Rotator Cuff Tear

Bicipital Tendinitis

The inflammation of the tendon of the biceps brachii muscle is one of the most frequent causes of shoulder pain. It can occur in isolation or derive from other pathologies of this joint.

Symptoms may be aroused by palpation of the biceps brachii in the groove along the humeral head, by flexing the elbow or by the resisted supination external rotation test, which practically confirm the diagnosis.

In addition, magnetic resonance imaging (MRI) or ultrasound exams will show the tendon surrounded by an oedema, which is characteristic of inflamed tissue.

Treatment requires rest, non-steroidal anti-inflammatory drugs (NSAIDs) and physiotherapy. When dealing with refractory cases, the solution might be an infiltration of diluted corticosteroid with a local anaesthetic, e.g. lidocaine.

Tindinitis / Subacromial Impingement Syndrome

This group of tendons may suffer an inflammatory process (tendinitis), causing pain, and a limited range of motion due to a conflict of space with the superior part of the glenohumeral joint, which is formed by the acromion.

These injuries are common not only in athletes but also in people whose regular activities involve repetitive arm movements above the head level.

These injuries can be caused by degenerative diseases or trauma, and there is some degree of correlation between their incidence and the convergent shape of the acromion.

Tindinitis / Subacromial Impingement Syndrome Treatment

• Physiotherapy

Physiotherapy associated with anti-inflammatory drugs allows the recovery in a high number of cases.

• Corticosteroid subacromial injection

Infiltration with corticosteroids in the subacromial area is especially suitable for this situation. Although often associated with deleterious effects, if correctly performed in the extra-articular area, in carefully selected patients, and when highly diluted with an anaesthetic, it may cause the symptoms to subside completely.

• Surgery

Subacromial decompression surgery is only indicated for cases in which other treatments, including physiotherapy or infiltrations, failed to succeed.

Arthroscopic surgery allows a faster recovery than open surgery since muscle disinsertion (of the deltoid) is not needed.

The clinical picture of a rotator cuff tear is generally characterised by acute onset of pain, not only when in rest but also while in movement.

During abduction of the arm some patients may also present a small clunk. Arm abduction usually becomes more limited when complete tears occur, considering that these types of movements depend on the deltoid muscle, which suffers with the upward migration of the humeral head.

Magnetic Resonance Imaging (MRI) is important to study patients in these conditions, it is a means of confirming a diagnosis and obtaining prognostic information whilst it aids therapeutic decision making. Not only does it allow an accurate assessment of the tear, including the extent of the retraction, but it also assesses the degeneration of the torn tendon and its progressive substitution by fat tissue.

Rotator Cuff Tear Treatment

• Physiotherapy

Elderly patients are often exclusively treated with physical therapy as most of the times the main objectives in this age group are related to pain management and functionality.

In younger patients, who will eventually undergo surgery, physiotherapy has the function of reducing inflammatory processes, managing pain and restoring passive range of motion.

Physical therapy also helps the patient to fully recover after surgery.

The strengthening of the deltoid and of the muscles that contribute to this function is expected to recentre the humeral head.

• Arthroscopic Repair

Surgical treatment of rotator cuff tears is recommended for elderly patients who show no signs of pain relief through non-steroidal anti-inflammatory treatment or physiotherapy. Surgery is also recommended for younger patients who want to improve shoulder functionality and prevent the progress of the injury, by repairing the torn tendons.

Surgeries are performed arthroscopically to treat intra-articular injuries and to allow a faster recovery.

Its aesthetic advantages, in comparison with traditional open surgery, are also worth noting.