Rotator cuff, also known as rotator cuff, is a group of tendon complexes wrapped around the humeral head. There are subscapular tendons in front of humeral head, supraspinatus tendons above, infraspinatus tendons and teres minor tendons behind. The movement of these tendons leads to the rotation, rotation and lifting of the shoulder joint, but more importantly, these tendons stabilize the humeral head on the glenoid, which plays an extremely important role in maintaining the stability and activity of the shoulder joint.
Extended data
The rotator cuff is composed of the tendons of supraspinatus, infraspinatus, teres minor and subscapular muscle, which are attached to the edge of the greater tubercle of humerus and the anatomical neck of humerus. Its inner surface is closely connected with the joint capsule, and its outer surface is the deltoid descending capsule. It surrounds the upper end of the humeral head, can be placed in the glenoid to stabilize the joint, assist shoulder abduction, and has the function of rotation. The supraspinatus muscle is attached to the uppermost part of the greater tubercle of humerus and is often penetrated by acromion coracoacromial ligament. From the anatomical structure and mechanical stress, this part is the weak point of rotator cuff. When the shoulder joint is suddenly adducted, it is easy to rupture, and because of the gravity of the limb and the pull of the rotator cuff, the crack expands and it is difficult to heal.
Etiology and pathogenesis
More common in men over 40 years old. If they are young people, most of them have a history of serious injuries. Because the rotator cuff has acromion protection, direct violence rarely leads to rotator cuff rupture. Indirect violence is mostly caused by abduction of upper limbs and sudden adduction of palms after the rotator cuff degenerates with age, especially because the supraspinatus muscle is weak and bears the greatest traction, so it is easy to rupture, accounting for about 50%.
According to the degree of rupture, rotator cuff injury can be divided into two types: partial rupture and complete rupture. If not handled properly, partial rupture will develop into complete rupture.
diagnose
(1) Clinical manifestations
More common in men over 40 years old. If you are young, you must have a history of serious injuries. When the rotator cuff breaks, patients often feel tearing sound, local swelling and subcutaneous bleeding. After the injury, the local pain is confined to the acromion and dissipated to the deltoid muscle. The tenderness between the tubercle and the acromion is obvious, and the patient can't actively abduct the shoulder joint.
(2) check
1. The tenderness between the tender nodule and the acromion is obvious. According to the size of tenderness, the size of rotator cuff rupture can be determined. Local tenderness points were blocked with 1% procaine. After the pain disappears, the patient can actively abduct the shoulder joint, indicating that the rotator cuff is not broken or only partially broken. If you can't actively spread out after sealing, it means serious damage or complete damage.
2. The buttoned rotator cuff will buckle when it passes under the acromion, especially when it is completely broken.
3. Patients with partial rupture of pain arc have pain in the shoulder abduction range of 60 ~ 65438+020.
4. If the crack breaks completely, you can feel the broken crack.
5. In the early stage of muscle atrophy, it is not obvious because of the fullness of deltoid muscle, but it is accompanied by the apraxia of supraspinatus muscle and infraspinatus for a long time, especially in infraspinatus. Deltoid muscles sometimes enlarge rather than shrink.
6. Abnormal joint movement When the rotator cuff is broken, the affected arm can't abduct, but shrugs instead. Due to rotator cuff injury, deltoid muscle contracts, and humerus moves along its longitudinal axis, forcing scapula to slide and rotate on the chest wall, resulting in abnormal shoulder joint movement and weakened abduction resistance.
7. After local anesthesia in the upper arm droop test, the affected upper arm was passively abducted 90 degrees. If there is no support, the affected limb can still maintain this posture, indicating that the rotator cuff injury is not serious. If the passive booth cannot be maintained, the rotator cuff is seriously or completely broken.
(3) X-ray examination
Intra-articular inflation or lipiodol angiography can be used. If it is found that the shoulder joint cavity and the shadow of the deltoid descending capsule are interconnected, it means that the rotator cuff is completely broken.
(4) Differential diagnosis
1. Shoulder fracture and dislocation.
2. The tendon of the long head of the biceps brachii is broken, and the broken part is mostly located in the intertubercular groove of the humerus. Acute trauma can cause severe pain and elbow flexion weakness. Chronic rupture, elbow flexion strength gradually weakened. The elbow flexion test makes you feel weak or painful.
Step 3 pull your shoulders.
treatment according to syndrome differentiation
(1) manual therapy
Manipulation should not be used in acute stage. In the stage of functional recovery, methods such as acupoints, pinching, poking, shaking shoulders, pulling and shaking can be used around the shoulder joint, and passive exercises such as abduction and lifting of the shoulder joint can be used to restore the function of the shoulder joint as soon as possible.
(2) Fixed therapy
Most patients with incomplete rupture do not need surgical treatment. They usually use abduction, flexion and external rotation of the shoulder joint under local closure, and fix it with herringbone plaster or abduction splint bracket for 3 ~ 4 weeks, so that the rotator cuff is broken and closed and healed.
(3) drug therapy
1. Yunnan Baiyao and Da Die Pills can be used for promoting blood circulation and qi circulation, reducing swelling and relieving pain in the early stage of internal medicine, and Jin Shu Pills can be taken orally in the later stage.
2. External use of Xiaoyu Zhitong ointment, medical education network to collect and sort out Jieguxujin ointment, etc.
Functional exercise
When the pain can be tolerated, shoulder joint function exercise can be carried out. At first, passive activities were the main activities, and actions such as lifting heavy objects were avoided within 3 months.
(5) Other therapies
1. Patients with severe local pain can be blocked locally in the subacromial space.
2. Surgical treatment for patients with partial rotator cuff fracture who can't recover strong, painless and active abduction of shoulder joint after 4-6 weeks of non-surgical treatment, patients with complete fracture and old fracture should undergo surgical repair.
References:
Baidu encyclopedia-rotator cuff