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Rupture of the rotator cuff

Rupture of the rotator cuff is among the most common problems of the shoulder. The rotator cuff is the tendinous structure which surrounds the head of the humerus and lifts the shoulder laterally and rotates it internally and externally. The tendons of the rotator cuff are broad, thin belt-like structures. A tendon rupture may occur in conjunction with a trauma or it may have a non-traumatic origin, for example through wear and tear under a tight acromion. Oftentimes, a tendon tear occurs in the supraspinatus tendon, which lifts the arm up from the side.

Symptoms

The classic symptoms of a supraspinatus tear are painful loss of range of motion and pain even in rest. Lifting the arm upwards, especially, is difficult if not impossible. Many times, there is only a partial tendon rupture in which case the arm moves, but it is weak and painful. If there is a complete tendon rupture, the strength in the arm may be remarkably weak.

Rotator cuff tendons consist of two layers: the inner and outer layer. Ruptures of the tendons may be partial whereby either one or the other layer is ruptured. However, the symptoms may still be pronounced, i.e. the arm is painful to move and there is significant loss of strength. Sometimes even a partial tear may need operative treatment.

Operative treatment

Rotator cuff operations are arthroscopic procedures. A torn cuff tendon is fixed back into place using suture anchors. The anchor screws are usually made of titanium or resorbable materials which have strong sutures attached.

An acromioplasty is usually performed as well. This procedure involves making more space for the repaired tendon underneath the acromial bone. Operation time is 45–60 minutes. The operation is conducted under general anesthesia and the patient is discharged from the hospital the same day.

Postoperative treatment

The patient wears a sling for four weeks. Light rotatory movements are allowed at the waist line. The patient can write, use a computer, make coffee, eat, etc. However, the patient must be extremely careful not to harm the reconstruction. The sling is removed after four weeks and active rehabilitation may begin 5–6 weeks after surgery. Taking care not to damage the reconstruction by using the arm too early is crucial. The patient may engage in heavy labor 3 months and sports 4–6 months after surgery.