The rotator cuff of the shoulder is an anatomical structure formed by 4 tendons of the supraspinatus, infraspinatus, subscapularis and teres minor muscles. These join together to insert at the level of the humerus tuberosities at the shoulder. The main function of the rotator cuff is to keep the head of the humerus centered in the joint so it can roll.
The secondary function is to assist in elevation and rotation of the shoulder. The tendon of the supraspinatus muscle is the most important from a functional point of view and also the most frequently injured.
There are usually multiple factors that cause rotator cuff damage. The main cause is due to a degenerative phenomenon or tendon wear, where it tends to progressively break down over time. During this process, the collagen fibers lose their properties and progressively degrade. This phenomenon is associated with age and other risk factors, such as smoking. Patients often do not realize progressive rotator cuff wear until the first symptoms, mainly pain, are triggered. shoulder.
Acute trauma to the shoulder can also injure the rotator cuff, in both young and old patients. However, this occurs most often in the context of a shoulder dislocation in patients over 40 years of age, where the energy involved is greater than the resistance capacity of the collagen fibers. In these cases, the shoulder will show symptoms abruptly.
This injury is very common in those who practice sports such as swimming, baseball, softball and tennis, it is also commonly seen in housewives where it is related to carrying out activities keeping the arms raised as it occurs when organizing cabinets, taking or placing objects in tall cabinets or bookshelves and when cleaning windows.
Diagnosis of the cause of shoulder pain requires a physical examination, X-rays of the shoulder in three views, along with an ultrasound or MRI of the affected shoulder. In cases where there is a good quality ultrasound and a reliable radiologist, radiography and ultrasound are sufficient to confirm the diagnosis and adopt a therapeutic approach. The MRI is an excellent method of study, which lets you see in detail the anatomy of the rotator cuff, evaluates muscle atrophy that may have occurred over time.
The treatment of rotator cuff injuries is conservative, it consists of the application of local physical means, anti-inflammatories and a rehabilitation plan, surgery is only necessary in cases where there is no satisfactory response to medical treatment or when there is a total rupture of one of the tendons that make up the rotator cuff.
