Eng – Rotator cuff disorders

In Articoli Scientifici, Patologie della Spalla by Spalla.it

Rotator Cuff Disorders

With "rotator cuff" we mean a set of tendons present in the shoulder joint that allows you to perform a wide range of complex movements: the shoulder is the joint of the human body that has the greatest joint excursion capacity.
The traumatic and/or degenerative insults that these tendons undergo can cause them to rupture, this condition is called a "rotator cuff injury".
It is one of the most common causes of shoulder pain in adults and the "young elderly" and was once referred to as "periarthritis".

Principles

Rotator cuff tears are often related to biological and mechanical factors such as postural defects. The shoulder, and in particular the rotator cuff in some respects pays the price of the evolution of the human species which has gone from a quadrupedal to a bipedal position for which the cuff works with a disadvantageous lever.

Symptoms

The rotator cuff tear is responsible for several symptoms, characteristic pain at night, weakness of the arm, especially when it is in motion. It may be associated with joint stiffness, active limitation of joint movement, more rarely swelling. The pain can also be localized in the anterolateral region of the arm, where the bicep runs and the deltoid is inserted.

Diagnosis

The orthopedic surgeon diagnoses a pathology of the rotator cuff according to the anamnestic collection and the clinical examination which must necessarily be integrated with diagnostic investigations, such as the radiographic examination, frequently the Magnetic Resonance (MRI) and sometimes the Computed Tomography ( TaC).

Conservative treatment options for the rotator cuff

  • Possible restraint with arm brace
  • Para-tendon intra-articular infiltrations
  • Downsizing of work and/or physical activity
  • Specific physiotherapy exercises that must be performed in a dedicated environment and with qualified personnel

Surgical treatment of the rotator cuff

Rotator cuff repair was previously performed using open surgery. Technological progress with high-definition optics and increasingly precise instruments has allowed arthroscopy today to completely replace open surgery for certain procedures such as the repair/suture of the rotator cuff. Titanium screws, sometimes bio-absorbable, called "anchors" are used; these allow the approach of the injured tendon to the bone tissue. Following the surgery, the patient will wear a very well tolerated brace for a few weeks (usually 3 or 4), to allow the tendon to take root again in the bone; these are defined as “biological times to repair”. A specific physiotherapy protocol will then follow, aimed at relieving pain, restoring movement and progressively integrating the "Shoulder ring" into the kinetic chain of the human body.