Brief overview
- Therapy: surgical, minimally invasive or open: Connecting the two ends by various techniques; conservative: pain relief, immobilization, then range of motion exercises.
- Symptoms: Pressure pain and pain at night, restriction of movement in the shoulder, sometimes also in the elbow joint, bruising
- Causes: Often due to previous damage such as wear and tear, external force in the context of an accident, favored by long-term use of anabolic steroids, smoking or high blood lipids
- Examinations: Physical examination, imaging procedures such as ultrasound or magnetic resonance imaging (MRI), X-rays if bone injury is also suspected
- Prognosis: Healing time depends on the extent of the tear and the treatment, after conservative therapy sometimes permanent muscle reduction and often muscle weakness in the shoulder area occur, consulting a shoulder specialist is recommended, appropriate rehabilitation measures are important
What is a torn tendon in the shoulder?
A torn tendon in the shoulder is one of the most common tendon injuries caused by wear and tear and is often the cause of shoulder pain.
Particularly important is a ring of four muscles (rotator cuff) that originate on the shoulder blade and attach with their tendons to the head of the humerus. These tendons are particularly susceptible to tendon rupture under stress. Shoulder pain often originates from the rotator cuff.
Another tendon runs in the area of the shoulder joint: the long biceps tendon, which – starting from the arm flexor muscle on the upper arm (biceps) – runs through a bony groove to the upper edge of the shoulder socket. It sometimes tears as well.
How is a torn tendon in the shoulder treated?
In principle, a torn tendon in the shoulder can be treated both surgically and non-operatively (conservatively). If there are bone fractures, vascular or nerve injuries in addition to the tendon tear, a complex treatment strategy is required.
The best treatment for a torn tendon in the shoulder depends on many factors. These include, above all, the degree of damage, severity of symptoms, age and individual requirements of the person affected by the shoulder. The goal of any therapy is to reduce pain and improve joint function. The attending physician then plans the therapy together with the patient and decides whether surgery is indicated or not.
Operation
Particularly in cases of tendon rupture due to injury, pronounced activity and little pre-damaged tendons, a tendon rupture in the shoulder is operated on. On the other hand, surgery should be avoided in cases of joint infections, nerve damage and advanced degeneration, among others. The result of the operation depends decisively on the tendon condition. Tendon suturing can only be successfully applied if the tendon is of good quality.
A tendon rupture in the shoulder is operated on within a few weeks if possible in order to achieve a good result. A distinction is made between the open tendon repair and the minimally invasive variant. Open surgery also allows more difficult techniques. However, this requires detaching the deltoid muscle lying around the shoulder from parts of the scapula. This is not necessary with minimally invasive surgery. Here, the surrounding tissue is spared due to the only small access to the joint.
The minimally invasive technique is more complicated for this and only allows simpler tendon repairs due to the narrowness. If a piece of bone is torn out with the tendon, then this is repaired in an open operation. Minimally invasive surgery is sometimes possible on an outpatient basis.
Injured tendons heal slowly, so careful aftercare is given. After surgery, the shoulder is initially protected in a bandage for two to six weeks (such as Gilchrist bandage, abduction splint).
A shoulder adduction splint is used to keep the arm in 30 degrees of abduction. The affected person initially moves the shoulder joint only passively. From the third week, he slowly begins assisted, active movement exercises. From the seventh week, active movements can be performed without restriction. Sporting activities are not recommended again until the third month.
Conservative treatment
Conservative treatment is considered for a non-accidental, slowly developing tendon tear in the shoulder. This form of treatment is particularly suitable for patients who are only active to a limited extent and for patients with a so-called “frozen shoulder” (frozen shoulder).
