What is a Rotator Cuff?

The rotator cuff is also called a rotation sleeve. It is a group of tendon complexes that surround the humerus head. The anterior side of the humeral head is the subscapular tendon, the upper part is the supraganglia tendon, and the rear is the subganglia tendon and small round tendon. It causes the shoulder joint to rotate in, out, and up, but more importantly, these tendons stabilize the humeral head on the scapula, which plays an extremely important role in maintaining the stability of the shoulder joint and shoulder movement.

Rotator cuff

Rotator cuff

The supraspinatus muscle is attached to the uppermost part of the great humerus tuberosus, and is often subject to abrasion of the acromioclavicular shoulder ligament. From the perspective of anatomical structure and mechanical stress, this part is a weak point of the rotator cuff. During adduction activities, rupture is prone to occur. Due to the gravity of the limbs and the rotator cuff pull, the rift is getting larger and larger, and it is not easy to heal.

[Etiology and pathogenesis]

It is more common in men over 40 years of age. For young people, most of them have a history of severe trauma. Because the rotator cuff is protected by the acromion, direct violence rarely causes the rotator cuff to rupture. Indirect violence is usually caused by the abduction of the upper limbs after the rotator cuff degenerates with age, and the palms abruptly adduct and rupture. Especially because the superior muscle strength of the ganglia is weak, and it has the greatest tensile force, it is easy to rupture, accounting for about 50%. %.

The rotator cuff injury can be divided into two types according to the degree of rupture. If not handled properly, partial rupture can progress to complete rupture.

diagnosis

(A) clinical manifestations

It is more common in men over 40 years of age. If they are young, they must have a history of severe trauma. When the rotator cuff ruptures, patients often consciously have tears, local swelling, subcutaneous bleeding, and local pain after the injury is limited to the top of the shoulder and to the deltoid muscle. The stop point is diffused, and the tenderness between the large nodule and the acromion is obvious. The patient cannot actively abduct the shoulder joint.

(Two) inspection

1. The tenderness between the large nodule and the acromion is obvious. According to the size of the tenderness site, the size of the rotator cuff rupture can be determined. The local tenderness point is closed with 1% procaine. After the pain disappears, the patient can actively abduct the shoulder joint, indicating that the rotator cuff is not ruptured or only partially ruptured. If the abduction cannot be actively abducted after sealing, it indicates a severe rupture or complete rupture.

2. The crack of the rotator cuff pops under the acromion, especially when it is completely broken.

3. Pain occurs in the shoulder arc abduction in the range of 60 ° 120 °.

4. If the crack is completely broken, you can feel the crack.

5. Muscle atrophy is not obvious due to full deltoid muscles in the early stage, and the atrophic atrophy of the superior and inferior ganglia muscles is present, especially in the inferior ganglia muscles. The deltoid muscle is sometimes not only atrophied but enlarged.

6. Abnormal joint movement When the rotator cuff ruptures, the affected arm cannot be abducted, and it should be replaced by shrugging. Due to the broken rotator cuff and the contraction of the deltoid muscle, the humerus moves upward along its vertical axis, forcing the scapula to slide and rotate on the chest wall, resulting in abnormal shoulder movement and weakened resistance to abduction.

7. After local anesthesia of the upper arm droop test, passively abduct the upper arm of the affected side to 90 °. Without support, the affected limb can still maintain this position, indicating that there is no serious injury to the rotator cuff. If the passive abduction position cannot be maintained, Indicates a severe or complete rupture of the rotator cuff.

(Three) X-ray inspection

Intra-articular inflation can also be performed with lipiodol oil. If the shoulder joint cavity and deltoid muscle sac sac intersect, it means that the rotator cuff is completely ruptured.

(Four) differential diagnosis

1. Shoulder fracture and dislocation.

2. The biceps brachii longus tendon rupture, most of the rupture is located at the humerus tuberosity. Acute trauma caused severe pain and elbow flexion weakness. With chronic rupture, the strength of elbow flexion gradually weakens. The resistance to elbow flexion test has no power or pain.

3. Pull the shoulder.

[Diagnosis and Treatment]

(A) manual treatment

In the acute phase, manual treatment is forbidden. During the functional recovery period, acupressure, pinch, pluck, shake, and shake can be used around the shoulder joint, and cooperate with shoulder abduction and passive movement to recover the shoulder joint function as soon as possible. .

(B) fixed therapy

Most patients with incomplete rupture do not need surgery. They usually use shoulder abduction, forward flexion, and external rotation under local closure. They are fixed with a "herringbone" plaster or abduction splint for 3 to 4 weeks to rupture the rotator cuff. Partially approached and healed.

(Three) drug treatment

1.In the early stage of internal medicine, blood circulation, qi swelling and pain relief can be performed with Yunnan Baiyao, Dada Pill, Shujin, Huoluo, analgesic and oral Shujin pills.

2. Topical medications External Xiaoyu Analgesic Ointment, Jiegu Xuanjin Ointment, etc.

(D) Functional exercise

Should pain be able to tolerate shoulder function exercises. At the beginning, it is mainly passive activities. Avoid lifting heavy objects within 3 months.

(5) Other therapies

1. Local closure therapy For patients with severe local pain, local closure can be performed in the space below the acromion.

2. Surgical treatment After 4 to 6 weeks of non-surgical treatment of rotator cuff rupture, patients who still cannot recover the strong, painless, active abduction of the shoulder joint and completely rupture and old rupture should be repaired by surgery.