Every day, a person makes hundreds of movements: walks, sits down, picks up something, turns around, etc. However, no one even wonders what processes are happening at that moment in the body and which joints are involved.
Anatomy, physiology and function
The shoulder joint is the most mobile in the human body.
One of the elements of its structure is the rotator cuff of the shoulder joint (also called rotational).
The rotational cuff is formed by four muscles of hard fibrous tissue enveloping the surface of the spherical shoulder joint. According to medical terminology, they are called subscapular, supraspinatus, infraspinatus and small round. They are attached on the one hand to the edge of the scapular bone, and on the other - spreading across the entire joint of the shoulder, to the humerus. It is they who set the shoulder joint in motion.
Each muscle has its own function:
- Due to the supraspinatus, the arm rises during the contraction process, and when the shoulder is abducted, the shoulder head is pressed into the recess of the joint capsule. The supraspinatus muscle performs a guiding movement.
- The function of the infraspinatus muscle is the outward rotation of the arm.
- The subscapularis muscle provides the rotation of the shoulder joint inward.
- Small round rotates the limb out and bringing it to the torso.
Together with the deltoid, these muscles are involved in raising the arms from the body.
Possible causes of damage
In medicine, there is a distinction between fresh, chronic, degenerative damage to the rotator cuff of the shoulder joint, as well as impingement syndrome.
At risk for ruptures of the rotator cuff are people older than 50 years. The reason for this is age-related changes in tendons. Damage of this kind can occur in people at a young age due to the strong impact - injury. After fifty years, the likelihood of a fracture increases significantly and along with a large tubercle of the shoulder, the supraspinatus muscle will tear off. The rupture of the rotator cuff occurs as a result of a sudden powerful lifting of the arms with any resistance, in the case of an attempt to mitigate the fall or from lifting weights. In older people, the cuff is torn from minimal injury.
The frequency of damage to the rotator cuff of the left shoulder joint and the right practically do not differ. However, the fact that most people are right-handed leaves its mark on this. Those who are professionally engaged in tennis, are constantly engaged in painting work or plastering rooms, as well as in other cases when a person puts his right (working) hand under significant stress, and the left is in relative rest, damage to the rotator cuff of the right shoulder joint occurs more often, than left.
Ruptures of the rotator cuff can occur anywhere, but more often they occur where the supraspinatus muscle and the large tubercle are attached. The cuff breaks when it is squeezed by the head of the humerus, at the site where the collarbone and the process of the scapula connect. In case of rupture of more than a third of the tendon fibers, a decrease in strength is felt in the injured limb.
Rupture symptoms
Quite rarely, there are cases in which the patient, in the absence of any symptom of damage to the rotator cuff of the shoulder joint, immediately shows trauma and there is a sharp onset of pain, causing an inability to raise the limb. Having injured the shoulder joint, a person complains of joint pain that occurs during movement.
With such an injury, pain can spread up to the elbow joint or the place where the deltoid muscle is attached. In some cases, there is an increase in pain at night.
At present, regularities have not yet been established in which the type and degree of damage to the rotator cuff of the shoulder joint would affect the intensity of pain. However, during the examination of almost all patients there is an increase in pain while the affected shoulder is diverted to 60-120º. When pressing on the place where the tendons are attached to a large tubercle, the pain intensifies, despite the fact that damage to the cuff, even if it is completely torn, may not be felt.
In cases where the damage is classified as old or stale, in the process of movement, a feeling of crunching in the area of a large tubercle may occur. Studying the range of motion of the damaged joint, trying to independently move the shoulder, you can observe the rise of the shoulder girdle up. If the rotator cuff of the shoulder joint is damaged due to the scapular-rib joint acting, the angle of the active shoulder abduction usually does not exceed 40 °. With an increase in range of motion, a situation arises in which the shoulder joint rises only simultaneously with the scapula.
