 Diagnosis (Shoulder) |
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Doctors |
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Rehabilitation |
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Service |
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 From mechanical narrowing to damage of the rotator cuff |
The rotator cuff, a unit of tendons and muscles, extends between the shoulder blade and the head of the humerus.
Under functional aspects, it comprises five components. The rotator cuff is responsible for the dynamic stabilisation of the shoulder, the generation of force for inward and outward rotating and for laterally spreading and lifting movements of the arm. |
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 | | Supraspinatus tendon tear |
Degenerative tendon wear is the most common cause of damage to the rotator cuff. Occurrences of this type of damage increase with age. It often goes unnoticed if the tendon is only slightly defective. Complaints are often triggered by minor traumas. However, accidents (sports or occupational accidents) may also cause (often major) tearing off of the rotator cuff in younger patients. In addition to the natural ageing process of the poorly vascularised tendons, constant mechanical irritation by the previously mentioned bony spur formations in the acromion represents a major cause of spontaneous tears – especially enlarged tears of initially smaller and unnoticed tendon damage. A problem with pain does not occur until minor traumatic or even macrotraumatic events cause an enlargement of a single tendon or double tendon defect. |
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 | | Preparation of the tendon tear |
As the further course cannot be influenced conservatively, arthroscopic treatment is usually required. It should however be mentioned that massive traumatic ruptures, which involve almost all parts of the tendons, should preferably be reconstructed in a minimally invasive, open operation due to the anatomical complexity. Even for top-level athletes, open techniques or a combination of arthroscopic and open techniques can be considerably more beneficial, and the restoration of function more ideal, than with a purely arthroscopic technique – with subsequently unsatisfactory results that do not meet the functional/sporting demands of the patient. Both techniques, the arthroscopic and the minimally invasive open technique, have their own established role and they should be used individually or in combination as necessary. Experienced shoulder experts understand how to plan operations individually and to use one technique or another selectively to achieve an optimised overall result. |
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 | | Bony insertion of tendon reconstruction |
In addition to clinical, conventionally radiological and sonographic diagnostics, magnetic resonance imaging plays a significant role. MRIs may not display the extent of the potential narrowing of bone. However, they can depict the size of the defect, known as the extent of retraction, and the extent of fatty degenerative processes in the muscle connected to the tendon.
It may be legitimate to first attempt conservative therapy. However, if the situation remains unsatisfactory after a further three months, a surgical procedure should then contemplated. |
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The aim of the operation can be summarised as two aspects: |
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Firstly, to eradicate the source of the pain. Bony spur formations in the front of the acromion are the primary cause (mechanical impingement). Furthermore the often inflamed, adhered and swollen synovial bursa must be freed and removed. The long biceps tendon can be another pain factor. The experienced shoulder specialist can precisely evaluate this problem in advance. Once the pain has been relieved, the patient has a considerably better capacity to exert force in the intact rotator cuff tendons, which in the event of a not too serious defect (single or double tendon damage) can compensate greatly. Reconstruction of tendons is not always necessarily for supraspinal tendon tearing (biomechanical aspects). In some circumstances an additional reconstruction may however be useful or even necessary. |
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The second aspect is the reconstruction of the torn tendon structures on the base of bone in the head of the humerus, which later ensures the normal transmission of force. A tendon reconstruction is urgently required in certain instances of tendon defect localisation. Sewn tendons require a period of six to eight weeks before they have healed into the alveolus and can be subjected to load. Even though certain movement patterns should not be overdone during this period, early functional treatment and movement (starting the first day after the operation) must not be neglected. This serves to prevent adhesions and related mobility restrictions and to ensure optimum nutrition of the tissue and cartilage structures. |
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You will be given a detailed explanation of the requirement for reconstruction in addition to the decompressingoperation within the scope of clinical and imaging diagnostics during an outpatient consultation. |
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| Stitching of a tear |
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| Anchoring of tendons onto bone with suture anchor |
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| After sewing the long tear with direct stitches, the tendons are anchored in the alveolus using suture anchors |
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| © 2001-2008 Alpha-Klinik GmbH. Imprint |
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