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Shoulder pain - rotator cuff rupture

The diagnosis of a rotator cuff rupture is made by means of an interview, examination and possibly ultrasound examination. Whether the rupture will be treated surgically depends on various factors. In any case a tear in one of the rotator cuff muscles will eventually lead to a rehabilitation trajectory with a physiotherapist and a recovery time of four to six months.

Causes:

A rotator cuff rupture is caused by the (partial) tearing of one of the four muscles surrounding the shoulder. It is a very common disorder in people over 60 and is caused by the natural aging process of the body. Approximately 25% of the people over 60 years old have a rupture of one of the rotator cuff muscles. Fortunately, at least two-thirds of these people have no symptoms at all. Risk factors for a rotator cuff rupture are smoking and high cholesterol. In addition, a hereditary-genetic component also plays a role. A rotator cuff tear can also occur in sporty young people (30-50 years of age). In this case, the cause is often an injury during sports, such as a form of strength training, but also sports in which the risk of falling is greater. Examples include mountain biking or snowboarding.

Symptoms:

If there is a tear in one of the rotator cuff muscles, the following symptoms are often present: pain, loss of strength and limitations in the movement of the shoulder/arm. Lifting is often not possible.

PASTA lesion:

PASTA stands for Partial Articular Supraspinatus Tendon Avulsion. When there is a PASTA lesion, the tendon of the supraspinatus tendon has not torn completely, but only the lower layer has come loose from the bone. This injury occurs almost exclusively at a younger age as a result of a serious accident. This variant is less easy to examine and can often only be confirmed by means of an MRI.

Beloop:

If the decision is made not to operate, a rehabilitation process with the physiotherapist will follow. It will then take about four months until the function and strength are reasonably restored. Total rehabilitation is quite long, full recovery is often achieved after 5 to 6 months. Until that time, it is necessary to avoid great strength efforts.

Diagnosis:

The diagnosis of a rotator cuff rupture is made on the basis of an interview in combination with typical symptoms and a physical examination. The physiotherapist will carry out a number of specific tests to determine whether there is a rupture and which muscle is affected. In addition to these tests, ultrasound can help in making a diagnosis. Our bodies are subject to wear and tear as we age. It is normal from a certain age to sometimes see tears in tendon tissue. Therefore we must be careful in what kind of label we put on some complaints.

Treatment:

A torn tendon will not heal by itself, but it is not always operated on right away either. Which treatment method is chosen depends on different factors. Often, good progress can be made in recovery with physiotherapy. The goal of physiotherapy will be to improve the strength of the surrounding muscles and to reduce pain through mobilization and exercise therapy. Sometimes this is done in combination with painkillers (NSAIDs). If surgery is chosen, the torn tendon will be replaced (as close as possible) at its original location. After that, the physiotherapist will take care of increasing mobility in the first phase, and slowly work on restoring strength as well.

Conclusion:

A rotator cuff tear is more common in people who play sports where the risk of injury is greater. Think of falls or large peak loads. However, it can also be a natural process. From the age of 60 onwards, we see that the quality of the tendon tissue decreases, which means that injuries can occur more quickly. Ultrasound can help to make the right diagnosis, especially when there has been a serious fall or when the tendon is under heavy strain due to peak loads. Rehabilitation will always consist of gradually increasing the mobility and training the strength again.

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