Rotator cuff tear/inflammation
The rotator cuff is a group of muscles and tendons that work to move and stabilize the shoulder joint in general, and this group of muscles is (the supraspinatus muscle, the infraspinatus muscle, the teres minor muscle, the subscapularis muscle) with their tendons. Rotator cuff tear occurs when there is a tear, injury or inflammation in part of these muscles or their tendons, and this commonly occurs in patients who frequently practice movements that require raising the arm above the head, such as painters, painters, carpenters, or tennis, basketball and volleyball players.
Rotator cuff tear and inflammation of the shoulder joint
Causes and symptoms
Rotator cuff injuries may vary according to their severity, as the patient may not suffer from any clinical symptoms, or the patient may suffer from very mild symptoms that do not affect his daily activities, or the symptoms may be severe and greatly impede shoulder movement. The causes of rotator cuff tears are multiple, including:
A direct, substantial injury to the shoulder joint (due to a fall, accident or traumatic injuries).
Degeneration and aging due to aging.
Activities that require repeatedly raising the arm above the head.
Lifting heavy loads for a long period of time.
The presence of bony growths in the shoulder bone, which causes friction with the muscle tendons during movement, leading to injury and inflammation of the tendons.
Information: Supraspinatus muscle injuries are the most common.
As mentioned earlier, not all cases of rotator cuff tears may cause symptoms in the patient, even if MRI images show positive signs of rotator cuff tears. This means that the damage may occur for months or even years before the patient begins to suffer from clinical symptoms. The most common symptoms are:
You suffer from pain when raising the arm.
A feeling of weakness in the shoulder.
You feel discomfort in the shoulder joint when sleeping, especially when lying on the affected shoulder.
Inability to carry things that used to be easy for you to carry. Or you find it difficult to perform other normal movements such as combing your hair, or scratching your back.
Feeling a popping or crackling sensation in the shoulder joint when moving.
Diagnosis
Clinical examination: Rotator cuff tears are usually diagnosed through a clinical examination of the patient, by moving the shoulder joint in several specific ways. The strength of the muscles surrounding the shoulder and arm is also tested.
X-rays: Although X-rays do not show or diagnose a rotator cuff tear, the doctor may request them to consider the possibility of bony growths that may cause pain, or the possibility of other indications such as shoulder joint roughness or acromioclavicular joint roughness.
Ultrasound: Shows muscle and tendon tissues and is characterized by its ability to examine tissues during direct dynamic shoulder movement.
MRI: Shows muscle and tendon tissues accurately to confirm the diagnosis of a rotator cuff tear more accurately. It also shows connective tissues and internal structures of the shoulder joint that do not appear on X-rays.
Rotator cuff pain of the shoulder joint
Treatment
Conservative methods: In the early stages of a rotator cuff tear, conservative treatment options may be resorted to, the most important of which are physical therapy and exercises for the shoulder joint. This also includes rest, ice packs, or anti-inflammatory and analgesic medications.
Local injections: If conservative methods fail to improve the patient's condition, local injections may be resorted to, especially if the pain is causing discomfort to the patient during sleep. There are different types of them, such as:
Steroid injections (cortisone): These are a strong and effective pain reliever and anti-inflammatory. However, caution and deliberation must be taken when dispensing them, due to the risks of causing tissue and tendon rupture, which causes more severe future complications.
Regenerative therapy: This is one of the latest methods for dealing with rotator cuff tears, and is considered an alternative treatment to other local injections such as cortisone injections. Platelet-rich plasma injections are an alternative solution that works to relieve pain, improve movement, and stimulate the repair of damaged tissues in the tendons and muscles of the rotator cuff. This is done by injecting platelet-rich plasma derived from the patient's own blood and injecting it locally into the damaged area. The principle of this method is based on stimulating the healing process and self-healing of the damaged tissue, which is radically different from the methods mentioned above.
Surgical methods: Usually performed when there is a complete tear or cut in the muscle tendon and when there are bony protrusions that cause irritation to the tendon. There are several different surgical procedures that are determined according to the patient's condition. These include: suturing the muscle tendon to the bone via an endoscope, or sanding the bony protrusions that rub against the rotator cuff during movement, or by transplanting a tendon taken from another part of the body if the tendon tear is severe.
Frequently Asked Questions
Should I just resort to conservative treatment or do I get an injection?
Conservative treatment is a good option for cases whose symptoms have not reached a stage that causes discomfort to the patient's life, especially when sleeping.
Will conservative treatment or injections make me avoid surgery?
About 80% of cases benefit from this in terms of improving pain and shoulder joint function.
When is surgery a more appropriate option?
In many cases such as: not benefiting from other treatment methods and your symptoms persist for a period of about 6 to 12 months, the presence of a large tear (larger than 3 cm), severe weakness in the function of the shoulder joint, or while the tear occurred due to an acute and severe injury.
I did not benefit from physical therapy and conservative treatment, should I inject cortisone or plasma?
From our point of view, we see that plasma is a better alternative to many cortisone injections. There are several studies that compared the two procedures and concluded that plasma gives better results, and without any risks to the patient as occurs with cortisone injections.
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