From the Guidelines
Yes, internal derangement of the shoulder does encompass labral and rotator cuff tears. Internal derangement refers to a structural abnormality within a joint that disrupts its normal function, and in the shoulder, this includes damage to the labrum (the cartilage ring that deepens the shoulder socket) and tears in the rotator cuff tendons. These structures are essential for shoulder stability and function. Labral tears often occur from trauma, repetitive overhead activities, or shoulder dislocations, while rotator cuff tears can result from acute injury or degenerative changes over time. The diagnosis typically requires imaging such as MRI or ultrasound after a thorough clinical examination. Treatment depends on the severity of the tear, patient age, activity level, and functional demands, ranging from conservative approaches like physical therapy and anti-inflammatory medications to surgical repair for more significant tears that don't respond to non-operative management. Early diagnosis and appropriate treatment are important to prevent progressive damage and chronic shoulder dysfunction, as highlighted in the management of rotator cuff injuries 1. Key factors influencing treatment outcomes include patient age, with increasing age being a potential factor influencing outcomes and healing after rotator cuff surgery 1, and the presence of workers’ compensation, which has been correlated with less favorable outcomes after rotator cuff repair 1. Risk factors for rotator cuff tears include age over 40 years, repetitive lifting or overhead activities, and certain sports or occupations, such as tennis, baseball, painting, or carpentry 1. Given the complexity and variability of shoulder injuries, a comprehensive approach considering the patient's overall health, activity level, and specific condition is crucial for optimal management, as discussed in the context of traumatic shoulder pain 1.
From the Research
Internal Derangement of the Shoulder
- Internal derangement of the shoulder encompasses various conditions, including labral and rotator cuff tears 2, 3, 4, 5, 6
- These conditions often result from chronic overuse injuries, acute injuries such as dislocations, or a combination of both 2, 3, 6
- The diagnosis of internal derangement of the shoulder can be challenging, and imaging studies such as MRI or MR arthrography are often necessary to confirm the diagnosis 4, 5
Labral and Rotator Cuff Tears
- Labral tears and rotator cuff tears are common injuries that can occur together, especially in the context of internal impingement 3, 6
- The treatment of these injuries often requires a comprehensive approach, including labral repair, rotator cuff treatment, and rehabilitation 3, 6
- The use of imaging studies such as MRI or MR arthrography can help diagnose and guide the treatment of these injuries 4, 5
Diagnostic Methods
- Various diagnostic methods are available for internal derangement of the shoulder, including conventional arthrography, conventional MRI, and MR arthrography 5
- The choice of diagnostic method depends on the specific condition being diagnosed and the availability of resources 5
- A cost-effectiveness analysis of these diagnostic methods found that MR arthrography was the most effective and cost-effective method for diagnosing internal derangement of the shoulder 5
Pathomechanics of Labral and Rotator Cuff Tears
- The pathomechanics of labral and rotator cuff tears involve complex interactions between the shoulder joint, the labrum, and the rotator cuff tendons 6
- Superior humeral head motion and loading of the long head of the biceps tendon can contribute to the development of labral pathology 6
- A finite element model can be used to predict the mechanics of the labrum and guide the treatment of labral and rotator cuff tears 6