Download Rotator Cuff Injuries

Regional rheumatic pain
syndromes
Regional
rheumatic pain syndromes
Postižení měkkých tkání
• Zánětlivé změny kloubních
i mimokloubních struktur
• Entesitidy – záněty úponů šlach nebo
vazů do kostí
• Bursitidy – rameno, loket, koleno
• Tendinitidy – nejčastěji šlachy flexorů
• Tendovaginitidy – zánět šlachy i šlachové
pochvy
• Kapsulitidy – zánět pouzdra – rameno
Regional rheumatic pain
syndromes
• Inflammatory changes of joint ´s and
extraarticular structures
Localised:
• Enthesopathy
• Tendinitis
• Bursitis
• Carpal tunel syndrome
• Rotator cuff injuries
Regional rheumatic pain
syndromes
Systemic:
Fibromyalgia
Inflammation of Achille´s tendon
and TC joint
Carpal tunel syndrome
• Result of oedema and inflammation of
structures in carpal tunel
– pressure to n. medianus
• Pain:
– Goes to I. – III. fingers,forarm, elbow and
arm
– Worsening during the night
Periartritis humeroscapularis
• Tendinitis and enthesopathy
of rotator cuff
• Bursitisda
– of subdeltoid bursa
– of subacromial bursa
• Capsulitis of shoulder joint –
Retraction of capsula- „Frozen shoulder “
The rotator cuff is made up of muscles and
tendons. It holds the top of the upper arm into the
shoulder joint (socket).
The rotator cuff is made up of four muscles. The
muscles include the supraspinatus, infraspinatus,
teres minor, and subscapularis. The tendons
attach the muscles to four shoulder bones: the
shoulder blade (scapula), the upper arm bone
(humerus), and the collarbone (clavicle.) The
tendons are broad, measuring approximately 5
centimeters in width, and form a cuff encapsulating
the articular surface of the top of the humerus.
Anatomy
Rotator Cuff Injuries
Tendinitis: Tendons in your rotator cuff can become
inflamed due to overuse or overload, especially in
athletes who perform a lot of overhead activities. In
some people, the space where the rotator cuff
resides can be narrowed due to the shape of different
shoulder bones, including the outside end of the
collarbone or shoulder blade.
Bursitis: The fluid-filled sac (bursa) between your
shoulder joint and rotator cuff tendons can become
irritated and inflamed.
Strain or tear: Left untreated, tendinitis can weaken a
tendon and lead to chronic tendon degeneration or to
a tendon tear. Stress from overuse also can cause a
shoulder tendon or muscle to tear.
Rotator Cuff Tear
• A ripping of one or more of the tendons
• Result when a sudden eccentric force applied to the
rotator cuff resulting in failure of the tendon.
• Uncommon under the age of 40 but strains do occur.
• In the population over 40 years of age, supraspinatus
tears occur and less commonly, infraspinatus tears.
Tears in the subscapularis tendon are uncommon and
are often the result of a shoulder dislocation.
Rotator Cuff Injuries
Causes
• Repetitive stress: Repetitive overhead movement of your arms
can stress your rotator cuff muscles and tendons, causing
inflammation and eventually tearing. This occurs often in
athletes, especially baseball pitchers and tennis players. It's also
common among people in the building trades, such as painters
and carpenters
• Impingement: Falls or incorrect throwing techniques or arm
movements and weak shoulder muscles may cause the arm
bone to move up and trap the tendon. This may also happen in
persons who over-train or have a sudden change in arm or
shoulder activity.
Normal wear and tear: The rotator cuff tendons can degenerate
due to ages (starting around the age of 40) . This can cause a
breakdown of fibrous protein (collagen) in the cuff's tendons and
muscles.
• Calcium deposits: Calcium may deposit in the tendons due to
decreased oxygen and poor blood supply. These deposits may
cause irritation and inflammation
Causes
• Poor posture: When you slouch your neck and shoulders
forward, the space where the rotator cuff muscles reside can
become smaller. This can allow a muscle or tendon to become
pinched under your shoulder bones, including your collarbone,
especially during overhead activities, such as throwing.
• Falling: Using your arm to break a fall or falling on your arm can
bruise or tear a rotator cuff tendon or muscle.
