"Doctor, my shoulder hurts,
I can't lift my hand..."
Shoulder pain is a common complaint in primary healthcare facilities and sports medicine clinics.
It is estimated that the prevalence of shoulder pain in the general population ranges from 16% to 34%.
Rotator cuff pathology is the most common shoulder condition for which patients seek treatment.
In the United States, rotator cuff problems lead to approximately 4.5 million annual medical visits and around 40,000 surgeries.
In Taiwan, according to a retrospective analysis, 41% of patients with shoulder pain were confirmed to have a rotator cuff tear through joint cavity arthrogram, including 92.2% with a full-thickness tear and 7.7% with a partial tear.
Another 44% of patients showed adhesive capsulitis in their joint imaging results, and only 15% had normal findings.
Even without symptoms, up to 23% of people may have hidden rotator cuff tears, and the prevalence increases with age. (Note 1)
There are several classification methods for rotator cuff tears.
One of the most common classification methods based on the severity of the tear is the Ellman Classification:
l Partial Thickness Rotator Cuff Tear:
Grade 1: Less than 3 millimeters or less than 25% of tendon thickness (< 3mm or < 25% thickness)
Grade 2: 3 to 6 millimeters or 25% to 50% of tendon thickness (3-6mm or 25-50%)
Grade 3: Greater than 6 millimeters or more than 50% of tendon thickness (>6mm or >50%)
l Full Thickness Rotator Cuff Tear
If classified by the location of the tear, it can be divided into the following three types:
l Articular side tear
l Bursal side tear
l Intrasubstance or intratendinous tear
In the past, the diagnosis of rotator cuff tears could only be confirmed using magnetic resonance imaging (MRI), and treatment options were limited to traditional rehabilitation or surgery.
However, now, in addition to real-time dynamic diagnosis using advanced ultrasound, it is also possible to perform ultrasound-guided injections of substances rich in growth factors [such as PRP, dehydrated human amnion/chorion membrane (dHACM)…etc] or STABHA™ (Soft Tissue Adapted Biocompatible Hyaluronic Acid, a tendon-ligament repair agent) to facilitate the healing and repair of the ruptured tendons.
This type of treatment is not only faster and more effective than "traditional rehabilitation" or "post-surgery recovery waiting," but it is also highly safe, eliminating concerns about surgical risks and post-operative complications.
It represents the latest and best treatment method.
(Note 1:
According to a prospective study (https://pubmed.ncbi.nlm.nih.gov/10471998/#full-view-affiliation-1),
in individuals aged 50 to 59, 13% (22 out of 167 patients) had rotator cuff tears;
in those aged 60 to 69, 20% (22 out of 108 patients) had tears;
in those aged 70 to 79, 31% (27 out of 87 patients) had tears;
and in those over 80 years old, 51% of patients (25 out of 49) had tears.)
References:
Prevalence of Rotator Cuff Tears in Elderly Patients with Shoulder Pain-Rural Area at Local South of Taiwan
https://www.airitilibrary.com/Article/Detail/20719833-201405-201502020050-201502020050-7-7
Age-related prevalence of rotator cuff tears in asymptomatic shoulders
https://pubmed.ncbi.nlm.nih.gov/10471998/#full-view-affiliation-1
Prevalence of symptomatic and asymptomatic rotator cuff tears in the general population: From mass-screening in one village
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3768248/
Rotator Cuff Tears
https://www.orthobullets.com/shoulder-and-elbow/3043/rotator-cuff-tears
Rotator Cuff Classifications
https://www.shoulderdoc.co.uk/article/1456
Shoulder - Rotator cuff injury
https://radiologyassistant.nl/musculoskeletal/shoulder/rotator-cuff-injury
Rotator Cuff Shoulder Tendon and Muscle Injuries
https://now.aapmr.org/shoulder-tendon-and-muscle-injuries/
Subscapularis tears: hidden and forgotten no more
https://www.sciencedirect.com/science/article/pii/S2468602617300608
Management of rotator cuff tears
https://www.uptodate.com/contents/management-of-rotator-cuff-tears
