The shoulder joint is one of the most mobile in the human body. It can make movements in almost all directions, and thanks to this, the hand is capable of performing numerous functions and various complex work.
But for all the variety of movements, not only good mobility of the joint itself is necessary. You need the appropriate muscles. And they exist. The shoulder joint is surrounded by a well-developed muscle mass that provides flexion, extension, abduction, adduction, outward and inward rotation. Collectively, these muscles are called the rotator cuff. Its injuries are quite common.
Previously, the term glenohumeral periarthritis was used to refer to most pain in the shoulder joint.
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With the development of diagnostic capabilities, the accumulation of experience, and especially with the introduction of arthroscopy of the shoulder joint into medical practice, partial or complete ruptures of the rotator cuff tendons have become much more common. Currently, this pathology is considered one of the main causes of pain and limited function of the shoulder joint. She is treated by experienced traumatologists and orthopedists at the multidisciplinary clinic CELT.
Peculiarities
The shoulder joint has a round shape, which provides a high range of motion in it. The necessary strength and stability are factors to prevent the humeral head from protruding from the glenoid cavity. They are provided by the components of the rotator cuff, these include the supraspinatus, infraspinatus, subscapularis and teres muscles, as well as ligaments and tendons. An increase in load is accompanied by an increase in stretching of muscle fibers, which can lead to complete or partial rupture.
Factors Causing Shoulder Tendonitis
In 80% of situations, calcific tendinitis of the shoulder joint is due to increased physical activity and injuries that occur during it.
In some cases, inflammatory processes in the tendon area appear against the background of:
- Congenital abnormal development of joints;
- Infection caused by bacteria entering from the affected area or through a wound;
- Rheumatic pathology caused by the deposition of uric acid salts;
- Deficiency of sex hormones during menopause;
- Forced limitation of shoulder motor activity in the postoperative period;
- Dystrophic disorders in articular bones and cartilage of a chronic nature;
- Diseases characterized by pathological production of autoimmune antibodies;
- The use of certain hormonal agents (Hydrocortisone, Prednisolone).
Factors that can lead to rotator cuff tendonitis :
- Persons over the age of 45 years (the risk of developing pathology doubles, which is due to the loss of tissue elasticity and strength);
- Professional factor (people involved in sports activities; representatives of the construction profession; loaders; dancers);
- Deterioration of the immune system (after viral infections, stressful situations, during pregnancy, etc.);
- Exposure to thermal irritants (hypothermia);
- The influence of hormonal factors (during menopause).
Long-term inflammation of shoulder components
Long-term inflammation of shoulder components
Determining the causes is a mandatory activity that is carried out during a diagnostic examination and makes it possible to select the most adequate therapeutic tactics and prevent the recurrence of changes.
Symptoms of a biceps tendon rupture
In clinical practice, complete ruptures of the biceps head are more common. In this case, the tendon is completely torn and separated from the bone, contracts and is pulled towards the elbow joint.
Upon examination, a pronounced tubercle is visualized on the inner surface of the lower third of the shoulder. Immediately after the injury, swelling occurs that quickly spreads throughout the shoulder.
Fig. 2 Appearance of the shoulder with a rupture of the long head of the biceps.
The rupture may be isolated or accompanied by damage to other structures, such as the rotator cuff. With concomitant disorders, the clinical picture is atypical.
At the time of injury, acute pain is felt, attempts to bend the elbow are painful or impossible. When a tendon is torn or injured in older people, the clinical picture is blurred. The pain syndrome is moderate, flexion strength is reduced.
To determine muscle tone on the injured side, you need to compare it with a healthy arm, since in some patients the tone may be initially reduced.
Partial rupture
Partial rupture
Depending on the prevalence, an isolated change occurs, affecting only the supraspinatus muscle, or a combined injury, in which several components of the shoulder joint, including bones, change at once.
Cause
1) Injury If you fall with great force on a straight arm or lift a heavy object, the biceps tendon may rupture.
2) Excessive stress In many cases, rupture occurs as a result of abrasion and tearing of the tendon, which slowly progresses over time. This is a natural effect of the aging process. The condition can worsen as a result of excessive stress - repetition of the same hand movements. Overuse can cause a number of shoulder problems, such as tendonitis, impingement syndrome, or rotator cuff damage. The occurrence of any of these conditions leads to greater stress on the tendon, favoring its rupture.
Signs
A partial full-thickness rupture of the supraspinatus tendon is accompanied by the development of a fairly characteristic clinical picture, including the following symptoms:
- Pain in the girdle area of the upper limb from the side of the changes, which occurs abruptly after an injury or increases gradually against the background of the development of the pathological process.
- Impairment of the functional state, accompanied by the fact that it becomes difficult to raise the arm up.
- Decreased stability, leading to frequent shoulder dislocation (development of habitual dislocation).
- The appearance of inflammatory signs, including redness of the skin of the upper limb girdle, swelling of soft tissues with an increase in shoulder volume, increased pain that can bother a person at rest.
