Rotator cuff rupture

What is the rotator cuff?
Normally, the articular side of the rotator cuff inserts on the humerus just at the border of the cartilage.

Intra articular view of intact humeral cartilage and rotator cuff tendon insertion

Intra articular view of intact humeral cartilage and rotator cuff tendon insertion

Why the rotator cuff is at risk?
The rotator cuff is a group of four muscles that covers the humeral head. Their main action is to stabilize the shoulder and raise the arm. The tendons are located between two bones: the acromion above and the humeral head below. When you raise your arm, the rotator cuff tendons slide between these two bones.
Normally, the under surface of the rotator cuff tendons is perfectly smooth and shiny .
When the space is reduced for some reason, the tendons may be irritated or partially ruptured. This is called sub-acromial impingement .

When specific rehabilitation and steroid injections are not efficient,  an arthroscopic acromioplasty may be indicated to increase the space between the arcomion and the humeral head.

Sub-acromial impingement is caused by compression of the rotator cuff between the acromion above and the humeral head (not seen on this picture) below

Sub-acromial impingement is caused by compression of the rotator cuff between the acromion above and the humeral head (not seen on this picture) below

 

 

 

 

 

 

 

 

In the same patient, the tip of the acromion was removed by a burr under arthroscopy, treating the sub-acromial impingement

In the same patient, the tip of the acromion was removed by a burr under arthroscopy, treating the sub-acromial impingement

 

What is the rotator cuff rupture?

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At a later stage the tendons may present a full thickness rupture .
Fig 3 ROTATOR CUFF TEAR

Rupture or avulsion of these muscles can occur in young patients during an accident;
however, it most often occurs gradually after the age of 50. The rupture will extend gradually with time and cannot heal by itself. Medical treatment and rehabilitation can sometimes relieve pain, but only surgery can repair the tendons.
Some additional tests are useful to confirm and measure the size of the rupture, the quality of the muscles and articular surfaces.

Before surgery
X-rays and CT arthrograms are necessary before surgery.
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CT shows the edges of the rupture more precisely than Ultrasound and MRI.
Preoperative rehabilitation is always done before the operation. It aims to alleviate pain, relax the shoulder and strengthen the muscles unaffected by the failure. It is also very useful to help you to prepare the postoperative period. The postoperative splint is cumbersome and inconvenient for clothing. The physiotherapist will give you some tips to make life easier without risk and will show you the principles of postoperative rehabilitation. The movements you will learn are simple, but require your cooperation.
What is the procedure?
Reconstructive surgery of the rotator cuff has a double effect:
– To reinsert the ruptured tendons.
– To reduce the friction on the repaired tendons by decompression of the sub acromial space.
This procedure requires general anesthesia and a short hospital stay. Blood transfusion is never needed.
After the operation, your arm is usually placed on a ‘cushion’ splint to reduce tension on the repaired tendons .

In some cases the rupture is so extensive that the muscles cannot be repaired. It is then necessary to use the transposition of another muscle to ” fill the defect “.
Most of the time, it is possible to repair the rotator cuff arthroscopically. These arthroscopic techniques can reduce scarring and facilitate the postoperative period.

 

 

Fig 12 video RC repair subA view-page-001

And after the surgery ?
The splint should be applied constantly for 3 to 6 weeks. Rehabilitation is begun from the first day following surgery,.
The physiotherapist mobilizes your arms with no effort on your part (passively), to prevent any muscle contraction. The mobility of the elbow, wrist and fingers is preserved.
Your surgeon will see you in consultation to follow up proper healing and evolution of rehabilitation.
After the third week, the mobility of the arm is gradually increased; active movement is still prohibited during this period.
After the 6th week, the splint is abandoned and you can move your arm by yourself.
The recovery of activity is very progressive. A premature return to daily activities (gardening – maintenance) may put the repair at risk.
Complete recovery usually requires 3 to 6 months.

Summary
Rotator cuff rupture is most common after the age of 50.
Postoperative rehabilitation takes at least 3-6 months.
The surgery can relieve pain in 90 % of cases.
Recovery of strength and mobility is better when the rupture is recent and small.
An informed consent form will be given before surgery. We hope to inform you as objectively as possible about the principles of intervention, but also the risk of complications.