Synonyms
Rotator cuff lesion, rotator cuff rupture, rupture of the supraspinatus tendon, rotator cuff rupture, periathropathia humeroscapularis pseudoparetica, rupture of the tendon, rupture of the tendon
Definition
The rotator cuff forms the roof of the shoulder joint and is composed of four muscles and their tendons, which extend from the shoulder blade to the tubercle majus or tubercle minus. These four muscles are:
- The infraspinatus muscle,
- The supraspinatus muscle,
- The subscapular muscle,
- The musculus teres minor.
The rotator cuff has important functions. It stabilizes the shoulder, is responsible for internal and external rotation, and partly for lateral spreading of the upper extremity.
If a rotator cuff tears, the tendon sheath of these rotators, most commonly the supraspinatus tendon, tears because of its anatomically tight position under the acromion. Such a tear occurs either as a result of a severe accident, e.g. a fall on an outstretched arm, or as a result of degeneration (wear) of the weakened supraspinatus tendon.
- Clavicle
- Acromion (shoulder roof)
- Space between humeral head and acromion
- Humerus
- Shoulder joint (Articulatio glenohumerale)
- Rotator cuff tear
- Humeral head
- Supraspinatus – muscle (Musculus supraspinatus)
Symptoms of rotator cuff tearing
Depending on the underlying cause, the symptoms of a rotator cuff rupture are different. The most common symptom is a rotator cuff tear due to wear and tear, i.e. over the years the tendon mirror becomes thinner due to stress and abrasion, and the natural tendon quality and tear resistance decreases. Minor injuries or even without an accident can ultimately cause the tendon to tear.
In such cases, the patient initially feels a lack of strength in the arm during certain movements. For example, the arm can no longer be held at shoulder level or can only be held at shoulder level with great effort. The pain occurs during various movements (see functional shoulder joint examination), which is why the patient usually starts to avoid painful movements.
This is known as adopting a relieving posture. If the rotator cuff tears as a result of an accident, sudden pain occurs. In the case of a total rupture, external rotation or abduction (see functional shoulder joint examination) is either not possible or only with difficulty.
Pressure pain in the insertion area of the supraspinatus tendon is typical in both cases (tuberculum majus). The pain caused by a rotator cuff rupture can radiate beyond the upper arm and into the hand, but the pain is usually concentrated on the shoulder and lateral upper arm. Impingement syndrome is often found at the same time.
The loss of strength is a typical symptom of a rotator cuff tear. In an acute case, this loss of strength occurs immediately depending on the severity of the rotator cuff tear. At the same time, it also causes immediate pain.
In the case of only slightly pronounced tears of the rotator cuff, those affected sometimes feel only a loss of strength. Otherwise, a complete loss of strength can be assumed to be accompanied by a very pronounced rotator cuff tear. The loss of strength manifests itself in movements of the arm.
Affected persons find it difficult to lift the arm at shoulder level. In addition, external rotation or spreading of the arm is difficult or even impossible. In the case of a rotator cuff tear, the acute accident often causes severe pain in the shoulder, which can also move into the surrounding area.
Movement in the shoulder is associated with unpleasant pulling pain, which sometimes makes movement impossible. Patients hold their arm in a gentle position in front of the body to avoid stress. At night and when lying on the shoulder this causes stabbing pain. Especially lifting the arm causes problems. If it is a rotator cuff tear due to occlusion, it is possible that this is not actively perceived with pain and is only noticeable due to the restrictions on movement.
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