Dr. Soler Romagosa is a member of the TraumaAdvance group. Expert in the treatment of knee and shoulder joint pathology, he is a renowned orthopedic surgeon in sports and work injuries. In addition, he is also a reference in regenerative therapies and in the application of platelet-rich plasma and cell therapy. The rotator cuff (also known as the rotator cuff) is a set of tendons that surround the humeral head in front, above and behind, and which join the humeral head with the main musculature responsible for shoulder movement.
The most fragile tendon
The tendons that form part of the rotator cuff are the subscapularis tendon (in front of the humeral head), the supraspinatus tendon (above the humeral head), and the ingrainospinous, teres major and teres minor tendons (behind the humeral head). The most frequently injured tendon is the supraspinatus tendon, responsible for raising the arm upwards.
Types of injuries
The 2 main injuries that can affect the rotator cuff tendons are inflammation (tendinitis) or tendon rupture. Tendinitis is caused by a sustained overload of the tendon (e.g. repetitive work with the arm raised, frequent lifting, etc.) or by a sudden movement of the arm during an effort or a fall. Tendon ruptures occur after a sudden pull of the arm when making an effort or falling, or in older people due to the same degenerative process of the tendon tissue, which ends up breaking without the need for a major trauma.
When to see a specialist?
The patient with tendinitis usually comes to the consultation for presenting pain in the shoulder for weeks or months of evolution, often not remembering the cause of it. The pain progressively limits the ability to perform normal activities in daily life (carrying groceries, entering the toll or parking ticket, performing certain sports activities, …). The pain may be predominantly nocturnal (waking patients up), creating great discomfort. Rotator cuff tears can also present in the same way (pain in the shoulder of time of evolution, at night, …), but with the difference that at the moment of making an effort with the arm there is an important loss of strength and impossibility of doing it, due to the tendinous lesion. Likewise, there is usually a clear traumatism from which the pain and functional deficit begins.
The tendon injury will be intuited by the physical examination of the patient (there are a series of exploratory maneuvers that orient us towards a tendinitis or a tendon rupture). The most specific imaging test to confirm these lesions is magnetic resonance imaging.
Different treatments depending on the pathology
The treatment of rotator cuff tendinitis will initially be conservative: depending on the time of evolution, medical treatment with anti-inflammatory drugs may be prescribed, the patient may be referred for rehabilitation, or if the process is more advanced or previous treatments have failed, an infiltration with a cortisone derivative may be performed. The treatment of tendon ruptures will be mostly surgical, so that the ruptured tendon will be reinserted in its anatomical site of origin. Currently this intervention is performed by arthroscopic technique, and the results are very satisfactory, progressively improving the pain and functionality of the shoulder until its total normalization.
However, it should be taken into account that not all rotator cuff tears need to be operated: It is common to see in older patients tears with a long evolution time, but which are very well tolerated, causing neither pain nor functional deficit. These ruptures are characterized by having a very degenerated and retracted tendon, so it is difficult to reinsert it in its original place by operating it. When these patients suffer a traumatism or pull of the shoulder, an important deficit of mobility of this articulation appears due to the decompensation that causes the pain, revealing the chronic rupture. In these cases we will opt for conservative treatments (recovery, infiltrations) to reduce pain and recover joint functionality.