Rotator Cuff Diseases

The shoulder consists of three main parts, the humerus, the scapula and the clavicle.

The rotator cuff, in turn, consists of four muscles and their tendons that start from the scapula and end up covering the head of the humerus. The four muscles are:

• The supercontinent at the top.

• The subplate in front.

• The sub-occipital behind and above.

• Τhe elasson round behind and below.

The muscles of the rotator cuff originate from the scapula and converge towards the humerus where they then take refuge next to each other, forming a horseshoe-like structure. The rotator cuff muscles cooperate in almost all shoulder movements to achieve abduction, anterior flexion, internal and external rotation. Their smooth cooperation is essential both for movement and for stabilizing the head of the humerus in the scapula of the shoulder blade.

The most basic diseases of the rotator cuff are:

• Supraspinatus tendinitis.

• Acute calcifying tendinitis.

• Rotator cuff impact syndrome.

• Rupture of the hamstring.

• Rupture of the long head of the biceps.

Rotator cuff syndrome results from the continuous friction of the tendon against the bony prominence of the scapula, the acromion (subacromial friction syndrome). During movements of the upper limb and as the shoulder comes into extreme positions, the rotator cuff tendons become trapped between the humerus and the acromion of the scapula. Most vulnerable to this pathology is the supraspinatus tendon. This constant entrapment causes recurrent episodes of tendinitis and gradually leads to the weakening of the tendon. The end result of rotator cuff impingement syndrome is rupture of the tendons, which disrupts shoulder movements and leads to arthritis.

Symptoms

• Pain in the area of the shoulder joint, the onset of which may be acute (traumatic rupture) or gradually worsening (degenerative rupture).

• Pain that radiates up to the elbow area.

• Nightly occurrence of pain. The patient experiences sleep disturbances due to the pain and is unable to sleep.

• Muscle weakness. The patient is unable to carry out daily activities, even lifting a lightweight object.

• Stiffness-loss of mobility of the area. The patient reports difficulties with simple activities such as combing his/her hair and washing.

Treatment

Conservative Treatment

Conservative treatment is mainly aimed at reducing the painful symptoms and may include the following:

• Medication for the treatment of acute pain using analgesics and anti-inflammatory drugs.

• Ice pads and rest.

• Cortisone injections: In some cases cortisone infusion is indicated.

• Physiotherapy.

Surgical Treatment

In most cases, surgical rehabilitation is performed arthroscopically, giving the patient the opportunity to return home the same day. Arthroscopic Suturing is done. Arthroscopic repair of a shoulder rotator cuff tear is a common procedure, but it requires specialized training not only for the stage of tendon repair, but also for the proper judgment of how to repair the tear. The quality of the tendon also affects the amount of damage and is of great importance to the period of repair and the successful outcome of the surgery.

Supraspinatus tendinitis is the most common form of rotator cuff tendinitis. The rotator cuff is formed by four muscles the suprascapular, sub-scapular, sublateral, and ulnar round muscles. The suprascapular tendon is prone to inflammation due to its location and function, which leads to more intense stress.

Symptoms

The main symptoms are:

• Pain and burning sensation in the shoulder area. Usually the pain is localized to the shoulder area, but there are cases where it may reflect to the shoulder blade, neck or arm.

• Discomfort and pain during sleep when the person rests on the affected shoulder.

• Limited mobility of the arm, where the patient notices that they cannot raise their arm up or turn it towards their back.

Treatment

Conservative Treatment

The treatment depends on certain factors such as the patient's age, health condition, the severity of the condition, previous surgeries, resistance to certain medications, etc.

Initially the treatment consists of:

• Resting the affected limb in a shoulder support envelope and avoiding any movement that could aggravate the condition.

• Using a hot water bottle or ice therapy (depending on the patient's reaction) for ten to twenty minutes a day can provide relief to the sufferer.

• Medication to treat acute pain using analgesics and anti-inflammatory drugs.

• Physiotherapy.

• Intra-articular cortisone injections.

• Thrombocyte infusions.

Surgical Treatment

In cases of patients with anatomical problems and when conservative treatment fails, surgical treatment is the only solution. The operation is performed arthroscopically using a camera and small one centimetre incisions and the recovery is immediate. The subacromial space is widened and if tendon ruptures coexist, stapling is done with special anchors. The pain is eliminated very quickly and within a relatively short time following a special rehabilitation program the patient fully regains shoulder mobility.

Calcific tendinitis occurs when calcium salt deposits form in the shoulder tendons, especially in the rotator cuff tendons. This build-up can occur in anyone, regardless of age. While the exact cause remains unclear, the condition is most common in women between the ages of 30 and 60. The duration of symptoms can vary from a few weeks to months.

Symptoms

Patients may report:

• Severe pain in the front or outside surface of the shoulder. The pain may radiate up to the elbow as well as to the neck (nape of the neck) and back.

• Night pain that wakes the patient up, especially if they sleep on the affected shoulder.

• Weakness of the upper limb.

• Restriction of movement, difficulty in performing shoulder movements, stiffness.

In addition to the clinical examination, the doctor will request an ultrasound of the shoulder to examine the integrity of the tendon, the presence of fluid and the size and location of the calcification. An X-ray will also be needed to confirm that the pain and stiffness are due to calcification and not some other cause such as shoulder osteoarthritis. In some cases further investigation with an MRI scan may also be needed.

Treatment

Conservative Treatment

• Rest.

• Agotherapy.

• Physiotherapy.

Non-steroidal anti-inflammatory drugs.

• Injection of cortisone alone or in combination with other biological therapies.

Surgical Treatment

If these treatments are unsuccessful or if the condition is severe, surgery may be required using a minimally invasive technique - arthroscopy, in which using tiny incisions the surgeon advances a camera, visualises the calcium build-up and removes it with direct vision. In cases where the calcium has caused a rupture of the tendons in the area, then at the same time the tendons are sutured.

The biceps muscle starts - through two tendons - from the shoulder area and ends - through a tendon - at the elbow joint. In the shoulder, the first tendon is the short head tendon, which starts from a point near the joint (coracoid process) and rarely causes problems, while the second tendon is the long head tendon, which starts through the shoulder joint and is unfortunately the cause of frequent problems.

Rupture of the biceps in the elbow area is not a rare injury. The usual mechanism of injury is lifting a weight greater than 40 pounds, with the elbow in 90 degrees of flexion. It occurs most often in people taking anabolic steroids and in weightlifting athletes in general and is the result of chronic irritation and degeneration

Symptoms

Patients suffering from a rupture of the biceps tendon complain of:

• Sudden sharp pain in the elbow or shoulder. The pain is manifested depending on the location of the tear. Usually, there is a history of sudden eccentricity with the elbow in flexion.

• Swelling in the upper part of the arm.

• In patients with a rupture of the biceps tendon there is effusion, swelling and tenderness inside the elbow.

Treatment

Conservative Treatment

• Non-steroidal anti-inflammatory drugs.

• Physiotherapy.

• Injections (corticosteroids, local anaesthetics and PRP).

Surgical Treatment

It is usually chosen in refractory cases or tendon ruptures in young and active athlete or manual workers and involves arthroscopic tenotomy in older people and intra- or extra-articular tendon fixation in younger and more active patients.

The procedure is relatively easy, can be performed under regional anaesthesia and does not require a hospital stay. Early treatment of biceps rupture, up to 2 - 3 weeks after injury, ensures an excellent clinical outcome and the patient returns to pre-injury activities.