Membresup.com

La préhension retrouvée

  • CatalanCatal-ca_ES
  • English (UK)
  • Français (FR)

Tendinitis of rotator cuff

1.The  rotator cuff is formed by 4 tendons, recovering the head of the humerus. They assure the rise and the rotation of the arm (sub-scapularis and long biceps, supra-spinatus and infra-spinatus). Finally they maintain the head in front of glenoid of the scapula.

2. The infringement of the rotator cuff, which can go of the simple inflammation (tendinitis) to the break is due to several causes often associated:

  • Tendinous ageing, tendons do not assure any more their role of centring and the head tends to ascensionner where from...
  • Friction in the lower face of the acromion, especially if that this is constitutionally curved, in particular during the movements hands in the air;
  • traumas.

3. The infringement of rotator cuff is translated by several signs:

  • pains, in particular arm in the air or in rotation (for example to attach the bra). Very often these pains are aggravated in slept position, and radiate towards the neck or along the arm;
  • difficulties raising the arm;

4. The examination by the doctor, by simple tests, allows to confirm the diagnosis and in particular to eliminate a capsule's shrinkage associated, real reaction to pain.

5. Examinations are necessary:

  • x-rays to eliminate an osseous cause of pain, for example degenerative arthritis;
  • echography;
  • arthroCTscan (CTscan after injection of iodine in the joint, under local anesthetic). He allows to look for a break of tendon and appreciates its size and the state of the muscles which command tendons. Indeed when a tendon is broken, its muscle  be gradually going to atrophy and the repair of the tendon is then doomed to failure;
  • RMI (imaging by magnetic résonnance) which is allows to diagnose partial rotator cuff tears. The delay of obtaining  remainlong and it is not practicable at the claustrophobic person, or the carrier of a metallic implant.

 

acromioplastie coiffe MRI showing a tear of rotator cuff

6. When surgery is impossible (precarious general state, tear too much evolved with muscular atrophy) average palliatives exist:

  • analgesic and / or infiltration of cortison (not to repeat more then 2 or 3 times);
  • rehabilitation ( CGE process). The suppression of dangerous kinds of movement (hands above shoulders, repetitive gestures, lift more than 3 kgs…).

Surgery, mostly in one day, is realized  by  DSR  (without section, by  a camera introduced into the joint). This technique, respectful of the healthy tissues (in particular the deltoid) and treating very precisely the injured party, transformed the consequences of this surgery.

It contains one or some of the following gestures:

  • acromioplasty ("Planing" )of the lower face of the acromion to delete the constraints on the rotator cuff;

 

 

coiffe biceps bis

Normal arthroscopic view

 

coiffe acromio

Seen later accromioplastie

 

   
  • repair of one or several  tendons; the most recent technique is said " double row ". Requiring an important experience of the surgeon, she allows to reinsert double tendons on the bone, with consequently an important solidity. The tendon of the muscles is usually fixed to the bicipitale groove( ténodesis ).

A sprint is used during a few days in case of acromioplasty +- tenodesis of biceps, 45 days until tendons healing in case of suture.

7. The reeducation is begun at once, in passive(it is the physio who moves the arm of the patient which is allowed make) until the ablation of the splint, in active ( the patient alone shanty) then. The recovery of the amplitudes is major. The Lyon's protocol with immediate balneotherapy is very interesting as such. Three in six months of reeducation are necessary and a medical certificate of several months is prescribed in case of manual labor.

Cuff repair and arthroscopic acromioplasty

8. Measures of articular economy stay of stakes even remote of the intervention, what can raise the problem of the continuation of certain activities. The necessity of a fitted out post, even a professional redeployment or a stake in incapacity, is frequent. The company doctor, the doctor of the box and the social worker have then a determining role. A recognition in occupational disease is possible.

You are here: Home Diseases shoulder Rotator cuff