2023-06-05 03:03:55
[현대건강신문] A tennis program is on the air. Thousands of people in their 50s walk the court, dreaming of a winning shot. But let’s not forget that even in the midst of cheering up his attack points in style, his shoulder joints are wearing out.
The shoulder joint is one of the three major joints in our body along with the spinal joint and the hip joint, and is widely used in all physical labor and sports movements. The double rotator cuff refers to the muscles that surround the shoulder joint and are involved in the stability and movement of the shoulder.
The number of rotator cuff tendon rupture patients continues to increase due to aging and degeneration due to repetitive use, among which the increase in sports population is cited as one of the main causes.
The rotator cuff is a combination of four muscles that move the arm. It is called a rotator cuff because its main function is to raise the arm and to rotate it inward or outward.
Degenerative changes such as aging occur in the tendon of the rotator cuff attached to the bone and lead to rupture, which is called rotator cuff disease.
Rotator cuff syndrome is a degenerative disease, and if you look at patients in 2021, it occurred the most in the 50s and 60s. Compared to 2018, the number of patients in 2021 increased by nearly 15%.
The causes of rotator cuff tendon rupture are known as endogenous causes, such as degenerative changes in the tendon and reduced blood flow supply, and extrinsic causes, such as collision between the tendon and the sacroiliac bone and excessive use. Among diseases related to rotator cuff syndrome, rotator cuff tear occurs in many cases when the shoulder is injured repeatedly while playing sports that require a lot of shoulder, such as golf, badminton, and tennis, or when the shoulder is injured due to acute injury.
When shoulder pain occurs, it is often neglected thinking that it is a frozen shoulder. If the pain is caused by a rotator cuff tear at this time, you may miss the treatment period, so it is good to visit a hospital and get an examination.
For rotator cuff tears, press to see if there is tenderness at the ruptured area, check which part of each tendon has pain, conduct a physical examination to see if it is functioning normally, and then perform imaging tests such as X-rays, ultrasound, and MRI (magnetic resonance imaging). to be confirmed
MRI is helpful in selecting a surgical method and establishing a treatment plan because it shows not only the presence or absence of a rotator cuff tear, but also the size and pattern of the tear, and the degree of fat deposition and atrophy in the torn area.
A rotator cuff tear does not necessarily require surgery if it is a partial tear that is not severe. However, the treatment method is selected in consideration of the patient’s age, occupation, activity level, size of rupture, degree of functional decline, mechanism of damage, and degree of pain.
In the case of partial tear, the progress is observed while initially treating inflammation accompanied by conservative treatment such as oral medicine or injection. If the size of the rupture is small, the pain subsides, and the movement of the shoulder becomes smooth, daily life to some extent is possible without great restrictions.
In particular, if the rupture is not severe in patients over the age of 75, inflammation treatment using drugs or injections, shoulder joint flexibility recovery exercise using stretching, and muscle strengthening exercises around the shoulder can be performed step by step. Even if the response to these conservative treatments is good, ultrasound should be taken every 6 months or 1 year to check whether the rupture is progressing.
Rotator cuff tear over time, partial tear can progress to a complete tear, the size of the tear in the midst of a complete tear can gradually increase. If the rupture continues to progress and the size increases, surgery is recommended.
In addition, even with a partial rupture, if the pain continues even with drugs, injections, rehabilitation, and exercise therapy, surgical treatment is considered. In particular, when it is thought to be a traumatic tear caused by a strong external force in a young patient with high activity, and when serious functional abnormalities and muscle weakness are accompanied, surgical treatment should be considered at a relatively early stage.
Surgical treatment is basic to suture the ruptured tendon, remove inflammation of the bursa that causes pain, and remove part of the shoulder sacroiliac bone that can cause collision with the tendon.
Surgery is performed arthroscopically in most cases. The surgery is performed by drilling 4 to 5 holes in the skin, and the surgery is performed to suture the torn rotator cuff while observing the inside of the joint with a monitor. Arthroscopy has the advantage of less damage to the surrounding tissue due to the incision compared to the conventional incision.
The operation time is regarding 2-3 hours. You must be careful while wearing a brace for regarding 4 to 6 weeks following surgery. While wearing the brace, you should refrain from lifting your shoulders up or widening them to the side.
However, if the size of the rupture is extensive and the severed rupture is rolled toward the body and the contraction is severe, it is impossible to suture or there is a high probability of re-rupture even if sutured. Therefore, it is important to find a hospital and get treatment before the shoulder pain gets worse and muscle strength deteriorates.
After wearing the brace, rehabilitation treatment begins. If the brace is worn following surgery, the shoulder is stiff, so it is difficult to raise or rotate the shoulder immediately following wearing the brace. Therefore, first, do an exercise that gently creates the movement angle of the joint.
It is an exercise that moves the operated arm with the non-operated arm. You should do this for 20 to 30 minutes twice a day. If you do this for regarding 3 months, the movement of your shoulder will gradually become softer, and following regarding 3 to 6 months, you can use your shoulder without major restrictions in daily life like before surgery.
To prevent rotator cuff tears, it is important to keep your shoulders soft with regular stretching. It should not be done for a short time before exercise, but until the joints are sufficiently relaxed. It is also helpful to have a habit of stretching frequently on a daily basis. A hot compress is also good to relieve tension in the shoulders. Furthermore, it is even better if it is a bath where you can soak your shoulders.
It is good to strengthen the shoulder tendons with a balanced diet, and to develop the flexibility of the shoulder tendons and muscles by steadily doing shoulder stretching and strength exercises. [강동경희대학교병원 정형외과 김명서 교수]
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