How Do I Treat a Rotator Cuff Strain?
The rotator cuff is a general term covering the muscle tissues of the subscapularis, superior ganglia, subganglia, and small round muscles of the front, upper, and rear of the shoulder joint. It serves to stabilize and assist shoulder abduction, and has the effect of Inside and outside rotation function, so it is also called rotating sleeve. Rupture of the rotator cuff will weaken or even lose this function and seriously affect the function of upper limb abduction.
Rotator cuff break
Right!
- The rotator cuff is a general term covering the muscle tissues of the subscapularis, superior ganglia, subganglia, and small round muscles of the front, upper, and rear of the shoulder joint. It serves to stabilize and assist shoulder abduction, and has the effect of Inside and outside rotation function, so it is also called rotating sleeve. Rupture of the rotator cuff will weaken or even lose this function and seriously affect the function of upper limb abduction.
I. Trauma is the main cause of rotator cuff rupture in adolescents. It is caused by the abduction of the hand or holding a heavy object when absent, and abrupt abduction of the shoulder joint or sprain.
2. Insufficient blood supply causes degeneration of rotator cuff tissue.
3. Physical workers over 40 years of age are more likely to occur due to chronic impact injury to the shoulder and degeneration.
According to the degree of damage can be divided into partial and complete fracture. The former occurs only in a certain part of the rotator cuff; the latter is the rupture of the entire layer of the musculoskeletal cuff, and the joint cavity is in direct communication with the descending sac of the acromion. There are four types of pathology: rupture of the rotator cuff articular surface, rupture of the rotator cuff synovial surface, cracking of the rotator cuff tissue into several layers, and rupture of the rotator cuff tissue.
1. There is a short period of severe pain in the shoulder during trauma, accompanied by a tearing sound.
2. Shoulder pain, aggravated when the shoulder joint moves.
3. Acute swelling and scars on the shoulder.
4. Older people due to bursal effusion, deltoid muscle can be more swollen, and they and swollen bursa.
5. The superior and inferior muscles were atrophic.
6. In patients with complete laceration, when the two elbows are pulled backwards, the shape of the large tuberosity of adipose bone is asymmetric on both sides, and a groove-shaped depression may appear at the proximal end of the large tuberosity of the shoulder.
7. Fat bone nodules can touch the sleeve tears and dents and tenderness.
8. When the rifled sleeve is completely broken, it is difficult for the affected shoulder to complete the 15 ° C active abduction.
9. Within 60 ° -120 ° of shoulder abduction, suffering from shoulder pain.
X-ray plain radiographs are often unremarkable. Shoulder arthrography showed that the joint cavity was in communication with the acromion bursa, suggesting that the tendon sleeve was torn.
[Diagnosis and Differential Diagnosis]
(I) Diagnostic criteria 1. Occurrence in men over 40 years of age can also occur in severe physical injuries and severe trauma of young adults such as athletes.
2. Patients can often feel or hear cracking sounds and severe pain during rupture.
3. The tender point is in the large tubercle of the humerus, but the pain point of the deltoid muscle is often felt.
4. Partial tenderness point After using local analgesia, the shoulder movement returned to normal is incomplete rupture; there is still obvious obstacle should be total rupture.
5. When the shoulder joint is moved, there is a local pop and pain, especially those who are completely ruptured.
6. The rotator cuff is completely ruptured, and the superior or inferior muscles are atrophic.
7. X-ray plain film examination is often no obvious abnormalities. Shoulder arthrography showed that the joint cavity was in communication with the acromion bursa, suggesting that the tendon sleeve was torn.
- (2) Differential diagnosis of patients with early rotator cuff injury. Patients are afraid to move their upper limbs due to shoulder pain. At this time, the following inspections are possible to distinguish:
I. Procaine closure test: 1% procaine 10ml was used to close the tenderness point. After anesthesia, if the patient can actively abduct the shoulder joint, it indicates that the rotator cuff tears or is only partially broken; if closed, the shoulder joint remains Failure to actively abduct indicates severe rupture or complete rupture of the rotator cuff.
2. Upper arm droop test: The ipsilateral upper arm is passively abducted to 90 degrees. If it is not supported, the affected limb can still maintain this position, indicating that the rotator cuff is not seriously injured. If the passive abduction position cannot be maintained, it indicates that the rotator cuff is severely torn. Cracked or completely broken.
According to the degree of rotator cuff injury and the patient's condition, appropriate treatment methods are adopted.
1. Non-surgical treatment For those with fresh partial fractures, most do not require surgery. They can be fixed with shoulder herringbone plaster or outriggers in the abduction, forward flexion, and external rotation positions for 4-8 weeks. After the plaster is removed, reasonable treatment and functional exercises are performed. If necessary, it can be closed with prednisolone plus 1% procaine injection. However, some people think that braking may easily cause frozen shoulders in elderly patients, and advocate that active functional exercises begin when pain permits. If, after 4-6 weeks of strict non-surgical treatment, the shoulder joint cannot be restored to a strong, painless, active outreach, surgical repair is considered.
2. Surgery for patients with complete rotator cuff rupture, except for the frail elderly, the functional requirements are not high or surgery associated with serious medical conditions should not be surgery, should seek early surgery. The best surgical effect is within 3 weeks after the injury. Early surgery can restore the original tension of the rotator cuff and prevent muscle atrophy and the development of soft tissue lesions. The principle of surgery is to remove the necrotic key tissue at the edge of the laceration, restore the continuity of the rotator cuff, and restore the slip under the acromion. Shoulder hernia should also be used to fix the affected limb in abduction, forward flexion, and external rotation positions for 6-8 weeks. Exercise and physiotherapy after removing the plaster.