(Orthopedics) Shoulder disease that causes pain that worsens at night

Professor Lee Sang-wook, Department of Orthopedics, Incheon St. Mary’s Hospital, Catholic University of Korea

(Health Korea News / Lee Sang-wook) As the bitter winter cold continues, the number of people complaining of shoulder or knee pain is increasing. When the actual temperature drops, the joint fluid that acts as a lubricant in the joints hardens and blood circulation is disrupted, which can reduce the flexibility of the shoulder or knee joints and worsen pain.

Often, when a shoulder hurts, frozen shoulder (adhesive capsulitis) is first suspected. This is because frozen shoulder, which appears around age 50, is the most familiar among shoulder diseases. However, in reality, many of the people who visit hospitals with shoulder pain are patients with ‘rotator cuff tears.’

Rotator cuff rupture is a disease that occurs frequently in the elderly due to aging and degenerative changes, but recently, rotator cuff rupture has been increasing among young adults in their 30s and 40s due to repetitive use of the shoulder, such as golf, baseball, and badminton. The risk of damage should be reduced through sufficient stretching of the shoulder joint before and after exercise.

◇Differences in symptoms, etc. from frozen shoulder… Be careful when playing golf, which involves a lot of shoulder use.

A rotator cuff tear is a disease in which part of the rotator cuff connecting the shoulder and arm is torn or torn, causing pain. The rotator cuff refers to the four tendons that surround the shoulder: supraspinatus, infraspinatus, subscapularis, and teres minor. The reason these four tendons are called rotators is because these muscles allow the arm to move in or out, up or down.

The rotator cuff plays an important role in maintaining shoulder movement and stability, including four tendons that balance each other and maintains the shoulder joint to prevent dislocation of the arm bone. When the rotator cuff is torn, it becomes difficult to raise the arm above the head or move it backwards. .

It is often confused with frozen shoulder, or adhesive capsulitis, but the symptoms are different. Adhesive capsulitis is a disease in which the joint capsule, the sac surrounding the shoulder, becomes inflamed, causing pain and stiffness. As time passes, the joint capsule narrows, limiting the range of motion of the joint, and the entire shoulder becomes rigid, making it difficult to raise the arm even when forced.

On the other hand, with a rotator cuff tear, it is difficult to raise your arm on your own, but the difference is that you can raise your arm with the help of another person. However, it is difficult to distinguish between frozen shoulder and rotator cuff tear simply based on these symptoms. Diagnosis and treatment by a specialist is required.

The bigger problem with rotator cuff tears is that, unlike adhesive capsulitis, it does not heal naturally. If it is simply diagnosed as adhesive capsulitis and left untreated, the ruptured area may grow larger and damage other tendons.

◇If you find it difficult to lift your arm for more than 10 seconds, be suspicious… Pain gets worse at night

The causes of rotator cuff tears are divided into external and internal causes. External causes include repetitive use, shock, and trauma. Internal causes include problems with the tendon itself, such as degeneration. It occurs when blood flow to the tendon decreases and cells die. Rotator cuff tear is a progressive disease. Impingement syndrome is common in people in their 40s, partial rotator cuff tears in their 50s, and complete tears in their 60s.

The main symptom is pain. The location of the pain is usually from the front or side of the shoulder joint down to the bottom. The pain gets worse when you raise your arm or lift a heavy object, and gets worse when you lie down. If the rupture becomes severe, symptoms of muscle weakness may appear. If you find it difficult to raise your arm for more than 10 seconds, you may suspect a rotator cuff tear. The pain gets worse, especially at night.

However, in rotator cuff disease, the progression of the disease and symptoms are sometimes not proportional. While severe pain can be seen even with a mild partial rupture, there are many cases in which subjective symptoms are mild even with a complete rupture. The severity of the disease should not be judged based on symptoms alone.

◇60% of people in their 70s have rotator cuff tears… It is worth listening to other doctors’ opinions when prescribing surgery.

Treatment includes exercise, medication, physical therapy, manual therapy, and injection therapy. Steroid injections help reduce inflammation. If your blood sugar is high and you are taking medication for a chronic disease and it is difficult to use steroids, use hyaluronic acid injections, which help with joint lubrication and movement. Collagen injections are sometimes used for the purpose of tendon regeneration. If only the inside of the tendon is torn, collagen is usually placed well, but if the entire tendon is torn, collagen may be less effective because it is difficult to place collagen.

Surgery is performed when non-surgical treatments are ineffective. Partial tears of less than 50% usually do not require surgery. However, if the tear is more than 50%, conservative treatment is ineffective and if left untreated, the tear will continue to progress, so surgery is performed to suture the tear. The surgery is performed by removing bursitis and synovitis that cause pain, removing parts of the bone such as the acromion that can cause collision with the tendon, and suturing the torn tendon.

If the tendon is left in a state of complete rupture where it is completely cut, the tendon degenerates and degenerates and fat accumulates there, resulting in fatty degeneration. In this case, the suturing surgery itself is difficult and there is a high chance of re-rupture even after suturing. Additionally, joints and muscles become unbalanced, and cartilage begins to wear out, leading to arthritis.

This is called an extensive rotator cuff tear, and if you are over 65 years old and have difficulty in daily life due to severe pain, muscle weakness, or pseudoparesis, retrograde artificial joint replacement surgery is performed. Retrograde artificial joint is a surgery that gives up the rotator cuff tendon, which does not normally function, and allows the deltoid muscle to take over the role of the shoulder tendon. However, not all patients develop extensive rotator cuff tears. Depending on the patient, it may progress quickly or slowly.

For full-thickness rotator cuff tears, surgical treatment is the basic treatment, but if you are over 70 years old, have a concomitant disease, and are not in pain, surgery is not necessarily necessary.

Rotator cuff tears are closely related to aging. It is known that 6 out of 10 people over the age of 70 suffer from rotator cuff tears. Surgery is decided considering variables such as age, physical activity requirements, comorbidities, and pain. If you have been prescribed surgery, it is a good idea to get a second doctor’s opinion at least once.

Shoulder pain is often caused by incorrect upper body posture. Shoulders that are bent for a long time cause excessive tension in the surrounding muscles and ligaments, causing loss of flexibility, which can cause ligaments or tendons to easily rupture even with minor trauma. Stretching your shoulders 3 to 4 times a day can help keep your shoulders healthy and reduce the risk of tendon damage. Not only smoking, but also diabetes and high blood pressure are known to be factors that increase rotator cuff tears, so improving your daily lifestyle can also be a way to maintain shoulder health. (Written by Lee Sang-wook, Professor of Orthopedic Surgery, Incheon St. Mary’s Hospital, Catholic University of Korea)

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