Rotator cuff rupture of the shoulder

A rotator cuff tear is a tear of a muscle tendon of the shoulder girdle.

Since the shoulder joint has a great freedom of movement in several directions and often has to bear very large loads, it needs a firm and strong anchorage to the body. However, the shoulder is only connected to the trunk via one bone, namely the clavicle, which is why the joint is mainly supported by muscles and their tendons and ligaments. In order to be able to perform the many movements with the shoulder, an interaction of many muscles is necessary.

High loads can cause injuries to the supporting muscles, tendons and ligaments, with the rotator cuff being particularly affected. The rotator cuff is made up of several muscles that have the task of connecting the head of the humerus to the flat socket of the shoulder blade. In addition, these muscles are responsible for internal and external rotation of the arm. The rotators are connected to the humerus by tendons, which are tendon plates that form a sort of cap over the head of the bone. A rotator cuff tear is a tear in this tendon plate.

Rotator cuff tears are very often caused by chronic wear and tear of the tendons. If this wear and tear progresses over several years, it can lead to a tear of the tendon plate.

The risk of suffering a rotator cuff rupture increases with prolonged, heavy loading of the shoulder, especially when overhead movements are performed with the arms, such as golf or swimming. In these and other overhead sports, the tendons of the rotators are subjected to a great deal of stress due to the monotonous movement sequences and heavy training loads. This can result in minute damage, known as microtrauma, which can subsequently develop into larger tears.

Other causes of rotator cuff tears include dislocations as well as other damage to the shoulder joint or surrounding soft tissues.

Every now and then, a tearing sound can be heard when the rotator cuff ruptures. A sudden rotator cuff rupture is usually very painful, and it can also be accompanied by a powerless dropping of the arm, also known as drop arm syndrome. In addition, the shoulder's range of motion is restricted. Thus, lateral lifting of so-called "painful arc" or external rotation of the arm becomes difficult.

However, if the rotator cuff rupture develops gradually over a longer period of time due to wear and tear, the symptoms may be milder. In this case, nocturnal pain in the shoulder or crunching noises (crepitations) during movements of the shoulder joint are particularly indicative of a rotator cuff rupture.

It is usually possible to diagnose a rotator cuff tear by taking the patient's medical history (anamnesis) and carrying out an appropriate examination. Here, of course, a precise examination of the shoulder is very important, because by means of movement restrictions or pain during movements of the arm can be determined whether it is a rotator cuff rupture.

After a rupture, a cracking sound can often be felt when moving the shoulder. The affected person often finds it difficult to lift the arm to the side or forward or to hold it horizontally in the air. A difference in strength is usually noticeable, especially when compared laterally with the healthy arm. In some patients, special screwing movements can also be observed, with which they try to circumvent the weakness and lift the arm in this way. Among the imaging methods, magnetic resonance imaging is the method of choice, although conventional X-rays and ultrasound can also be usefully included in the diagnosis.

In the treatment of rotator cuff rupture, the size and shape of the rupture are the most important factors. Further strain by the patient has a great influence on the healing process. If the extent of the muscle tear is rather small, physiotherapy can be used to strengthen the muscles of the shoulder and thus further stabilize the humeral head in the socket.

If, however, there is no improvement with muscle training and severe pain persists, surgical repair of the rupture is advisable.

If the patient is younger and the rupture was caused by an accident, surgery should be performed as soon as possible. In this case, muscles can be prevented from retracting to prevent further damage to the shoulder.

The outlook after surgery is more favorable if the tear can be sutured without permanent tension and if there is not yet too much wear and tear damage. Depending on the type and size of the tear, the rotator cuff rupture is either only sutured, fixed to the bone or a muscle replacement plastic is used. After surgery, physiotherapy is definitely highly recommended, which involves strengthening the shoulder muscles through proper training to support the shoulder. Furthermore, the shoulder should not be loaded for a few months to prevent a new tear of the rotator cuff.

Possible consequences of a rotator cuff rupture are joint damage, bleeding or thrombosis. However, these only occur in isolated cases with proper physiotherapy. However, if these complications do occur, they can usually be treated surgically or with medication. More often, after a rotator cuff injury, the mobility and strength of the shoulder is limited, and sometimes minor pain can persist for a longer period of time. In these cases it is also possible to alleviate the symptoms with physiotherapy.

For the prognosis it is very important to perform a necessary surgery as soon as possible. While those affected usually have no problems with conventional movements and loads, the performance of overhead sports is often only possible to a limited extent.

In general, it can be said that the smaller the tear and the younger the affected person, the better the course of a rotator cuff rupture.