One of the characteristic signs of rupture of the rotator cuff of the shoulder joint is considered to be a symptom of a “falling arm”. It occurs with the inability to raise a hand in a horizontal position and hold it without assistance. Most often, this symptom occurs in patients with a "frozen shoulder", the reason for this is a long immobilized position of the arm. The test for the “frozen shoulder” is performed as follows: the hand painfully rises by an angle of 90 ° and when it is held in this position, pressure is applied in the wrist or lower part of the forearm, as a result of which the limb falls.
Discontinuation Methods
The treatment of the rotator cuff of the shoulder joint during rupture is carried out on the basis of the results of ultrasound studies or magnetic resonance imaging.
Only in 50% of all patients with damage to the shoulder joint improvement occurs as a result of conservative therapy. When the cuff is completely broken in young people, doctors use early surgical treatment. For the elderly, leading a less active lifestyle, most often the operations are replaced by alternative treatment methods. They need not to neglect passive physical exercises.
In order to clarify the type and degree of rupture of the rotator cuff, arthroscopy of an injured joint is often prescribed.
If there are significant gaps, then conservative treatment is pointless, since the places of the gap are most likely not to grow together. In such cases, surgical treatment is preferred.
Partial damage, even if the adjacent tendons of the rotator cuff of the shoulder joint take over the functions of the torn, requires surgical intervention. Including those cases when the movement of the joint does not bring pain.
An operation is prescribed if:
- The movement of the shoulder joint is limited or completely impossible due to a complete rupture;
- Limited joint movement and pain sensation result from partial rupture;
- Conservative treatment has failed.
During the operation, the torn tendon is pulled and sutured to the place where it was attached before. In this case, special materials are used.
It is necessary to clarify that in cases where several weeks have passed since the rupture before surgical treatment, the muscle whose tendon has come off is reduced in size. Sometimes, especially if the injury is old, it is very difficult to stretch this muscle to its original state, which complicates the work with a damaged tendon, as this does not allow it to return to its original place.
According to medical practice, the most effective are operations performed earlier than 3 months after the gap.
What is tenosynovitis?
The tenosynovitis of the rotator cuff of the shoulder joint is the process in which the synovial tendon membrane, which consists of connective tissue, is inflamed from the outside.
The following types of tenosynovitis are distinguished:
1. In form: acute, chronic.
2. Due to development:
- Aseptic, which happens: traumatic, diabetic, allergic, immunodeficiency, endocrine, etc.
- Infectious, flowing with the presence of pus, which happens: bacterial, viral, fungal, specific, non-specific.
Causes of tenosynovitis
There are many causes and factors for the development of inflammation. These include:
- Tendon injury and injury. In the absence of infection in the injury, the wound heals faster and less painfully. In case of penetration into the infection, the treatment period increases, requiring drug exposure. During the disease with tenosynovitis, the patient has a loss of limb motor ability. However, after recovery, this ability is fully restored.
- Rheumatic disease. It occurs with a decrease in immunity, since the body is not able to resist with an infection that has penetrated the outer sheath of the tendon.
- Joint degeneration. Diseases such as bursitis often affect tendons.
- Genetic predispositions.
- Infectious diseases. In the case of tuberculosis, HIV, syphilis, herpes, etc., the infection carries blood throughout the body.
Symptoms of tenosynovitis
The development of symptoms and signs of this disease occurs gradually. Initially, a person feels mild discomfort in the joint. Most do not pay attention to this, since people consider this a temporary phenomenon related to the load on the limb. Since the transition from acute to chronic tenosynovitis is very rapid, the appearance of any of these symptoms is a reason for going to the doctor:
- Pain of any kind (acute, dull, prolonged, etc.).
- The appearance of a tumor, visible or palpable.
- Stiffness in joint movement.
- Redness in the tendon.
- Increased pain during movement.
Diagnosis and treatment
For the diagnosis of tenosynovitis, it is necessary to conduct a general examination, study a blood test and take an x-ray. All these measures will ensure the exclusion of osteomyelitis, bursitis, or arthritis from the list of suspected diseases.
Treatment can be medication, physiotherapy and surgery.
Drug treatment involves taking:
- Anti-inflammatory drugs.
- Antibiotics if the nature of the disease is infectious.
- Immune drugs to enhance immunity.
