of a rotator cuff rupture is performed as an early functional treatment, especially in older patients or in cases of partial rupture of the rotator cuff. This includes pain relief (analgesia) on the one hand, and training of movement, especially strength and coordination on the other.
Pain in rotator cuff rupture can be controlled by means of tablets (non-steroidal anti-inflammatory drugs, NSAIDs, NSAIDs, e.g. Voltaren Ibuprofen or Arcoxia) or local procedures. The latter methods include the injection (local infiltration) of painkillers (anesthetics) and cortisone into the shoulder and the application of cold (cryotherapy) or electricity (electrotherapy). If the tuberculum majus is torn off as the cause of the rotator cuff rupture, conservative therapy can also be initiated if there is no displacement of the structures (dislocation).
Those affected receive a special bandage (Gilchrist dressing) to immobilize the shoulder. Subsequently, movement exercises of the shoulder are started, which should be performed without pain. As an alternative for rotator cuff rupture, early functional treatment is contrasted with surgical therapy, which is performed on younger patients, active older patients and patients with complete rotator cuff ruptures.
The torn tendon (rotator cuff tear) is reattached to the humerus. First, a so-called interweaving suture is applied to the tendon. Then two channels are drilled through the humerus at the tuberculum majus, through which the ends of the suture are passed and knotted.
Alternatively, the tendon can be attached to the bone using artificially produced bone anchors. If the tuberculum majus is torn off with displacement of the structures (dislocation), it is attached to the bone in its old position by a tension screw or tension strap. These surgical procedures can be performed arthroscopically as “keyhole surgery” or as “mini open reconstruction”.
Arthroscopic accesses are only a few centimeters in size and are performed under camera control (similar to arthroscopy). In “mini open reconstruction”, an approximately 5 cm skin incision is made. After surgery for rotator cuff rupture, the shoulder must be immobilized.
For this purpose, the shoulder is placed on special positioning splints to relieve the tendon (shoulder cushion, letter carrier’s cushion) in abduction position (spreading the arm), so that the vision can heal quickly without tension. After about three weeks, physiotherapy exercises are usually started. Active movements are only allowed after about six weeks, but without the use of force.
This is only possible after about three months. Full function after a rotator cuff rupture is usually restored after about six months.
