What is the rotator cuff?
The rotator cuff is a set of four tendons that wrap around the head of the humerus like a cap.
The supraspinatus is the superior tendon that slides under the acromion and is most frequently injured. The subacromial bursa is a soft tissue sac with synovial fluid. This bursa serves to improve the gliding of the tendons under the acromial arch when the arm is elevated.
How does a rotator cuff tear occur?
A tear can occur as a result of a traumatic event or develop gradually. Patients whose onset is gradual usually have previous symptoms of impingement tendinitis. Age-related tendon degeneration also causes tears.
These ruptures can be partial (not completely dividing the tendon) and total (with complete section of the tendon). Total ruptures can be small and affect only one tendon, or very wide, involving several tendons.
What symptoms does the rupture of the supraspinatus tendon cause?
The symptoms are very varied and depend on the type of rupture. If the rupture is extensive, the patient will present pain and inability to lift the arm. In other ruptures, the patient will have pain, some crunching and decreased strength, but will be able to lift the arm without difficulty. In some elderly patients, the tendon rupture will not cause symptoms and the patient will not know that he/she has a rupture in this area.
As far as diagnosis is concerned, this is clinical. However, in most cases it can be confirmed by ultrasound or MRI.
How are supraspinatus tendon ruptures treated?
Given the existence of very different situations, individualized treatment will be required depending on the patient’s needs and the type of rupture.
An older, inactive patient will be recommended conservative treatment similar to that for tendinitis. It is also possible that this person may have severe rotator cuff loss, inability to elevate the arm, and may not improve with conservative treatment. In this case, the professionals in Traumatology will advise the placement of a total reverse shoulder prosthesis. In the case of a young, active patient with a traumatic tear, the patient will require urgent repair. This operation will be performed arthroscopically by making small incisions.