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What Is Rotator Cuff Injury?
Rotator cuff injury is one of the most common causes of shoulder pain and limited activity, and it affects a large number of people. On average, about 4.5 million patients with rotator cuff injuries visit the hospital every year. Among them, the incidence rate of middle-aged and elderly patients over 50 years old is as high as 23%, and the incidence rate of rotator cuff injury in elderly patients over 80 years old is as high as 62%.
Shoulder Joint Anatomy
The rotator cuff is a sheath-like structure composed of the tendinous parts of the supraspinatus, infraspinatus, subscapularis, and teres minor muscles. It surrounds the glenohumeral joint, humeral head, and joint capsule, forming a similar sleeve-like muscle-like structure. It has the function of maintaining the stability of the glenohumeral joint, maintaining various postures of the upper arm, and completing various movements.
Causes of rotator cuff injuries:
1. Trauma is the main cause of rotator cuff injuries in adolescents.
2. Insufficient blood supply causes degeneration of rotator cuff tissue.
3. Chronic impact injury of the shoulder. Some scholars believe that rotator cuff injuries are the result of long-term shoulder impact wear and that circulation disorders and trauma are not the main reasons.
Treatment of rotator cuff injuries:
1. Non-surgical treatment
Non-surgical treatment can be used for patients with small tears (<1.0cm) injuries within 3 months, and whose symptoms are not very severe. Non-surgical treatment methods include rest, immobilization of the affected limb, application of non-steroidal anti-inflammatory drugs, local closure, etc.
However, the prognosis of non-surgical treatment of huge rotator cuff injuries is poor. Generally, there is only an improvement in subjective symptoms, but there is no significant improvement in the affected shoulder function. However, for some older and huge rotator cuff injuries that do not require high shoulder function, Patients can be treated non-surgically.
For patients with huge rotator cuff injuries who have a long injury time and severe fat infiltration of the rotator cuff and its surrounding tissues, it is usually judged based on their clinical conditions. The surgical effect is poor and conservative treatment can be adopted without causing pain. Patients with sleeve tears who do not require surgery can use non-surgical conservative treatment, but MRI should be used regularly to observe changes in the tear and adjust treatment strategies promptly.
2. Arthroscopic surgical treatment
Arthroscopy is the most accurate way to diagnose shoulder injuries and is also a way to treat rotator cuff injuries. Arthroscopy has unique diagnostic and therapeutic value for cases where long-term conservative treatment is ineffective and other examination methods are difficult to diagnose.
Surgical methods include:
Subacromial decompression – can relieve the impingement syndrome caused by subacromial stenosis and avoid further impingement of the tendons. It is suitable for patients with narrow subacromial space and the presence of osteophytes in the coracoacromial ligament. Subacromial decompression can achieve precise results in the treatment of calcific tendonitis;
Arthroscopic rotator cuff suture – Arthroscopic repair of rotator cuff injuries has the advantage of less trauma, but the disadvantages are also obvious. Less exposure will lead to less contact area after rotator cuff reconstruction and insufficient tendon-bone contact pressure. These are factors that influence tendon-bone healing;
Arthroscopy is quite effective in the treatment of huge rotator cuff tears. Some scholars have reported that after shoulder arthroscopy treatment, the UCLA score can be improved by 17.1% to 32.4%, the pain score can be improved by 4.4 to 8.6 points, and the functional score can be improved by 4.0%. ~9.2%, all indicating that satisfactory therapeutic effects can be achieved after shoulder arthroscopy. Using arthroscopy to repair huge subscapularis injuries, in the clinical follow-up investigation results of 2 to 4 years, it was found that the strength of the subscapularis muscle and its tendons integrity is maintained very well.
3. Non-arthroscopic surgical treatment
There are many methods of surgical treatment. Depending on the degree of injury, different surgical methods are selected. The purpose of surgery is to eliminate pain and rebuild the force couple balance of the rotator cuff, remove unstable tear edges, expand the subacromial interval, remove impingement factors, and promote shoulder joint Restoration of functions to meet the needs of life and sports.
Rotator cuff repair surgery begins by pulling the ruptured and retracted tendon back to near its insertion point. At the same time, the adhesions and scars around the rotator cuff need to be completely released, and the narrow subacromial space also needs to be repaired until the rotator cuff tissue can reach the greater tuberosity when the shoulder joint is abducted, and then the fixation operation can be performed.
The effect of surgery is not only related to the degree of tear and injury time, but also to the strength of the suture, the tendon-bone contact area and contact pressure, the micro-motion between tendon and bone, the bone quality of the humerus, and the design and material of the suture. and postoperative functional exercises are closely related.
Rotator cuff repair surgery
Mainly used for small tears, this method is used for simple rotator cuff injuries without impingement syndrome. The suture repair method is similar to the Achilles tendon rupture repair. Currently, there are conventional tendon suture methods and anchor fixation suture methods.
In the repair of Achilles tendon injuries, we have found that wired anchors have the advantages of simple operation and reliable suturing. The conventional supraspinatus suture method involves decorticating the surface of the greater tuberosity after releasing the adhesions between the tendon and surrounding tissue. After bleeding the bone until it is sufficiently fresh, drill a hole with a Kirschner wire at the greater tubercle of the humerus, and use sutures to fix the tendon to the bone.
The effect of anchor fixation and suture is better than that of conventional supraspinatus suture fixation. Its advantage is that the anchor is directly fixed in the bone, and the fixation is more reliable. At the same time, the surgical exposure is less, the trauma is small, the operation is fast, and the risk of greater tuberosity fracture of the humerus is reduced.
Double-row anchor fixation has been widely recognized because it can provide better contact area and contact pressure between tendons and tubercles than single-row fixation.
2. Tendon transfer surgery
In cases of huge tears and post-injury repair failure, conventional methods cannot be used for repair, and many scholars use tendon transposition to repair such cases. The method used is to peel off some attachment points of the supraspinatus muscle while retaining its blood supply, and push the muscle outward to repair the defect.
It is mainly used for patients with large supraspinatus tendon defects. In addition, the latissimus dorsi, teres major, pectoralis major, deltoid, triceps, and trapezius muscles are used for tendon transfer. The effect of this type of surgery is not accurate.
Conclusion:
In the spectrum of treatments for rotator cuff injuries, the methods emphasizing anchor fixation and suture techniques exhibit notable advantages. Notably, these approaches offer reliable and direct fixation into bone, ensuring enhanced stability and a reduced risk of humerus fractures.
Canwell Medical boasts a product aligned with these effective methodologies, contributing significantly to clinical practice. Our product focused on anchor fixation and suture, holds promise in enhancing surgical procedures for rotator cuff injuries. With its attributes of minimal invasiveness, rapid operation, reduced risks, and improved fixation reliability, this product stands as a favorable option in addressing rotator cuff injuries requiring surgical intervention.”