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Rotator Cuff Rupture: Causes and Treatments

A rupture of the rotator cuff is a rupture of one or more tendons of the muscles located at the level of the shoulder which are used to initiate movement. It can occur either by the wear of the tendons due to repetitive daily gestures or following a trauma. Symptoms and treatments with Dr. Jean-Luc Gahdoun.

Definition: What is a rotator cuff tear?

The shoulder is made up of muscles that serve to initiate movement and rolling of the shoulder. The tendon is the terminal part of the muscles. The rotator cuff, which includes 4 tendons, as its name suggests, caps the head of the humerus like a hat, stabilizing it and initiating movement of the shoulder. If these tendons rupture, the shoulder will become off-centered and up and down or rotational movements will be difficult and painful.

What are the symptoms of a rotator cuff tear?

The pain accompanied by impotence, inability to lift arm straight away, are the first symptoms. Several different manifestations can be observed. The shoulder is painful with crunches when moving, but it retains a certain mobility without force. The shoulder has lost much of its mobility (pseudo-paralytic) and is painful. The shoulder has recovered full active mobilization but remains painful. It’s necessary quickly consult.

What causes a rotator cuff tear?

The causes of rotator cuff tear are either of traumatic origin mainly in young people, very rarely before the age of 40, i.e. the consequence of wear rotator cuff tendons in older people. “In young subjects, tearing of the cuff is observed following an accident and often a sports accident : a fall from a bike, ski, an explosive lifting effort (especially in the context of the practice of crossfit), their muscles and tendons will thus be torn brutally”. Among older people, often people who have had significant handling activities (masons, plasterers, farmers, cashiers or nursing assistants), the repetitive daily movements will have worn out their tendons. Around the age of 55-60, these people whose tendons are worn out will, following an innocuous gesture, pull or carry something brutally, and see their tendons rupture (this is a recognized occupational disease). “Rupture of the cuff is seen in one in five over 65s and one in two people over 80“, emphasizes Dr. Gahdoun.

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The diagnosis is mainly made by clinical examination of the patient. This will then be confirmed by a unscrambling exam which makes it possible to take stock of a rupture of the cuff with the help of an ultrasound to analyze the tendons and evaluate the rupture. If the operation option is considered, a IRM (magnetic resonance imaging) will be necessary to complete this information, in particular on the importance of the rupture.

What is the treatment for a rotator cuff tear?

From physiotherapy sessions will be proposed from the outset because they will allow the development of compensatory muscles. “A short immobilization of the shoulder can be prescribed for a few days initially to reduce inflammation. And very quickly, the re-education will be started to soften the shoulder and develop the compensating musclesnote by Dr Gadhoun. Thus, the pain will fade: in 4 to 5 months but a loss of mobility and strength may remain. The repair of the rotator cuff cannot be decided without at least 20 rehabilitation sessions. People operated on will be partially immobilized for 6 weeks. Physiotherapy sessions will allow them to perform passive and accompanied movements of their shoulder. Certain gestures will be possible for them, such as extending their elbow, putting their hand to their mouth, holding a book… gestures mainly with their arms down. A very correct function of the shoulder, after simple surgery or rehabilitationis often recovered in 8 to 10 months.

When to consider an operation?

The operation will only be considered, at the end of rehabilitation, in patients whose shoulder remains painfulhaving a functional impairment and whose age is below 65, but it is above all the quality of the tendo (“the belt”) and of the muscle (“the motor”) which determines the possibility of surgery. “Under 55, it is in our interest to operate: without surgery, the tendons retract and the risk is to develop osteoarthritis. Thus, the head of the humerus rises and causes destruction of the cartilage“added Dr. Gadhoun.

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Is there a risk of sequelae afterwards?

The main sequelae after rotator cuff tear without surgery are loss of strength, loss of mobility, and pain especially if several tendons have been affected. “The most important long-term sequelae is the appearance of osteoarthritis which can be installed in about fifteen years“The later the operation is performed, the greater the risk that the tendon will not heal.”In effect after age 65, tendon healing rate is low. The intervention is therefore not necessary to repair the tendons but sometimes it can be recommended on a biceps which remains painful. If the pain and impotence is still present despite rehabilitation and possibly one or two infiltrations, the alternative treatment will be the placement of a reverse prosthesis which replaces the main tendon of the rotator cuff”.

Thanks to Dr Jean-Luc Gahdoun, surgeon in the specialized shoulder rehabilitation unit, Fontvert clinic in Avignon.

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