Shoulder Trauma Part 2- Tendons
My name is Gavin Jennings. I am a specialist orthopaedic shoulder surgeon. This presentation is the second of three parts giving an overview of trauma of the shoulder girdle.
In part 1, injuries to the bones of the shoulder girdle were discussed. This part will cover injuries to the tendons of the muscles.
Firstly, I will talk about the most common tendon issues i.e. those involving the muscles of the rotator cuff. Then I will cover biceps and pectorals major trauma.
The rotator cuff muscles include the subscapularis which originates on the under-surface of the scapula (shoulder blade) and attaches to the front of the shoulder at the lesser tuberosity. The supraspinatus and infraspinatus arise from the back of the scapula and attach to the top of the shoulder at the greater tuberosity. The teres major is rarely involved in trauma, with the most commonly injured tendon being that of the supraspinatus.
Traumatic rotator cuff tears in a previously relatively normal tendon are usually considered for repair. However if there is evidence of pre-existing significant degeneration and damage to the tendons and muscle, a repair may not be feasible. People can compensate for tendon degeneration over time if the degeneration is slow, and thus such patients often have no symptoms prior to a specific trauma. These patients are thus often surprised when they are informed of these pre-existing structural changes in the tendons. Evidence of pre-existing problems is sometimes seen on the radiographs (x-rays) which are often taken following an injury. Significant upward migration of the humeral head suggests chronic thinning or tearing of the tendons and may be a bad prognostic sign in terms of reparability.
Traumatic rotator cuff tears often present with significant pain felt in the deltoid region with difficulty lifting the arm up from the side. Traumatic tears such as the one depicted here are usually repaired with a keyhole (arthroscopic) technique. However in some circumstances, e.g. when there is near complete separation of the entire rotator cuff, an open repair may be preferable.
Biceps tendon ruptures occur either as the result of an acute traumatic event, as a result of degeneration over time or indeed as a combination of both.When considering biceps tendon ruptures, it is important to note that there are two tendons at the top (shoulder) end of the muscle but only only one tendon at the bottom (elbow) end. As a generalisation, ruptures at the top end are not repaired, but those at the bottom end (where there is no other remaining attachment) usually are. Biceps tendon ruptures usually result in a bulge in the central portion of the muscle.Determining the site of the rupture is usually fairly straight-forward, based on the site of any bruising, the area of pain and tenderness and the presence or absence of a palpable tendon at the elbow
Pectoralis major tendon tears tend to occur more in males, particularly those who engage in weight training or contact sports such as rugby. The exact site of the tear within the tendinous portion of the muscle is a little variable, but in general operative treatment to reattach the tendon is preferred in what is often a fairly active patient group.
The diagnosis is usually clear based on tenderness at the site of the normal insertion, bruising and an abnormal contour and lack of tension in the lower fold of the axilla, as well as asymmetry of the chest.
Thank you for listening to Part 2 of an overview of shoulder trauma. Part 3 will cover injuries to the ligamentous structures around the shoulder.