Rotator cuff tendinitis

　　The causes of rotator cuff tendon injury are mainly due to repeated abnormal-range rapid rotation of the shoulder joint, especially the abduction of the upper arm, which causes the rotator cuff tendons and subacromial bursa to be continuously compressed, rubbed, and pulled by the humeral head, acromion, or coracoid ligament. Since the supraspinatus muscle is in the center of the rotator cuff, when the shoulder joint is abducted, especially with a slight internal rotation during abduction, the rotator cuff tendons, especially the supraspinatus tendon, continuously rub and compress against the acromion, so the supraspinatus tendon is most prone to injury. When the upper arm is abducted to 60-120 degrees, this friction and compression is most severe, and after the abduction exceeds 120 degrees, due to the upward rotation of the scapula, the distance between the supraspinatus tendon and the acromion increases, and this friction and compression phenomenon is reduced or disappears. The pathological changes of rotator cuff tendon injury first appear in the rotator cuff tendons, mainly the supraspinatus tendon. The tendon fibers appear glassy degeneration, rupture, or partial rupture, and sometimes calcification and ossification may appear in the tendon fibers, and necrotic or scar tissue fills the gaps, with round cell infiltration around small blood vessels, showing chronic inflammatory changes, such as thickening of the capsule wall, glassy degeneration, punctate defects and纤维素 on the synovial surface, villous hyperplasia and adhesions, etc. In the late stage of injury, the tendon insertion points of the humerus show chondrocalcinosis, glassy degeneration, ossification, or cystic changes, with a rough or defective surface.

　　Rotator cuff tendon injury often occurs with nerve and vascular injuries or bone and joint injuries, and can also occur with closed tears, especially in patients with compression injuries, where these complications are more likely to occur. Generally, after tendon rupture, the corresponding joint will lose its functional activity. In addition, after surgery, this disease is prone to complications such as tendon adhesions. Tendon nutrition, tendon healing, and tendon adhesions are a cause and effect relationship; the more severe the destruction of tendon nutrition, the slower the tendon healing, and the more severe the tendon adhesions will be. Even the collapse and atrophy of the tendon sheath may occur.

　　The degree of symptom manifestation of rotator cuff tendon injury varies with the duration of the disease and the acuteness of onset.

　　1 Chronic injury: Generally, the shoulder is not painful, and there is no pain during general activities or overcoming resistance with the arm externally or internally rotated, but pain occurs only during certain special movements.

　　2 Subacute injury: Chronic formation due to repeated injuries, most common in rotator cuff injuries. The main symptoms are pain during active or passive abduction of the upper arm from 60 to 120 degrees or during internal and external rotation, but the pain often subsides or disappears after abduction of the upper arm exceeds 120 degrees or after forceful traction of the upper arm before starting the abduction movement. During examination, tenderness is often found under the acromion and at the greater tubercle of the humerus. Shoulder pain occurs when the arm is elevated in a reverse arch throwing posture, known as reverse arch pain. Pain during resistance abduction and internal and external rotation, with abduction limitation. In patients with a long course of disease, the supraspinatus and deltoid muscles may atrophy.

　　3. Acute injuryIt often occurs suddenly due to a sprain or overexertion, mainly manifested as symptoms of acute subacromial bursitis. Shoulder pain, limited movement, severe tenderness in the lateral subacromial area, the shape of the shoulder is often changed due to the swelling of the bursa, and there is pain during the resistance activity of the shoulder joint in all directions.

　　To prevent rotator cuff tendon injury, it is necessary to pay attention to the following three points during fitness exercises, as prevention is more important than treatment:

　　1. Before starting formal exercise, do a 'warm-up' activity, that is, slowly and controlledly rotate the upper arm, which can help stretch and exercise the rotator cuff muscles, and can effectively prevent rotator cuff injury.

　　2. During exercise, athletes should pay attention to themselves, that is, to consciously 'feel' their shoulder response; once pain and other adverse feelings occur, attention should be paid and exercise should be stopped, and then necessary protective measures or early treatment should be taken.

　　3. Avoid excessive exercise, especially in the gym. For example, after exercising the pectoralis major and latissimus dorsi, it is not advisable to perform intense shoulder training. Overexertion is a great taboo.

