Rotator cuff tear - epaule Toulouse

Preamble: we prefer the term of “lesion” than “tear” concerning the rotator cuff tendons because the word tear introduces a notion of trauma which concerns only a small part of the cases.

You will find through the following pages what it is wise to know if you’re suffering from cuff tear :

What is the difference between a partial rupture of the tendon and transfixing of a tendon?

How are tendon lesions classified?

What may be the appearance or quality of the muscles concerned by these tendons (a tendon being the fibrous and resistant end of the muscle which is inserted on the bone)

Partial and 'transfixing' lesions

The term ‘transfixiantes’ refers to lesions that reach the entire thickness of a tendon (equivalent to the famous ‘rupture’), unlike partial lesions in which there remains a more or less fine thickness of tendon (lesions of the superficial side of the tendon acromion side and deep cartilage side of the head of the humerus). Both types of lesions can cause pain and justify medical or surgical management.

A ‘rupture’ (in fact lesion) tendon is not necessarily synonymous with surgery, unlike minor or invisible lesions on imaging can explain significant pain and require repair.

Muscular trophicity:

Aspect of the muscle, especially the volume it occupies in its muscular fossa. When it occupies a small volume one speaks of amyotrophie (this one is often reversible after repair of the tendon).

Fatty muscle degeneration:

When a muscle is no longer ‘stretched’ by its tendon due to a transfixing lesion, it presents an architectural disorganization with loss of parallelism of its fibers. Over time if the situation persists the space between the fibers gradually fills with fatty tissue, until the muscle contains more fat than muscle (*). Unfortunately this situation (*) is not reversible and contra-indicates tendon repair because « we do not change the belt of a broken engine! »

Types of rupture

Preamble: we will prefer the term tendinous lesion to rupture because the word rupture introduces a notion of trauma which concerns only a small part of the cases.

There are different types of tendon lesions

according to the origin of the lesion:

degenerative

most often, ie caused by a tendinous disease favored by a poor tendinous vascularization and by the repetition of gestures resulting in progressive tendon wear. They are the result of unusual efforts like DIY, renovation or professional. they are also found frequently after 50 years in the general population.

It is more often a perforation (tendon wear) than a rupture (notion of trauma)

Traumatic

Sometimes (a third of cases), following a fall on the shoulder, dislocation of the shoulder, violent trauma.

It should be noted that many traumatic ruptures involve degenerative caps and can decompensate them.

Front view: Partial lesions and ‘transfixing’

The term ‘transfixiantes‘ refers to lesions that reach the entire thickness of a tendon (equivalent to the famous ‘rupture’), unlike partial lesions in which there remains a more or less fine thickness of tendon (lesions of the superficial side of the tendon acromion side and deep cartilage side of the head of the humerus). Both types of lesions can cause pain and justify medical or surgical management.

Partial injuries:

type-de-rupture-pas-de-rupture — Insertion normale (tendon supra-épineux)

type-de-rupture-coiffe-1-fente — Fente (« fissure ») intra-tendineuse

type-de-rupture-coiffe-1-profonde — Rupture partielle de la face profonde

type-de-rupture-coiffe-1-superf — Rupture partielle face superficielle

Transfixing lesions

type-de-rupture-pas-de-rupture (1) — Insertion normale tendineuse (supra-épineux)

type-de-rupture-coiffe-1-totale — Rupture transfixiante stade 1 (distale proche du tubercule)

type-de-rupture-coiffe-1-INTERMEDIAIRE — Rupture transfixiante stade 2 (intermédiaire)

type-de-rupture-coiffe-1-RETRACTEE — Rupture transfixiante stade 3 (rétractée à la glène)

Lateral view: shape of the transient rupture

There is a great variety and a great polymorphism in the form of breaks (transfixing for the blow ..)

In addition to the description, the analysis of the lesions is fundamental to determine the tendinous reintegration method

vue-sumrapin-dessus-sain — Insertion normale

vue-sumrapin-dessus-L (1) — vue-sumrapin-dessus-L.jpg

A ‘rupture’ (in fact lesion) tendon is not necessarily synonymous with surgery, unlike minor or invisible lesions on imaging can explain significant pain and require repair.

Fatty muscle degeneration

Fatty muscle degeneration (DGM):

When a muscle is no longer ‘stretched’ by its tendon due to a transfixing lesion, it presents an architectural disorganization with loss of parallelism of its fibers. Over time if the situation persists the space between the fibers gradually fills with fatty tissue, until the muscle contains more fat than muscle (*). Unfortunately this situation (*) is not reversible and contre-indicates tendon repair because ‘we do not change the belt (= tendon) of a motor (= muscle) broken! ‘