The rotator cuff is a tendinous structure that surrounds and covers the shoulder joint. It is composed of the tendons of four muscles: the supraspinatus, infraspinatus, teres minor, and subscapularis, which attach to the head of the humerus. These tendons function as stabilizers of the joint and allow for rotational movements and elevation of the arm.

Damage to the rotator cuff tendons is one of the main injuries that occur in the shoulder joint. It is commonly caused by trauma or chronic degenerative changes in the tendons. This condition can affect a wide range of age groups.

Causes of rotator cuff tendon damage

In young individuals, direct trauma such as a fall on the shoulder (e.g., during skiing) or indirect trauma resulting from excessive force or leverage on the shoulder joint, as well as repetitive overhead movements (e.g., basketball, tennis, swimming), are the main causes of rotator cuff tendon damage. In individuals who do not participate in sports but engage in occupations requiring continuous arm elevation, similar types of injuries can occur.
In older patients, most cases of tendon damage result from a combination of microtrauma, overload, and degenerative changes in the tendons and muscles, leading to weakening and eventually damage.
However, the highest-risk group consists of patients over 40 years of age.

Symptoms

Depending on the etiology, symptoms of rotator cuff tendon damage can appear suddenly due to trauma or gradually worsen over time. The most significant symptom is shoulder pain, which occurs most often during arm elevation or sudden movements, and the pain may intensify at night. Patients may also experience limited range of motion in the joint and weakness in the arm, such as the inability to hold the arm parallel to the ground. Sensations of clicking and crepitus in the joint may also be observed.

Diagnosis

The initial diagnosis is made based on the patient’s history and a clinical examination performed by a doctor. This includes conducting a series of specific tests to assess the function and endurance of muscles and tendons suspected of being damaged. Additional diagnostic tests are then decided upon based on these findings. X-ray imaging is typically the initial imaging test, which provides information about potential fractures or degenerative conditions in the joint.
Ultrasound (USG) allows for a fairly accurate determination and localization of rotator cuff tendon damage and allows for dynamic assessment of the joint.
Magnetic resonance imaging (MRI) enables a detailed evaluation, location, and type of damaged structures, including not only tendons but also muscles and intra-articular structures such as the joint capsule and articular surfaces.

Treatment of rotator cuff tendon damage

The decision on the type of treatment for rotator cuff tendon damage depends on several factors, including the patient’s age, requirements, lifestyle, activity level – including sports activity, the type of damage, and whether it is a result of trauma or degenerative damage.

In most cases of traumatic injuries, especially in younger patients experiencing symptoms such as pain and limited function, surgical treatment is chosen. Older patients with degenerative damage, who have good joint function and no persistent pain complaints, may be treated conservatively.

Conservative treatment includes rehabilitation, aimed at improving joint biomechanics, strengthening the shoulder girdle muscles, and reducing pain. This type of treatment may be supplemented with pharmacotherapy, including pain relievers and periodically used anti-inflammatory drugs.

For partial tears or degenerative changes, regenerative therapies can be considered. These therapies involve the local administration of substances that stimulate tissue healing. Such procedures are performed under ultrasound guidance.

In surgical treatment, arthroscopic surgery is the standard approach. The procedure is performed under general anesthesia, using several small incisions in the skin. Specialized instruments are used to address the damaged areas of the tendons and perform their reinsertion. This involves reattaching the tendon to its anatomical attachment site on the humerus bone using special anchors. The duration of the procedure depends on the extent and severity of the damage, ranging from 1.5 to 3 hours.

Following surgery, immobilization in a brace is required for approximately 4-6 weeks. The start of postoperative rehabilitation depends on the type of damage and may begin in the first week or even after 6 weeks post-surgery. The start of postoperative rehabilitation depends on the type of damage. Rehabilitation can be initiated within the first week or even after 6 weeks post-surgery. It involves muscle relaxation, gradual mobilization of range of motion, and phased introduction of exercises based on the patient’s adaptation. The return to activity is a lengthy process and typically takes around 3-6 months. Achieving full functionality, including sports activities, and completing rehabilitation can take up to 12 months.

At MIRAI, the shoulder area is managed by:
Bartosz Dominik – material development for the website
Michał Drwięga

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