　　4. Rotator cuff tendinitis is common, comprehensive treatment should be timely. Rotator cuff injury is divided into two types of diseases: rotator cuff tendinitis and rotator cuff tear. The vast majority of rotator cuff injuries are rotator cuff tendinitis, which can usually be restored by timely comprehensive treatment, while rotator cuff tears require excision and suture treatment.

　　Laboratory tests needed for rotator cuff tendon injury

　　1. X-ray imagingIn some cases, the surface of the great tuberosity cortex bone is irregularly hardened or osteophytes are formed, and the cancellous bone shows bone atrophy and looseness. In addition, if there are X-ray manifestations such as a low acromial position, hook-shaped acromion, and ossification and irregularity of the subacromial joint surface, it provides evidence of the presence of impingement factors. During the dynamic observation of the lifting movement of the affected arm, the relative relationship between the great tuberosity and the acromion and the presence of subacromial impingement can be observed. X-ray films also help in distinguishing and excluding shoulder joint fractures, dislocations, and other bone and joint diseases.

　　2. ArthrographyThe glenohumeral joint is normally connected to the subscapular bursa and the biceps brachii long head tendon sheath, but it is not connected to the acromial bursa or the subdeltoid bursa. If the acromial bursa or the subdeltoid bursa is visible on the arthrogram of the glenohumeral joint, it indicates that the separating structure - the rotator cuff - has ruptured, causing the contrast medium in the glenohumeral joint cavity to leak out through the rupture and enter the acromial bursa or the subdeltoid bursa (Figure 2). Arthrogram of the glenohumeral joint cavity is a very reliable diagnostic method for complete rotator cuff tears, but it cannot make an accurate diagnosis for partial rotator cuff tears.

　　3. CT examination: The use of CT alone is of little significance in the diagnosis of rotator cuff lesions. The combination of CT and arthrography is useful for detecting tears in the subscapularis and supraspinatus muscles and for detecting coexisting pathological changes. In cases of widespread rotator cuff tears with glenohumeral joint instability, CT examination helps to detect abnormal anatomical relationships and instability between the glenoid and humeral head.

　　4. Magnetic resonance imaging: Magnetic resonance imaging (MRI) is an important method for diagnosing shoulder cuff injuries, which can show pathological changes in tendon tissue based on different signals of damaged tendons in terms of edema, congestion, rupture, and calcium salt deposition. The advantages of MRI are that it is a non-invasive examination method, has reproducibility, and is highly sensitive to soft tissue injuries, with a high sensitivity (over 95%). However, the high sensitivity leads to a higher rate of false positives. Further improvement of the specificity of diagnosis requires in-depth research on imaging and pathological comparison studies, as well as the accumulation of case numbers and practical experience.

　　5. Ultrasound diagnostic method: Ultrasound diagnosis is also a non-invasive diagnostic method, which is simple, reliable, and can be repeated. Its advantages are its simplicity and reliability, and the ability to repeat the examination. Ultrasound diagnosis can clearly differentiate shoulder cuff injuries, and high-resolution probes can show traumatic pathological changes such as edema and thickening of the shoulder cuff. It shows shoulder cuff defects or atrophy, thinning, in partial tears; and in complete tears, it shows the ends and fissures, and displays the range of tendon defects. Ultrasound diagnosis is superior to arthrography in diagnosing incomplete tendon tears.

　　6. Arthroscopic diagnosis: Shoulder arthroscopy is a minimally invasive examination method, generally used for cases suspected of having rotator cuff injury, labral lesions, long head of the biceps brachii tendon avulsion (SLAP) lesions, and glenohumeral joint instability.

　　Dietary recommendations for patients with shoulder袖 tendons injury

　　1, You can eat more foods rich in vitamin B1 to supplement: milk and its products, animal liver and kidney, egg yolk, eel, carrot, mushroom, seaweed, celery, orange, tangerine, and orange, etc.

　　2, Choose light, easy-to-digest, and nutritious foods.

　　3, Increase the intake of fresh fruits and vegetables, cold vegetables and fruits, such as winter melon, pear, banana, watermelon, and can increase animal liver, milk, and egg yolk appropriately.

