Tendon tear – shoulder

Tendon tear – shoulder: description

A tendon tear (shoulder) is one of the most common tendon injuries and is often the cause of shoulder pain.

The shoulder joint is a complex structure with one main joint and three smaller side joints. The main joint consists of the loose socket, which is largely formed by the shoulder blade (scapula), and the condyle of the humerus. The bone guide of the shoulder joint is relatively free compared to other joints. This allows the arm to be moved in many directions. The shoulder joint is stabilized by a variety of muscles, ligaments and tendons that can rupture under heavy load. Particularly important is a ring of four muscles (rotator cuff called), which arise on the scapula and attach with their tendons on the head of the humerus. These tendons run under the connective tissue-bony roof of the joint (acromion) and are particularly susceptible to torn tendons under load. Shoulder pain often comes from the rotator cuff.

There is another tendon in the area of ​​the shoulder joint: the long biceps tendon, which – starting from the arm flexor muscle on the upper arm (biceps) – passes through a bony groove to the upper edge of the shoulder socket. She can tear too.

Tendon tear – shoulder: symptoms

As with all tendon tears, sufferers also notice a restriction of movement in a shoulder-tendon tear, for example when lifting the arm. The joint also loses stability, so that it can dislocate (luxate) in certain cases. Other symptoms that can occur with a tendon tear (shoulder) are pressure pain, nocturnal shoulder pain and bruising.

In the case of a rupture of the long biceps tendon, in addition to the mobility of the shoulder, also that of the elbow joint may be reduced. However, the biceps still attach to the shoulder via a second tendon (short biceps tendon), so that a tear of the long tendon alone usually does not lead to a complete loss of function of the muscle.

Tendon tear – shoulder: causes and risk factors

A tendon tear (shoulder) is often due to wear. Mechanical damage can lead to inflammation of tendons and bursae in the shoulder joint. The affected tendons can first be torn under load and later completely severed.

The muscle tendons on the shoulder are very susceptible to a tear due to the anatomical features. Some muscle tendons under the joint roof of the shoulder (subacromial) and can be easily clamped between the head of the humerus and the bony joint roof.

In addition to degenerative changes often accidents (such as a dislocation of the shoulder) lead to a tendon tear.

Shoulder tendon tears are favored by several factors. These include smoking, various medications (such as anabolic steroids), high blood lipids (hypercholesterolemia), and high-shoulder activities.

Tendon tear – shoulder: examinations and diagnosis

If you have the suspicion that a shoulder tendon is torn, you should consult an orthopedist or accident surgeon. There are also doctors who specialize in shoulder disorders and injuries. Early diagnosis of shoulder damage is important to prevent more severe progression and complications.

Before the examination, the doctor will ask you the following questions:

• Since when does the movement restriction exist?
• Can you localize the pain?
• Did you stress your shoulder a lot?
• Do you have a previous illness on the shoulder?

To investigate the suspicion of a tendon tear (shoulder), the doctor will examine you. To do this, you have to clear your upper body. Already when taking off the upper part of the physician may notice movement difficulties. When looking at the affected area, the doctor can notice changes, such as the decrease in muscle mass (such as the so-called epaulette sign). During palpation, pain points can be identified and any irregularities detected.

Thereafter, the doctor tests the mobility of the shoulder and compares it with the (healthy) opposite side. To find out which muscle tendon is affected, the doctor can perform various provocation tests. Depending on the type of arm and shoulder posture as well as the movement, the physician can identify the affected muscle tendon (including job, lift-off or belly-press test).

Ultrasound (sonography)

If a tendon tear (shoulder) is suspected, an ultrasound examination of the shoulder is performed first. During the examination, the shoulder can be moved freely so that the doctor can examine the joint in different positions and during the movement. If the tendon course is incomprehensible, is atypical or does not change despite movement, the suspicion of a tendon tear (shoulder) is confirmed.

