Release date: 2016-08-29 The rotator cuff injury is a common shoulder joint disease in middle-aged and elderly people, and its incidence rate accounts for 17% to 41% of shoulder joint diseases. It is mainly characterized by shoulder pain and severe shoulder dysfunction. Anatomy The rotator cuff is covered by the anterior, superior, and posterior aspect of the shoulder joint. It consists of the tendon of the supraspinatus, infraspinatus, the small round muscle, and the subscapularis muscle . It is attached to the edge of the sacral nodule and the sacral anatomical neck. The capsules are closely connected and the outside is a deltoid sac. Surrounding the upper end of the humeral head, the humeral head can be incorporated into the glenoid to stabilize the joint, assist the shoulder joint abduction, and have a rotating function. Cause The causes of rotator cuff injuries are summarized in the theory of degeneration and impact theory. Impact Theory: Presented by Neer in 1972, he believes that 95% of rotator cuff tears are caused by subacromial impact, because the rotator cuff tendons are located between the shoulder arch and the humerus nodules, when the shoulder joint is abducted. When lifted, the rotator cuff tendon is very susceptible to congestion, edema, degeneration or even fracture due to the collision of the shoulder arch [1]. Degeneration theory: It is believed that the ganglion muscle vasoconstriction area increases with age, and the muscle fiber tissue necrosis occurs. In case of minor trauma, obvious damage can occur, which is degenerative trauma [2]. Nowadays, it is believed that the two factors are combined by impact and degeneration. The rotator cuff injury can be divided into complete fracture and incomplete fracture according to the degree of rupture. Clinical manifestation Shoulder joint pain and activity disorder are the main symptoms of rotator cuff injury. The initial pain is intermittent. After the labor and nighttime, the symptoms of the lateral position are aggravated and relieved after rest. Shoulder joint dysfunction, limited mobility, absent abduction or inability to abduct. Physical examination revealed atrophy of the supraspinatus, infraspinatus and deltoid muscles, and tenderness between the anterior and posterior acromions and the large nodules. The rotator cuff can be bounced when it passes under the shoulders, especially if it is completely broken. The pain arc was positive, and the pain of the arm abduction was increased from 60° to 120°. If you are completely broken, you can feel the crack in the crack. Imaging characteristics X-ray examination is not specific for diagnosis, but it helps to identify and exclude shoulder fractures, dislocations, and other bone and joint diseases. MRI is currently the most effective imaging method for examining rotator cuff injuries. The rotator cuff injury is divided into stage I hemorrhagic edema, stage II tendinitis and rotator cuff fibrosis, and stage III partial or complete tearing. MRI can show the performance of rotator cuff injury through abnormal response of morphology and signal [1]. In the fluoroscopy, intra-articular injection of iodine-containing contrast agent with tiny rotator cuff tears is more clearly shown by the contrast agent, and the accuracy of magnetic resonance arthrography is over 90%. Figures 3 and 4 show the left shoulder MR, suggesting that the left shoulder joint of the supraspinatus muscle is injured with tendon tear, and the left biceps brachii sulcus is bursitis. A small amount of fluid in the left shoulder joint, left shoulder degenerative changes (picture from the Shaoyifu Hospital orthopedics) Differential diagnosis 1. The biceps tendon rupture of the biceps muscle: the fracture is mostly located at the intercondylar notch of the tibia. Acute traumatic rupture, severe pain, elbow flexion and weakness. In chronic rupture, the elbow strength is gradually weakened. Resistance to flexion elbow test weakness or increased pain. 2. Shoulder fracture and dislocation: a history of obvious trauma, it can be found that the shoulder has a square shoulder deformity, Dugas sign positive. 3. Periarthritis of the shoulder: Also known as "fifty shoulders", "frozen shoulders", early shoulder soreness and pain, limited shoulder mobility in the mid-term, dysfunction, progressive relief of late symptoms, and self-healing tendency. treatment Non-surgical treatments include: rest, non-hormonal anti-inflammatory drugs, physical therapy, partial closure, calcified sediment, aspiration, various beneficial muscle strength exercises, and comprehensive rehabilitation methods. Most of the fractures do not require surgery. The shoulder joint can be fixed in abduction, flexion and external rotation for 3 to 4 weeks with plaster or an abduction frame, and then active function exercises are performed [3-5]. Surgical treatment should be based on early surgery, except for the weakness of the elderly, low functional requirements or serious medical problems. The principle of surgery is to remove the necrotic tissue at the edge of the tear, restore the anatomical continuity of the rotator cuff, and restore the subacromial sliding. Surgical methods include open surgery (open), arthroscopically assisted open surgery (mini-open), and full shoulder arthroscopy. (1) Open surgery (Open) Since the first open rotator cuff repair surgery in 1911, it has been more than 100 years old. Neer proposed five basic principles of open surgery: 1 repairing the starting point of the deltoid muscle; 2 removing the decompression of the shoulder of the shoulder ligament; 3 loosening the rotator cuff; 4 fixing the humerus; 5 strict rehabilitation exercise. Traditional open surgery has a large trauma and high postoperative infection rate [4, 6-8]. (2) Arthroscopically assisted open surgery (mini-open) was proposed by Levy et al. in 1990. The advantages of this procedure over open surgery: 1 reduced the number of hospital stays; 2 reduced deltoid damage; 3 early postoperative (3 months postoperatively) quality of life scores higher than open surgery. However, this type of surgery has shortcomings such as postoperative pain, joint adhesion, and high postoperative infection rate compared with total arthroscopy [4, 9, 10]. (3) Total shoulder arthroscopy With the continuous improvement of shoulder arthroscopy technology, in the early 1990s, many scholars underwent arthroscopic decompression, cleansing, rotator cuff injury and acromioplasty. The excellent rate is 80% to 92%. Surgical procedures include simple repair of rotator cuff injury, McLuohling repair, and rotator cuff repair with acromioplasty. 1 simple repair of rotator cuff injury: mainly for small and fresh lesions without other pathological changes and impact signs; 2McLuohling repair method: anatomical neck above the humeral large nodules to fix the tendon and bone or The proximal end of the rotator cuff is embedded in the bone groove at the anatomical neck and fixed, which is suitable for patients with very few distal end stumps or unable to perform direct anastomosis [5]. 3 rotator cuff repair at the same time shoulder acroplasty: mainly used for rotator cuff injury with impact signs. Acromioplasty consists of resection of the shoulder ligament, thickening of the shoulder sac, and wedge-cutting of the anterior and posterior aspect of the acromion until the arm does not impact during ascending abduction. The combination of subacromial decompression, rotator cuff repair, and acromioplasty is the most common method for treating rotator cuff injuries [1]. Author: Sir Run Run Shaw Hospital orthopedic Zhang Xuyang Source: Lilac Garden Fresh Cut Diced Auricularia auricula Fresh Cut Diced Auricularia Auricula,Diced Auricularia Auricula,Frozen Auricularia Auricula,Delicious Auricularia Auricula Guangyun Agricultural Biotechnology (Jiangsu) Co., Ltd , https://www.7-mushrooms.com
Figure 1 is derived from Knight's concise orthopedic map 
Figure 2 from Baidu pictures 
