What is a shoulder disease that makes it difficult to lift the arm for more than 10 seconds and makes the pain worse at night?
Dec 25, 2024
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When the shoulder hurts, the frozen shoulder (adhesive articular cystitis) is often suspected first. This is because the frozen shoulder, which appears around age 50, is the most familiar among shoulder diseases. However, many of the people who visited the hospital due to shoulder pain are patients with 'rotator cuff rupture'.
Lee Sang-wook, a professor of orthopedic surgery at the Catholic University of Korea's Incheon St. Mary's Hospital, said, `Rotor cuff rupture is a disease that occurs frequently in the elderly, such as aging and degenerative changes, but the number of cuff rupture is increasing recently due to golf, baseball, and badminton, which are often used repeatedly by young adults in their 30s and 40s"You should reduce the risk of damage by stretching your shoulder joints before and after exercise."," he said.
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Rotator cuff rupture is a disease that causes pain by bursting or breaking some of the rotator cuff connecting the shoulder and arm. The rotator cuff refers to the four tendons surrounding the shoulder, namely the maxillary muscle, the hypoparasic muscle, the scapular muscle, and the sartorial muscle. The reason why these four tendons are called rotator muscles is that they allow the arms to move in or out, up and down.
The rotator cuff plays an important role in maintaining shoulder movement and stability, such as maintaining shoulder joints so that the four tendons are balanced with each other and the arm bone is not dislocated.
It is often confused with the frozen shoulder, that is, adhesive articular cystitis, but there are differences in symptoms. Adhesive articular cystitis is a disease in which pain and stiffness occur due to inflammation of the articular sac, a pocket surrounding the shoulder. As time passes, the joint sac narrows, limiting the range of motion of the joint and hardening the entire shoulder, making it difficult to raise the arm by force.
On the other hand, rotator cuff rupture is difficult to raise the arm on its own, but the difference is that you can raise the arm if someone else helps you. However, it is difficult to distinguish between the frozen shoulder and the rotator cuff rupture simply by these symptoms. A specialist's diagnosis and treatment are needed.
Professor Lee Sang-wook explained, "The bigger problem with rotator cyst rupture is that unlike adhesive articular cystitis, it does not heal naturally."If it is simply concluded and left unattended as adhesive articular cystitis, the rupture site becomes larger and can damage other tendons." he warned.
◇ Doubt if it's hard to lift your arm for more than 10 seconds... The pain gets worse at night
The cause of rotator cuff rupture is divided into external and internal causes. External causes include repeated use, shock, and trauma. Internal causes are cases where there is a problem with the tendon itself due to degenerative conditions. It is caused by the loss of blood flow to the tendon and the death of cells. The rotator cuff rupture is a progressive disease. Collision syndrome occurs well in the 40s, and progresses to partial rupture of the rotator cuff in the 50s and complete rupture in the 60s.
The main symptom is pain. The position of pain is generally downward from the front or side of the shoulder joint. The pain gets worse when you lift your arm or lift heavy objects, and it worsens in a lying position. If the rupture intensifies, symptoms of muscle weakness may appear. If it is difficult to hold it for more than 10 seconds with the arm raised, a rotator cuff rupture may be suspected. The pain gets worse, especially at night.
However, rotator cuff disease sometimes is not proportional to the progression of the disease and symptoms. While severe pain may be seen even with minor partial rupture, there are many cases where the symptoms of perception are mild even with total rupture. Symptoms should not be used to determine the severity of the disease.
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For treatment, exercise, medication, physical therapy, manual therapy, and injection therapy are performed first. Steroid injections help calm inflammation. If your blood sugar is high and it is difficult to use steroids due to taking chronic disease drugs, use hyaluronic acid injections that help lubricate and move your joints. Collagen injections are sometimes used for the purpose of regenerating tendons, but if only the inside of the tendon is torn, collagen can be seated well, but if all tendons are torn, collagen can be difficult to settle, which can be less effective.
Surgery is performed when it is not effective even for non-surgical treatment. Usually, partial rupture of less than 50% is not performed. However, if it is torn more than 50%, it is not effective in preservation treatment, and if left alone, the rupture continues, so surgery is performed to seal the rupture. The surgery is carried out by removing mucocystitis and synovitis that cause pain, removing parts of bones such as tendons that can cause collisions with tendons, and sealing torn tendons.
If the tendon is left completely broken and completely ruptured, the tendon degenerates and degenerates, and fat accumulates there, resulting in fat degeneration. At this time, suture surgery itself is difficult, and even if sutured, there is a high probability of re-destruction.
In addition, the joints and muscles are out of balance, and cartilage begins to wear out, leading to arthritis. This is called extensive rotator cuff rupture, and if daily life is difficult due to severe pain, muscle weakness, and pseudo-paralysis, retrograde artificial joint replacement is performed. Retrograde artificial joint is a surgery that makes the rotator cuff tendon, which is not functioning originally, give up and the deltoid muscles replace the shoulder tendon. However, not all patients progress to extensive rotator cuff rupture. Depending on the patient, it can proceed quickly or slowly.
Surgical treatment is the basic for rotator cuff tear, but if you are over 70 and have a comorbid condition and no pain, you do not need to operate.
The rotator cuff rupture is deeply related to aging. Six out of 10 people in their 70s and older are known to be patients with rotator cuff rupture. Surgery is determined by considering variables such as age, physical activity requirements, comorbidities, and pain. If you have received a prescription for surgery, it is recommended to listen to other doctors' opinions at least once.
Professor Lee Sang-wook said "Shoulder pain is often caused by an improper posture of the upper body. Long-bending shoulders cause over-tension of surrounding muscles and ligaments, which causes tendons or tendons to rupture easily even in small trauma. "Shoulder stretching 3-4 times a day can protect shoulder health and reduce the risk of tendon damage" he said. In addition, as diabetes and high blood pressure, as well as smoking, are known to be factors that increase rotator cuff rupture, improving one's usual lifestyle can also be a way to maintain shoulder health," he stressed.
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bellho@sportschosun.com