The severity of clinical manifestations depends on the degree of damage to the connective tissue fibers of the supraspinatus tendon.
Biceps tendon rupture
Symptoms:
- a palpable cracking sound when the tendon ruptures
- biceps tendon rupture after strength training and weight lifting
- proximal displacement of the muscle belly of the biceps (lat. Musculus biceps brachii) in the shoulder
- subcutaneous hemorrhage on the elbow
- limitation and weakness in forearm flexion
Often, the biceps tendon ruptures when lifting weights, resulting in a cracking sound in the elbow area. After this, the biceps loses its strength. A rupture of the distal biceps tendon is a partial or complete separation of the tendon from its attachment to the radius. This injury does not cause severe pain in the elbow, but it limits the strength and coordination of the forearm. This injury is mainly common in men who work in heavy physical work or professional athletes. A subcutaneous hematoma occurs at the site of a rupture of the biceps tendon in the upper part of the forearm.
Partial or complete ruptures are diagnosed using ultrasound and MRI.
Treatment for a biceps tendon rupture
Conservative treatment for a proximal biceps tendon rupture includes ice, activity restriction, and nonsteroidal anti-inflammatory drugs to reduce pain and swelling. To restore mobility and strengthen surrounding muscles, your doctor may prescribe certain flexibility and strengthening exercises.
To restore muscle strength and normal hand motor skills after a biceps tendon rupture, there is only one method - surgical treatment. During the operation, an orthopedic surgeon reattaches the tendon to the forearm, which restores the previous function of the arm.
Surgery to reattach the torn tendon back to the bone is rarely necessary. However, for patients with partial tears who continue to experience symptoms after non-surgical treatment or who want to regain full strength in their arms, such as athletes or manual workers, surgery may be the best option. Complications are rare and re-rupture of the repaired tendon is rare. After surgery, you will need to do flexibility and strengthening exercises to improve your shoulder range of motion.
Your surgeon may choose several surgical procedures for a distal biceps tendon tear where the distal biceps tendon attaches to the forearm bone. Some doctors use two incisions instead, and some use only one. Both procedures have certain advantages and disadvantages. During the procedure, the tendon is attached with sutures through holes drilled inside the bone, or small metal implants may be used to attach the tendon to the bone.
Complications are rare and may include numbness and weakness in the forearm, new bone formation, limited movement, and re-rupture.
Surgery for biceps tendon injury
If it is intended to repair damage to the biceps tendon, the Kyiv operation is performed at the Linko Clinic immediately and must be done as soon as possible (that is, within three weeks after the injury) in order to make the operation technically easier, reduce the scar and improve the healing of the tendons. If surgery is delayed, the tendon can be pulled up the arm, making surgery longer and more difficult.
The tendon is placed through an incision over the front of the elbow. It is then manipulated to the point where it has torn off the radius and reacted. The tendon is secured in place using a small metal button on the other side of the bone and supported by an interference screw.
After surgery, your arm will be in a sling for 6 weeks, but you can immediately begin doing exercises to maintain your range of motion. Strengthening exercises should not be performed for at least 3 months after surgery.
Our specialists at Linko Orthopedic Clinic will discuss whether this procedure is right for you during your visit.
Ultrasound
Ultrasound
In order to determine the severity and location of a partial rupture of connective tissue components, an additional objective examination is prescribed. It includes modern techniques that make it possible to assess the condition of internal structures. These include radiography, tomography (layer-by-layer scanning of tissue using X-rays or the effect of magnetic resonance of nuclei), arthroscopy (visual examination using an optical device inserted into the joint cavity), ultrasound (ultrasound examination).
Treatment
Therapeutic measures in case of diagnosed partial rupture of connective tissue components are complex. Conservative treatment is predominantly prescribed, which includes several areas of action:
- General recommendations aimed at limiting functional load. If necessary, the joint is immobilized (immobilized) for the entire period of therapy.
- Prescription of medications including anti-inflammatory drugs, chondroprotectors, vitamins.
- Physiotherapeutic procedures that relieve the severity of chronic inflammation and also accelerate the process of tissue regeneration (healing), these include magnetic therapy, ozokerite, and mud baths.
A more pronounced change in the properties of the connective tissue components is the basis for performing surgery with plastic surgery of the fibers of the connective tissue components. In modern clinics specialized in the treatment of structures of the musculoskeletal system, a low-traumatic technique of arthroscopic manipulation is used.
Is it possible to cure shoulder tendinitis?
The risk group includes persons exposed to regular and increased physical activity (construction workers, athletes, etc.). If the patient applies in a timely manner, experts give a 90% prognosis for the complete restoration of the functions of his shoulder joint. Moreover, in the acute form, the treatment period can reach 14 days; in the case of a chronic disease, the procedure may be delayed, which is a consequence of the presence of calcifications.
The period of complete recovery can reach 4-6 months.