Tendon tear - shoulder

Clemens Gödel is a freelancer for the medical team.

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If a tendon rupture affects the shoulder and upper arm, those affected usually have severe pain and can only move the shoulder joint to a limited extent.The diagnosis is made through an in-depth examination and ultrasound or other imaging test. Depending on the type and severity of the injury, the tendon tear (shoulder) is either operated on or treated conservatively. Read everything you need to know about tendon ruptures and shoulders here!

ICD codes for this disease: ICD codes are internationally recognized codes for medical diagnoses. They can be found, for example, in doctor's letters or on certificates of incapacity for work. M66

Tendon tear - shoulder: description

A tendon tear (shoulder) is one of the most common wear-related tendon injuries and is often the cause of shoulder pain.

The shoulder joint is a complex structure with a main joint and three smaller secondary joints. The main joint consists of the loose joint socket, which is largely formed by the shoulder blade (scapula), and the joint head of the upper arm bone (humerus). The bone guidance of the shoulder joint is relatively free compared to other joints. This allows the arm to be moved in many directions. The shoulder joint is stabilized by a multitude of muscles, ligaments and tendons that can tear when subjected to high loads. A ring made up of four muscles (called a rotator cuff) is particularly important. They arise from the shoulder blade and attach their tendons to the head of the humerus. These tendons run under the connective tissue-bony joint roof (acromion) and are particularly prone to tendon rupture when stressed. Shoulder pain is often caused by the rotator cuff.

Another tendon runs in the area of ​​the shoulder joint: the long biceps tendon, which - starting from the arm flexor muscle on the upper arm (biceps) - runs through a bony groove to the upper edge of the shoulder socket. It can tear too.

Tendon tear - shoulder: symptoms

As with all tendon tears, those affected also notice a restriction in movement with a shoulder tendon tear, for example when lifting the arm. The joint also loses stability, so that in certain cases it can dislocate (luxate). Other symptoms that can occur with a torn tendon (shoulder) include tenderness, shoulder pain at night, and bruising.

If the long biceps tendon tears, mobility of the shoulder and mobility of the elbow joint can also be reduced. The biceps, however, still attaches to the shoulder via a second tendon (short biceps tendon), so that a tear in the long tendon alone usually does not lead to a complete functional failure of the muscle.

Tendon tear - shoulder: causes and risk factors

A tendon tear (shoulder) is often due to wear and tear. Mechanical damage can lead to inflammation of tendons and bursae in the shoulder joint. The affected tendons can initially be torn when exposed to stress and then completely severed later.

The muscle tendons on the shoulder are very prone to tearing due to their anatomical features. Some muscle tendons run under the joint roof of the shoulder (subacromial) and can thus easily be pinched between the head of the humerus and the bony joint roof.

In addition to degenerative changes, accidents (such as a dislocation of the shoulder) often lead to a tendon rupture.

Shoulder tendon tears are favored by various factors. These include smoking, various medications (such as anabolic steroids), high blood lipids (hypercholesterolemia) and activities with a high shoulder load.

Torn tendon - shoulder: examinations and diagnosis

If you suspect that a shoulder tendon has torn, you should consult an orthopedic surgeon or trauma surgeon. There are also doctors who specialize in shoulder diseases and injuries. An early diagnosis of shoulder damage is important to prevent more severe disease and complications.

Before the examination, the doctor will ask you the following questions, among others:

• How long has the restriction of movement existed?
• Can you locate the pain?
• Did you put a lot of strain on your shoulder?
• Do you have any previous illnesses on your shoulder?

The doctor will examine you to investigate any suspected torn tendons (shoulder). To do this, you need to free your upper body. The doctor may notice movement difficulties as soon as the top is taken off. When looking at the affected area, the doctor may notice changes, such as a decrease in muscle mass (such as the so-called epaulette sign). When palpating, pain points can be identified and any irregularities noted.

The doctor then tests the shoulder's mobility and compares it with the (healthy) opposite side. To find out which muscle tendon is affected, the doctor can perform various provocation tests. Depending on the type of arm and shoulder posture as well as the movement, the doctor can identify the affected muscle tendon (including Jobe, lift-off or belly press test).