- Medicines that affect the normalization of metabolism.
- Analgesics.
- Nonsteroidal anti-inflammatory drugs.
- Painkillers.
Physiotherapeutic treatment is carried out on the basis of:
- Magnetotherapy.
- Laser therapy.
- Ultrasound.
- Electrophoresis.
- Cold and thermal applications.
- UV light.
- Therapeutic massage of the inflamed joint.
Surgical intervention occurs by puncture of the joint, which does not recover after the above measures. The doctor removes the fluid accumulated in the affected joint and the exudate of the inflammatory process. After that, in order to relieve inflammation, a hormonal drug is administered. The whole process is accompanied by rigid fixation of the limb to reduce pain. After fixation occurs with plaster or tire. Crutches can be used to avoid straining tendons.
What is tendonitis?
Tendonitis of the tendons of the rotator cuff of the shoulder joint is a pathology that causes inflammatory processes in the soft tissues that surround the joint of the shoulder. As with other diseases of the shoulder joint, with tendonitis, a decrease in joint mobility is observed and pain appears.
The main reason for the occurrence of tendonitis is the treatment of damage to the joint of the shoulder after injury, not carried out properly, or an insufficient postoperative rehabilitation period. Also, one of the reasons is the use of a plaster cast for a long time, as a result - the joint is stationary for too long.
Many do not attach importance to cervical osteochondrosis, however, it can also lead to tendonitis of the tendons of the rotator cuff of the shoulder joint.
It can develop after sports injuries, which is why it is widespread among professional athletes (swimmers, basketball players, tennis players).
At risk are patients who are diagnosed with diabetes mellitus or some other diseases associated with the thyroid gland.
Symptoms of tendonitis
Tendonitis of the rotator cuff of the shoulder joint occurs at the moment when inflammation of the joint capsule begins. It thickens, and the tissues surrounding the capsule are involved in the inflammatory process. Due to severe pain, movements are significantly limited. The result is the formation of adhesions - the first sign of lack of proper movement in the joint. In the event of their appearance, even after complete recovery, it is almost impossible for a person to return to the former mobility of the shoulder joint. That is why, contrary to pain during medication treatment of tendonitis, doctors recommend physical therapy. Moreover, this should not be a chaotic exercise, but a well-designed by the doctor course.
The main symptom that forces a person to consult a doctor is limited movement in the joint. It comes to the fact that the patient cannot dress on his own.
In the process of examining such a patient, the doctor cannot raise his hand, even when it is in a state of complete relaxation. This indicates that tendonitis has passed into an advanced stage, which is incurable. Against this background, biceps muscles begin to atrophy.
Do not forget about pain. They can be aching, sharp and give to the elbow.
Diagnostics
Tendonitis of the rotator cuff of the shoulder joint, and in particular its tendons, is not diagnosed at the initial stage of development using radiography. It is effective only in advanced stages, since only then will any visible changes in the joint associated with tendonitis be visible in the images. With this method, you can find out the causes of the disease.
It is believed that MRI is an ideal diagnostic method, as it can show ligamentous apparatus and muscle tissue.
Treatment of tendonitis
In the event that the disease is not started, with a high probability there is a complete recovery. However, during the recovery period, patients should not load the shoulder, but it is better not to refuse physical therapy.
Non-steroidal anti-inflammatory drugs will help get rid of pain. And only if they are ineffective are steroids used. These injections are made by the doctor directly into the joint. Procedures aimed at treating tendonitis help completely get rid of inflammation and pain, but they do not affect the causes of the disease.
If the rotator cuff tendonitis is started, then there is no way to do without surgical intervention. The whole procedure is carried out under anesthesia, and after rehabilitation, the motor amplitude of the joint is fully restored.
Currently, this kind of operation is considered less traumatic. The rehabilitation period after it can be up to 6 months. Joint activity cannot be reduced at this time, because this can lead to the re-formation of adhesions.
Often, doctors' forecasts are positive, especially with an early diagnosis of tendonitis. If the disease was started, then full restoration of the joint is sometimes impossible.