Supraspinatus rupture ❉ Etiology The rupture of the supraspinatus occurs acutely during a brutal thwarted movement (tractionon the arm, the latter being in the firing position...) or refrigerated for low intensity activity. Inthis case the rupture is explained by the poor quality of the tendon, weakened by neglectedtendinitis or several infiltrations. ❉ Diagnosis . Physical examination The rupture is clearly described by the patient who felt a "tearing"locally and sometimes heard a popping noise. On inspection the shoulder stump is elevatedrelative to the opposite side. Abduction is difficult up to 0° and practically impossible beyondthis angle. Passive abduction is also excessively painful if the patient's shoulder is notcaptured. . Radiological examination Confirmation is provided by radiography: - Standard images (face, internal and external rotation) show elevation of the humeral head,an indirect sign of destabilization of the joint. - Arthrography shows a contrast fluid leak atthe zenith of the articular bursa.- MRI identifies the loss of continuity of the supraspinatus tendon. Their rupture, total orpartial, is visible on the images obtained in frontal and horizontal sections, in T1 and T2. OnT1, the tendon appears torn, the muscle distended while a gap covers the humeral head. OnT2, the rupture zone appears hyperbright and extended from the top of the cuff to theacromio-coracoid ligament. At the same time, we will ensure bone integrity (absence ofimpaction fracture), the anatomical position of the long biceps and the acromioclavicularligament. ❉ Treatment The treatment is exclusively surgical by repairing the tendon. It is possible, in the case ofrecent damage, to perform this intervention arthroscopically. After the operation, the arm isimmobilized for a few days ( to ). Shoulder rehabilitation is started very quickly and continueduntil complete adaptation of the humeral head. The last phase consists of rebuilding all themuscles in the region. ➢ Infraspinatus tendonitis ❉ Etiology It is caused by all the repeated cocking and shooting movements, that is to say by the work successive agonist/antagonist of the external rotator and internal rotatormuscles. The suffering of infraspinatus can therefore originate from a repeated gesture inexternal rotation (cocking the arm in handball, etc.), or the end of a violent gesture in internalrotation (shooting in handball, etc.). ❉ Diagnosis . Physical examination Palpation (subdeltoid, with the arm abducted at 0°) localizes the pain just below the humeral head. The latter is exacerbated during antepulsionand/or abduction of the arm. It is increased during counteracted external rotation of the arm,
or during passive internal rotation. . Radiological examination Only MRI can demonstratedamage to the tendon, which is also impossible to dissociate from that of the teres minor, inthe form of a zone of hyper brilliance located in the upper and posterior part of the humeralhead. ❉ Treatment The treatment combines: . ● The removal of the gesture in question (partial rest). .● The prescription of local anti-inflammatory treatment (cryotherapy, ultrasound) and orally. . ● Gentle rehabilitation of the entire shoulder. Unlike supraspinatus tendinitis, infraspinatus tendonitis rarely requires complete immobilization of the shoulder. ● She responds much more quickly to treatment. ➢ Infraspinatus strain ❉ Etiology The infraspinatus strain is caused by a sudden cessation of the external rotation movement of the arm (cock blocked by an opponent, etc.). It mainly concerns the rears. ❉ Diagnosis . Physical examination The injured athlete presents with posterior shoulder pain, located atthe level of the infraspinous fossa, sometimes significantly more externally. The examinationis hampered by a reflex contraction of the rhomboids and latissimus dorsi. Opposed internalrotation movements are painful, active external rotation is practically impossible. .Radiological examination Ultrasound shows a hyperechoic area located in the externalregion of the subspinous fossa. An intramuscular hematoma may be detected. ❉ Treatment The treatment is essentially physiotherapy. It combines: ● Absolute rest of the shoulder .● Multi-day practice of cryotherapy (3 to 4 times per day).● Ultrasound monitoring of the hematoma (thand thdays). .● Passive maintenance of the cuff muscles, followed by stretching techniques after the healing. . ● Dynamic remusculation work. ➢ Teres major tendonitis ❉ Etiology Insertion tendonitis of the teres major is rare. They originate from bodybuilding exercises practiced in sets that are too long or with inappropriate movement. ❉ Diagnosis . Physical examination Palpation of this muscle is difficult; only its humeral insertion can be felt. Any thwarted internal rotation movement causes pain at its insertion onthe anterior surface of the humerus. The pain can also be evidenced by the thwartedretropulsion of the arm. . Radiological examination is of little interest. Only MRI is likely toreveal signs of tendon irritation at its insertion.
❉ Treatment The treatment of teres major tendinitis is identical to that described for the cuff tendons. It combines relative rest of the shoulder (limiting internal rotations), the prescriptionof NSAIDs and the practice of ultrasound. ➢ Insertion tendonitis of the teres minor ❉ Etiology Like the infraspinatus, the teres minor is heavily used in all exercises using arm rotations. As a motor muscle for cocking movements, as a frenator muscle at the end of theshot. ❉ Diagnosis . Physical examination Teres minor tendonitis manifests itself as pain when abducting orantepulsion the arm. Its tendon can be palpated at the outer edge of the scapula, below thatof the supraspinatus. The pain is increased during counteracted external rotation, or duringpassive internal rotation of the arm. It is very difficult clinically to dissociate this tendinitisfrom that of the infraspinatus. . Radiological examination is of no interest. If an MRI isperformed, a highlight can be highlighted on T2 on the posterior surface of the greatertuberosity, but it remains inseparable from the involvement of the infraspinatus. 2 ❉ Treatment The treatment is identical to that given for the infraspinatus. ➢ Contracture of the rhomboids Like the trapezius, the main pathology encountered in the rhomboids is muscle contracture. ❉ Etiology The main movements concerned are related to land training (weight training) and repetitiverotations of the trunk. ❉ Diagnosis . Physical examination The athlete consults for debilitating back pain, bothersome at night,requiring morning relief and increased by driving. On examination, palpation revealsmuscular contracture between the edge of the scapula and the spine. Antepulsion of the armis painful. . Radiological examination The radiological examination is an eliminationexamination. The differential diagnosis arises in fact with contractures secondary tomoderate dorsal scoliosis and with the pain of Scheuermann's disease. We will only practicea dorsal spine from the front and in profile. ❉ Treatment The treatment is identical to that proposed for trapezius contracture.