Magnetic Resonance Imaging (MRI)

The MRI examination (also called magnetic resonance tomography) is an imaging procedure that can detail body structures without radiation exposure. It is also suitable for suspected tendon rupture (shoulder). However, the recording is only done in a joint position (static), so that no movements can be recorded.

roentgen

In the radiograph, tendons can not be displayed. Only a possible bone damage, which can be accompanied by a tendon tear (shoulder), can be detected.

Tendon tear – shoulder: treatment

A tendon tear (shoulder) can in principle be treated both surgically and non-surgically (conservatively). If broken bones, vascular or nerve injuries persist alongside the tendon rupture, a complex treatment strategy is required.

The best treatment for a tendon tear (shoulder) depends on many factors. These include above all the degree of damage and individual demands on the shoulder. The goal of every therapy is to reduce pain and improve joint function.

In almost all cases, a pain and inflammatory treatment is started first. Sometimes cortisone is injected directly into the joint. Strict immobilization is not recommended due to the risk of joint stiffness. Instead, early-stage physiotherapy (shoulder school) is planned and started in the early stages of treatment.

Tendon tear – shoulder: operation

In most cases, a tendon tear (shoulder) is operated on – especially in the case of injury-related tendon tears, pronounced activity and little pre-damaged tendons. On the other hand, one should refrain, among other things in joint infections, nerve damage and advanced degeneration on an Op. The result of the procedure is critically dependent on the condition of the tendons. Only with a good tendon quality, a tendon suture can be successfully performed.

A tendon tear (shoulder) should be operated on within a few weeks if you want to get a good result. One distinguishes the open tendon repair from the minimally invasive variant. An open procedure also allows more difficult techniques. However, the deltoid (deltoid muscle) around the shoulder must be detached from parts of the scapula. In a minimally invasive operation, this is not necessary. Here, the surrounding tissue can be spared due to the small access to the joint. The minimally invasive technique is more complicated and allows only easier tendon repairs due to the tightness. If a piece of bone has ruptured with the tendon, then this must be provided in an open surgery.

There are a number of different techniques for sewing tendon ends. Which is used in individual cases, depends on the type of crack. In addition, it may be necessary to increase the space around the tendon by decompression or to insert a (endogenous) tendon transplant.

After surgical treatment, the shoulder should be protected in a bandage for two to six weeks (Gilchrist bandage, abduction splint etc.). With a shoulder adduction splint, the arm is held in 30 degrees lift. The shoulder joint may initially only be moved passively. From the third week onwards, assistive active movement exercises begin slowly. From the seventh week active movements can be carried out without restriction. Sporting activities should not resume until the third month.

Tendon tear – shoulder: Conservative treatment

Conservative treatment is considered in a non-accidental, slowly developing tendon tear in the shoulder. This form of treatment is particularly well suited for patients who are only partially active, as well as for a so-called “Frozen Shoulder” (shoulder stiffness).

Usually, the treatment is divided into three phases: First, the pain and inflammatory processes in the shoulder are relieved, such as with medication and / or a cold treatment. Cortisone may also be injected into the joint. In the second step, a slow build-up training is started to ensure the stability of the shoulder joint and to counteract muscle breakdown. Finally, the training is continuously increased in order to exercise the necessary for everyday life, sports or work movements again.

If the pain persists or becomes worse after initial recovery, patients should go to the doctor again. Then an operation may be necessary.

Early stabilization and build-up training is essential to prevent muscle breakdown and joint stiffness and to restore shoulder mobility quickly. But it can take up to six months for the shoulder to be fully loaded again.

Tendon tear – shoulder: Disease course and prognosis

A general statement on the prognosis in a tendon tear (shoulder) is difficult to hit. For example, it is crucial which tendon is affected and to what extent. After conservative treatment, more than 50 percent of sufferers complain about a permanent muscle reduction and almost all patients have at least a slight weakness in the shoulder area. Treatment with proven shoulder specialists can significantly improve the prognosis, especially for surgical treatment. Essential for the preservation of function and strength is in any case an early functional rehabilitation after one Tendon tear (shoulder).