Rotator cuff tendon rupture is one of the most common causes of shoulder pain and instability in adults. This problem can be found in a large number of people in adulthood. A tendon tear weakens the shoulder to a great extent and makes everyday activities such as dressing or combing a problem and cause pain.
As the shoulder is stabilized by the rotator cuff muscles, the tendon injury affects the destabilization of the shoulder and the function of the shoulder joint. The injury can also affect the bursa (the mucous sac that surrounds the tendons of the muscles, lubricating them and reducing friction in the narrow space between the bone tissue), which becomes irritated and painful. Rupture or rupture of one or more tendons causes the tendon to no longer be fully attached to the humerus. In many cases, the tendons are gradually damaged (worn out). As the process progresses, a complete tendon tear occurs. This can happen, for example, when lifting a load. There are different types of tendon rupture:
- A partial rupture in which there is a rupture of one layer of tendon.
- A complete tendon rupture in which the tendon is completely detached from the attachment to the bone.
The two main causes of rotator cuff rupture are injury and degeneration.
Acute rupture occurs when you suddenly lift a heavy load or fall with your arm outstretched. Degenerative tendon rupture is more common than acute rupture and occurs gradually. Aging is one of the causes of this process, as well as the dominant use of one hand. If this process occurs in one shoulder, there is a good chance that it will occur in the other. There are a number of factors that influence, i.e. contribute to chronic degeneration of the rotator cuff tendon:
Repetition of the same movements, which most often happens to athletes or people who perform a type of work in which there is a routine of repetitive arm/shoulder movements.
Poor circulation, most often caused by aging, also means poor blood supply to tendons and muscles, which reduces the body’s ability to repair damaged tendons.
Growths on the bones that occur due to aging can come into contact with the rotator cuff tendon when the arm is raised, causing its gradual damage.
If a patient with an initial rupture of the rotator cuff tendon continues to perform daily activities, there may be a worsening of the condition, a larger rupture in the tendon. Therefore, it is necessary to react in a timely manner and start treatment.
Age is also a risk factor, so people over the age of 40 are more at risk of tendon tear than the younger population. Those who perform certain activities in their work, constantly raising their arm above shoulder level, are also at risk. Of the athletes, the most at risk are tennis and baseball players. At a younger age, the most common cause of tendon rupture, if it is not sports, is injury.
Common symptoms of this condition are as follows:
- Pain at rest, as well as at night.
- Pain when raising and lowering the arm, as well as during specific movements.
- Feeling of weakness in the arm and shoulder.
- A crunch-like sound during certain movements.
Acute tendon rupture due to injury causes sudden severe pain and weakness in the upper arm. In a gradual, chronic tendon tear, the pain may be mild at first and present only during certain movements, and may become constant, present and in a state of rest and rest. This kind of pain can make daily routine activities very difficult.
After the diagnosis is established, treatment occurs, which depends on the age of the patient, the type of activities that the patient performs in everyday life and, of course, the degree of impairment. The goal of treatment is to reduce pain and restore normal shoulder function. Non-operative treatment (rest, reduction of activity, medication, physical therapy, blockades…), as well as operative treatment is possible.
Surgical treatment certainly gives better results, because in this way the torn tendon is sewn to the place where it is usually attached. There are several surgical techniques for repairing a ruptured tendon. The surgery can be arthroscopic through 3-5 small incisions in the shoulder area, which requires exceptional skill of the surgeon. Open surgery is most commonly used for large tears. Recently, surgical techniques of rotator cuff plastic are becoming more and more popular in irreparable injuries, i.e. conditions where the torn tendon of the rotator cuff is extremely large and lasts for a long time, and it is not possible to attract the ends of the split and contracted tendon to the appropriate attachment site on the humerus.
In any case, the repair of the cleft tendon is imperative, with the aim of restoring the anatomy and biomechanics of the shoulder joint and preventing the occurrence of degenerative diseases of the joint itself – arthritis. In some cases, treatment is initiated inoperatively at the discretion of the doctor, most often in acute partial ruptures or in chronic tendon injuries in which it is a massive lesion or in very old people. Non-operative treatment is aimed at reducing pain, enabling movement in the shoulder and training the patient for everyday life and work. Physical therapy in the form of training aims to strengthen other groups of shoulder muscles in order to regain painless mobility of the shoulders.
In chronic breakups or in the elderly, it is possible to apply a shoulder block to reduce irritation and pain in the shoulder so that the patient can start training.