• Lifting or Pulling: Lifting an object that's too heavy, or doing so
improperly (especially overhead) can strain or tear your tendons
or muscles. Pulling something, such as an archery bow of too
heavy poundage, may cause an injury.
Common in sports such
as:
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Baseball
Tennis
Football
Weight Lifting
Skiing
Swimming
Racquetball
Symptoms
• Pain in the shoulder or arm , especially with arm movement
(reaching overhead, reaching behind your back, lifting, pulling or
sleeping on the affected side.
• Radiation of the pain to the upper, lateral arm
• Pain at night
• You may not be able to move your arm well, especially away from
your body.
• Your shoulder may feel weak, numb, or tingly.
• Loss of shoulder range of motion
• Inclination to keep your shoulder inactive
• Lying or sleeping on the affected shoulder also can be painful
Physical Examination
The physical examiner must detect the torn muscle
by isolating the muscles through manual testing.
Perform following with patient seated:
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External rotation - with elbow at right angles and held into side, turn the
arm outwards as far as possible.
Internal rotation - with elbow held into side, raise arm as far as possible
up patient's back.
Internal rotation with 90° forward flexion - support elbow and shoulder
with elbow at right angles pointing vertically downwards and palm
facing backwards, turn the forearm as far backwards as possible.
Forward flexion - start with arm at patient's side and lift arm forwards
and upwards as far as possible.
Extension-with arm by the patient's side, lift the arm back wards as far
as possible.
Abduction-with arm at patient's side, lift arm away from the body as far
as possible, continuing past the horizontal by allowing the shoulder to
externally rotate, bringing the hand behind the head.
Adduction-draw the arm across the anterior chest wall as far as
possible.
Diagnosis
Diagnosis is usually made after a physical
examination, often by a sports medicine
physician. X rays are also sometimes used in
diagnosis as well as an arthrogram. However,
the arthrogram is an invasive procedure and
may be painful afterwards. For this reason,
magnetic resonance imaging (MRI) is preferred
to determine tendon tears as it also shows
greater detail than the arthrogram.
Diagnosis Continued
• Arthrogram: A test done by injecting dye into the
shoulder joint and then taking x-rays. Areas where the
dye leaks out indicate a tear in the tendons.
• Magnetic Resonance Imaging (MRI) Scan: A special
radiological test that uses magnetic waves to create
pictures of an area, including bines, muscles, and
tendons.
• Ultrasound: An ultrasound is a test that looks inside your
body. Sound waves are used to show pictures of your
muscles and tissues on a TV-like screen
Diagnosis Continued
• Arthrogram: A test done by injecting dye into the
shoulder joint and then taking x-rays. Areas where the
dye leaks out indicate a tear in the tendons.
• Magnetic Resonance Imaging (MRI) Scan: A special
radiological test that uses magnetic waves to create
pictures of an area, including bines, muscles, and
tendons.
• Ultrasound: An ultrasound is a test that looks inside your
body. Sound waves are used to show pictures of your
muscles and tissues on a TV-like screen
Treatment
Initial Care: Treatment will depend on your symptoms and the
length of
time you have them. Your caregiver may want you to limit activity
on
your affected shoulder to decrease stress on the tendon. This may
help
prevent further damage, decrease pain, and promote tendon heal.
The
primary treatment is resting the shoulder and, for minor tears and
inflammation, applying ice packs. You may need to wear a sling to
keep
the shoulder from moving.
Medicines: Anti-inflammatory medications may also be prescribed.
As
Rehabilitation
Rehabilitation is crucial to restore the rotator cuff strength. The length
of recovery depends of the severity of the tear.
Rehabilitation can be divided into three phases:
Phase I: Pain control: Use of non-steriodal antiflammatory agents,
cryotherapy, protection of the injured tissue through the use of a sling
or shoulder immobilizer. Exercises such as the pendulum can be
performed. This is important for preservation of strength, which will
speed recovery time.
Phase II: 5 to 7 days after injury: In an overuse problem, this phase begins
when pain diminishes. Range of motion is fully restored. Progressive
resistive exercises are initiated to establish normal strength. Some
examples of exercises are rotator cuff strengthening and strengthening
of the scapular stabilizers. Restoration of strength and mobility of the
shoulder is vital to allow for a successful return to sports.