What is called the rotator cuff, which leads from the shoulder blade to the head of the upper arm, consists of four separate ligaments. They are responsible for stabilizing the shoulder, for internal and external rotation, and for the lateral abduction of the arm.
Tears and damage to the rotator cuff
Wearing away of the ligaments is the most common cause of damage to the rotator cuff. This damage increases as one gets older. The pains are usually triggered by very minor injuries. To be sure, accidents (in sports or at work) may also be the cause. Shoulder luxations can also damage the rotator cuff. The supraspinatus tendon is most frequently affected. The arm usually can not be lifted up at the side. Subsequently, patients complain about pains even while at rest and during the night. in larger tears, they detect a significant loss of strength. In young patients and among athletes, operative reconstruction of the torn rotator cuff is necessary as early as possible. In older patients, an operation should be planned only after conservative therapy has been tried for 3 months without success. If shoulder stiffness exists in addition to damage to the rotator cuff, movement of the shoulder should be improved by intensive physical therapy before the operation.
The goal of the operation is to fasten the torn tendon structures to the head of the upper arm in order to assure normal transfer of power. Additionally, inflamed structures and bony protuberances that cause pain must be removed. Small tears can be dealt with by arthroscopy. In most cases, an open operation is necessary. A small incision in the skin on the front side of the upper arm reveals the torn tendons, which are then mobilized and fastened with special bone anchors to the head of the upper arm. In addition, the sliding room of the tendon under the shoulder roof is expanded (acromion plastic surgery) in order not to damage the tendon suture.
The long biceps tendon is responsible for forward lifting of the arm. Due to its complicated course, inflammations or injuries often occur. Quite often we find tears of the tendon related to accidents at the upper edge of the joint socket (SLAP lesions). In such cases an arthroscopic refixation is necessary. In chronic tendinitis or with partial tears of the tendon, complete separation of the tendon may be helpful (biceps tenotomy).
Immobilization after the operation is necessary only for a few days. Rehabilitation is lengthy (about 3-6 months), and must be performed consistently. Early mobilization is absolutely necessary in order to avoid clumping. Activities of movement over the head should be avoided for 6-8 weeks.