Ultrasound (sonography)

If a tendon tear (shoulder) is suspected, an ultrasound examination of the shoulder is carried out first. The shoulder can be moved freely during the examination so that the doctor can examine the joint in different positions and while it is moving. If the course of the tendons cannot be traced, is atypical, or does not change despite movement, the suspicion of a tendon tear (shoulder) is reinforced.

Magnetic resonance imaging (MRI)

The MRI examination (also known as magnetic resonance imaging) is an imaging procedure that can depict body structures in detail without exposure to radiation. It is also suitable if a tendon tear (shoulder) is suspected. However, the recording is only made in one joint position (static), so that no movements can be recorded.

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Tendons cannot be shown in the X-ray image. Only possible bone damage can be recognized, which can be associated with a tendon tear (shoulder).

Tendon tear - shoulder: treatment

A tendon tear (shoulder) can in principle be treated both surgically and non-surgically (conservatively). If there are bone fractures, vascular or nerve injuries in addition to the tendon rupture, a complex treatment strategy is required.

The best treatment for a torn tendon (shoulder) depends on many factors. Above all, this includes the degree of damage and the individual demands placed on the shoulder. The aim of every therapy is to reduce pain and improve joint function.

In almost all cases, pain and inflammation treatment is started first. Sometimes cortisone is injected directly into the joint. Strict immobilization is not recommended due to the risk of joint stiffening. Instead, early functional physiotherapy (shoulder school) is planned and started in the early phase of treatment.

Tendon tear - shoulder: surgery

In most cases, a tendon tear (shoulder) is operated on - especially in the case of injury-related tendon tears, pronounced activity and little pre-damaged tendons. On the other hand, surgery should be avoided in the case of joint infections, nerve damage and advanced degeneration, among other things. The outcome of the procedure depends to a large extent on the condition of the tendon. A tendon suturing can only be performed successfully if the tendons are of good quality.

A tendon tear (shoulder) should be operated on within a few weeks if you want to achieve a good result. A distinction is made between open tendon repair and the minimally invasive variant. Open surgery also allows more difficult techniques. However, the deltoid muscle lying around the shoulder (Musculus deltoideus) has to be detached from parts of the shoulder blade. This is not necessary for a minimally invasive operation. The surrounding tissue can be spared through the only small access to the joint. The minimally invasive technique is more complicated and only allows easier tendon repairs due to the tightness. If a piece of bone with the tendon has been torn out, it must be treated in an open operation.

There are a number of different techniques for suturing the ends of the tendons. Which one is used in each individual case depends on the type of crack. In addition, it may be necessary to enlarge the space around the tendon by decompression or to insert a (endogenous) tendon graft.

After surgery, the shoulder should be protected in a bandage for two to six weeks (Gilchrist bandage, abduction splint, etc.). The arm is held at a 30 degree elevation with a shoulder adduction splint. The shoulder joint may initially only be moved passively. From the third week onwards, assisted, active movement exercises are slowly started. From the seventh week onwards, active movements can be carried out without restriction. Sports activities should not be resumed until the third month.

Torn tendon - shoulder: conservative treatment

Conservative treatment is considered in the case of a slowly developing tendon tear in the shoulder that is not caused by an accident. This form of treatment is particularly suitable for patients who are only active to a limited extent and for so-called "frozen shoulder" (frozen shoulder).

The treatment is usually divided into three phases: First, the pain and inflammation processes in the shoulder are relieved, for example with medication and / or cold treatment. Cortisone may also be injected into the joint. In the second step, a slow build-up training is started in order to ensure the stability of the shoulder joint and counteract muscle breakdown. Finally, the training is continuously increased in order to be able to exercise again the movements necessary for everyday life, sport or work.

If the pain persists or gets worse after initial improvement, patients should see their doctor again. Then surgery may be necessary.

An early stabilization and build-up training is essential to prevent muscle breakdown and joint stiffness and to quickly restore the mobility of the shoulder. However, it can take up to six months for the shoulder to be fully resilient again.

Tendon tear - shoulder: disease course and prognosis

It is difficult to make a general statement about the prognosis for a tendon tear (shoulder). For example, it is crucial which tendon is affected and to what extent. After conservative treatment, more than 50 percent of those affected complain of permanent muscle shrinkage and almost all patients of at least a slight weakness in the shoulder area. Treatment by proven shoulder specialists can significantly improve the prognosis, especially in the case of surgical treatment. In any case, early functional rehabilitation after a tendon tear (shoulder) is essential for maintaining function and strength.

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