　　4, Take 20 grams of papaya, 15 grams of Eucommia ulmoides, 15 grams of Angelica sinensis, 15 grams of Achyranthes bidentata, 10 grams of Acanthopanax sieboldianus, 10 grams of Eucommia ulmoides, 10 grams of Cinnamomum cassia, 1 pair of pork feet, ginger, scallion, and salt in appropriate amounts. First, scald the pork feet and clean them, then cut into small pieces. Heat some oil in a pot, add ginger and scallion, and sauté until fragrant. Add the pork feet and stir-fry for a while, then add an appropriate amount of water. Next, rinse the above herbs with water and add them to the pot. Boil with strong heat and then simmer over low heat until the pork feet are tender, season with salt to taste. Eat the pork feet and drink the soup in two servings, one dose per day, and it usually takes 2-3 doses to see the effect. This recipe has the functions of tonifying the kidneys and nourishing the blood, removing wind and dampness, and promoting circulation and relieving pain.

　　5. Avoid excessive alcohol consumption. Because excessive alcohol intake can cause significant liver damage, reduce the body's immunity, and have a serious impact on the recovery from the disease.

　　6. Avoid spicy, fried, and roasted foods.

　　The choice of treatment for rotator cuff tendon injury depends on the type of rotator cuff injury and the time of injury. In the acute phase of rotator cuff contusion, partial tear, or complete tear, non-surgical therapy is generally adopted. The treatment for rotator cuff contusion includes rest, triangular bandage suspension, immobilization for 2 to 3 weeks, and local application of physical therapy to reduce swelling and relieve pain. For those with severe pain, 1% lidocaine combined with corticosteroids can be injected into the subacromial bursa or glenohumeral joint cavity. After pain relief, shoulder joint functional rehabilitation training can begin. The treatment for the acute phase of rotator cuff tear includes supine position, upper limb zero position (zero position) traction, that is, skin traction is performed at 155° of abduction and 155° of anteroposterior elevation when the upper limb is in position. The duration of traction is 3 weeks. At the same time, bedside physical therapy is performed. After 2 weeks, traction is intermittently released 2 to 3 times a day, and shoulder and elbow functional exercises are performed to prevent joint stiffness. It is also possible to switch to zero position shoulder in-line plaster or zero position brace fixation after 1 week of bed traction to facilitate ground activities. Zero position traction helps the rotator cuff tendons to repair and heal under low tension, and it is also conducive to utilizing limb weight to promote the recovery of glenohumeral joint function after traction is removed. Surgical treatment is indicated for large rotator cuff tears, rotator cuff tears that are not responsive to non-surgical treatment, and cases with coexisting subacromial impingement factors. Large rotator cuff tendon tears generally cannot heal spontaneously, and factors affecting spontaneous healing include: separation of the ends, defects, ischemia of the residual ends, joint fluid leakage, and the presence of subacromial impingement factors. There are many methods for repairing rotator cuff tendon injuries, and the commonly used method is the Mclaughlin method, which involves making a bone groove near the greater tuberosity at the original insertion site of the rotator cuff and implanting the proximal end of the rotator cuff into the bone groove in the position of the affected arm abduction. This method has a wide range of indications and is suitable for large and extensive rotator cuff tendon tears. To prevent postoperative adhesion and impingement of the subacromial space, the coracohumeral ligament should be cut and a partial resection and成形术 of the anterior and lateral part of the acromion should be performed at the same time as the rotator cuff repair. For patients with subacromial impingement syndrome, shoulder osteotomy is an indication (Figure 4). For rotator cuff defects caused by extensive tears of the supraspinatus and infraspinatus tendons, the upper two-thirds of the subscapularis muscle from the insertion site of the lesser tuberosity can also be freed, forming a subscapularis muscle flap that is transferred upwards and fixed over the combined defect site of the supraspinatus and infraspinatus tendons (Figure 5). In addition, Debeyre's method of shifting the supraspinatus muscle for repair is also a surgical treatment method for giant defects of the supraspinatus tendon. This involves freeing the supraspinatus muscle from the suprascapular fossa, retaining the suprascapular nerve branch to the supraspinatus muscle and the accompanying vascular bundle, shifting the entire supraspinatus muscle laterally to cover the defect site of the tendon, and re-fixing the supraspinatus muscle in the suprascapular fossa (Figure 6). For large rotator cuff defects, synthetic fabric grafts can also be used for repair. After postoperative physical therapy and rehabilitation training, the function of the shoulder joint can be largely restored, pain can be relieved, and daily activities can be met.