Rotator interval tear

　　1. Etiology

　　It is often caused by work-related injuries, sports injuries, or repeated cumulative injuries.

　　2. Pathogenesis

　　The injury mechanism of shoulder cuff gap splitting caused by throwing sports is: a rapid transition from external rotation and abduction to internal rotation and adduction, leading to the rupture of loose connective tissue in the muscle gap, and the splitting of the supraspinatus tendon and the subscapularis tendon. The anterior wall of the glenohumeral joint capsule may herniate from the gap or tear simultaneously.

　　Dysfunction: In patients with large shoulder cuff tears, active elevation and abduction of the shoulder are limited. The range of abduction and elevation is all less than 45°. However, there is no significant limitation in passive activity. Muscle atrophy: In patients with a history of more than 3 weeks, there is varying degrees of atrophy in the shoulder muscles, with the deltoid, supraspinatus, and infraspinatus muscles most common. Secondary joint contracture: In patients with a course lasting more than 3 months, there is varying degrees of limitation in shoulder joint movement, with abduction, external rotation, and elevation being more obvious.

　　1. Pain located in the anterior shoulder, a persistent dull pain, symptoms worsen after shoulder joint movement, with localized tenderness at the shoulder cuff gap site on the outer side of the coracoid process.

　　2. Weakness and fatigue.

　　3. Unstable or loose feeling of the shoulder joint.

　　4. Joint intra-articular crepitus.

　　This condition is caused by direct trauma to the shoulder, such as falls, slips, or sudden braking while driving. Therefore, attention should be paid to lifestyle habits, and high-risk workers such as construction workers, miners, and mechanics are prone to injury, and protection should be taken during work. Stay calm in case of emergencies to avoid emotional excitement and conflict leading to the condition. In addition, early detection, early diagnosis, and early treatment are also of great significance in preventing the condition.

　　1. X-ray photography

　　Place the affected arm in the maximum elevation position, and sometimes a dislocation between the glenohumeral joints may occur.

　　2. Shoulder joint arthrography

　　The contrast agent overflow at the shoulder cuff gap site forms a strip-like, papillary, or irregularly shaped shadow on the outer side of the coracoid process.

　　3. Arthroscopic examination

　　It can be seen that there is congestion and exudation at the rotator cuff interval.

　　What kind of food is good for the shoulder cuff interval splitting:

　　It is advisable to eat light, eat more vegetables and fruits, and rationally match the diet. The diet of patients should be light and easy to digest, eat more vegetables and fruits, and rationally match the diet, pay attention to adequate nutrition. In addition, patients also need to pay attention to avoid spicy, greasy, cold foods.

　　For all fresh injuries, non-surgical treatment should be adopted first, such as immobilization, oral anti-inflammatory analgesics, and physical therapy. It can also be taken to rest in bed with zero traction for 3 weeks, or change to shoulder orthopedic plaster or brace after traction for 1 week to continue zero fixation. At zero position, the scapular spine and humerus are on the same axis and on the same plane, achieving consistency between the anatomical axis and the physiological axis, and the rotator cuff is in a relaxed resting state, with the lowest muscle potential. The low stress state is conducive to the re-healing of the fresh fissure. Physical therapy can be performed during the period of fixation, and joint function rehabilitation training can be started after the fixation is removed.

　　The indications for surgical treatment are:

　　1. Non-surgical treatment has been ineffective for more than 2 months.

　　2. The glenohumeral joint is obviously unstable or there is an old scar of rotator cuff interval splitting with joint contracture.

　　3. There are impact factors under the coracoid arch.

　　The operation adopts an anterior deltoid split approach, splits the deltoid, incises the subacromial bursa, exposes the coracoid process and the interval between the supraspinatus and subscapularis muscles on the lateral side, and pulls the affected arm downward in the internal rotation and external rotation positions respectively. Check whether the glenohumeral joint is loose. Observe whether there is a tear or a depression of the size of the finger pad at the rotator cuff interval. If the anterior wall of the joint capsule has also been ruptured, cut the coracohumeral ligament, appropriately enlarge the incision, explore the joint cavity, including the articular cartilage, synovium, labrum, etc. If the anterior wall of the joint capsule is still intact, suture the tendons of the supraspinatus and subscapularis with 7号线 in a running suture for 3 to 4 times. After the repair is completed, repeat the downward traction in the internal rotation and external rotation positions, if the depression in the rotator cuff interval does not reappear, the repair is completed. The excision of the coracoacromial ligament and the release of the subacromial interval adhesion are conducive to the recovery of shoulder joint function after surgery. Generally, a satisfactory therapeutic effect can be obtained after surgery.