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<Provider Id="sundheddkcms"> <Item Id="{F6754D6A-DB5B-4D3B-B965-3E3F76A74647}" Name="rotatorcuff-skade" Type="LHContentPage" ParentProviderId="sundheddkcms" ParentItemId="{19468569-4950-4A21-B5EA-94D74029830F}" SortOrder="900" PublishDate="2009-03-04T13:43:00" DeleteDate="2999-12-31T00:00:00" PotItemType=""> <Content> <HtmlField Name="PageContent"><![CDATA[<h2>Diagnose</h2> <h3>Diagnostiske kriterier</h3> <ul> <li>Diagnosen stilles på grundlag af sygehistorien, kliniske fund, UL-skanning og MR-skanning</li> </ul> <h3>Sygehistorie</h3> <ul> <li>Formålet med sygehistorien er at skelne mellem akutte traumatiske skader og degenerative ikke-traumatiske skader</li> <li>Patientens alder er væsentlig, da graden af degenerative forandringer i rotator cuffen stiger med alderen. Således opstår rotator cuff-skader sjældent før 40-årsalderen</li> <li>Patienterne klager over smerter, nedsat bevægelighed og nedsat kraft i skulderen</li> <li>Patienterne kan opleve ukarakteristiske føleforstyrrelser i armen </li> <li>Smerter <ul> <li>Belastningsrelaterede smerter når armen bruges væk fra kroppen eller over skulderhøjde</li> <li>Søvnforstyrrende smerter</li> <li>Patienterne kan oftest ikke ligge på den afficerede skulder</li> </ul> </li> </ul> <p>Akut traumatisk skade: </p> <ul> <li>Se oftest hos yngre patienter over 40 år</li> <li>Skade på en normal rotator cuff kræver høj energi</li> <li>Traumemekanismen beskrives for at få et indtryk af, hvor stor en belastning, skulderen har været udsat for</li> <li>Skadesmekanismen er oftest et fald på strakt arm, som for eksempel ved et cykelstyrt, skistyrt, fald ned ad trappe eller ved et kraftigt træk i armen</li> <li>Patienterne mærker ofte et smæld i skulderen</li> </ul> <p> Degenerativ ikke-traumatisk skade:</p> <ul> <li>Ses oftest hos ældre patienter</li> <li>Patienterne har som regel haft delvise skader på rotator cuffen, før de fik symptomer eller kom til skade. Ved en mindre belastning eller forløftning brister den sidste del af senen, og derved får patienterne symptomer</li> <li>Hvornår og hvordan debuterede symptomerne? Symptomerne debuterer oftest efter overbelastning eller forløftning uden stor energi</li> <li>Hvilke belastninger provokerer smerterne? Belastninger, hvor armen bruges væk fra kroppen eller over skulderhøjde, vil typisk udløse smerter på lateralsiden af skulderen og ned i overarmen</li> <li>Belastninger, hvor armene er ned langs kroppen, giver oftest ikke symptomer </li> </ul> <h3>Kliniske fund</h3> <ul> <li>Inspektion <ul> <li>Af- og påklædning observeres. Patienter med rotator cuff-skade bøjer sig oftest frem, når de tager trøjen af. Herved udnytter de tyngdekraften</li> <li>Atrofi af supraspinatus og infraspinatus muskulaturen vurderes og sammenlignes med den raske skulder. Ved atrofi vil spina scapula fremstå tydeligt og prominerende</li> <li>Muskelatrofi ses ved degenerative ikke-traumatiske rotator cuff-skader, eftersom det tager måneder til år at udvikle synlig atrofi</li> <li>Scapulas bidrag til bevægeligheden vurderes </li> </ul> </li> <li>Palpation <ul> <li>Oftest er der diffus ømhed ved palpation af skulderen</li> <li>AC-leddet palperes i differentialdiagnostisk øjemed </li> </ul> </li> <li>Bevægelighed <ul> <li>Det er vigtigt at vurdere den aktive og passive bevægelighed</li> <li>Ved rotator cuff-skader kan den aktive bevægelighed være nedsat, mens den passive bevægelighed vil være normal. Hvis både den aktive og passive bevægelighed er nedsat, er artrose eller frossen skulder mere sandsynligt, da disse sygdomme giver stivhed i skulderen</li> <li>Supraspinatus bidrager til abduktionen fra 90°</li> <li>Infraspinatus og teres minor bidrager til udadrotationen</li> <li>Subscapularis bidrager til indadrotationen. Indadrotationen beskrives efter, hvor langt patienten kan føre hånden til ryggen (samme hofte, nates, lænderyg, mellem skulderbladene)</li> </ul> </li> <li>Muskelstyrke <ul> <li>Kraften vurderes og sammenlignes med den raske skulder</li> <li>Hvis der er nedsat kraft svarende til en af rotator cuffens muskler, skal man mistænke rotator cuff-skade</li> <li>Supraspinatus testes isometrisk med armen eleveret til 90°, og tommelfingeren skal pege nedad. Kraften ved elevation vurderes</li> <li>Infraspinatus og teres minor testes isometrisk med armen ned langs kroppen og albuen flekteret 90°, så armen peger lige frem. Kraften i udadrotation vurderes </li> <li>Subscapularis testes isometrisk med armen bag ryggen, hvor patienten skal presse væk fra ryggen i indadrotation. Herved testes subscapularis isoleret, og de øvrige indadrotatorer som pectoralis minor og latissimus dorsi aktiveres ikke</li> </ul> </li> <li>Impingement <ul> <li>Hawkins test: Undersøgeren fikserer akromion, og indadroterer patients arm fra en 90 grader eleveret stilling. Positiv test er genkendelige smerter, som regel lateralt over deltoideus</li> <li>Impingement test: Patientens smerter forsvinder de første timer efter subacromiel blokade med lokalbedøvelse og kortikosteroid<a href="http://www.ortopaedi.dk/fileadmin/DSSAK/kompendier/Skulder_kompendium.pdf" data-type="other-reference" data-value="Skulderundergelser, et mini kompendium" data-url="http://www.ortopaedi.dk/fileadmin/DSSAK/kompendier/Skulder_kompendium.pdf" title="Skulderundergelser, et mini kompendium"><sup>1</sup></a> </li> </ul> </li> </ul> <h3>Supplerende undersøgelser i almen praksis</h3> <ul> <li>Røntgen af skulderleddet bør foreligge, hvis der er klinisk mistanke om akut traumatisk eller degenerativ ikke-traumatisk rotator cuff-skade </li> <li>UL-skanning af rutineret specialist kan overvejes. Kvaliteten af UL-skanninger er varierende. Patienter med vedvarende funktionsnedsættelse og smerter 3 måneder efter tilskadekomst, bør henvises til ortopædkirurgisk vurdering trods normal UL-skanning</li> </ul> <h3>Andre undersøgelser hos specialist </h3> <ul> <li>Røntgen af skulderleddet bør foreligge inden henvisning til ortopædkirurgisk afdeling</li> <li>MR-skanning <ul> <li>Er den foretrukne undersøgelse i diagnostikken af rotator cuff-rupturer</li> <li>Skanningen giver information om: <ul> <li>Hvilke sener der er påvirkede </li> <li>Hvor stor en del af senen, som er skadet (partiel eller komplet) </li> <li>Graden af sene retraktion </li> <li>Graden af muskelatrofi</li> <li>Vurdering af differentialdiagnoser</li> </ul> </li> <li>MR-skanning bør foreligge inden operation</li> </ul> </li> <li>Ultralyd <ul> <li>Kan bruges som screeningmetode ved rotator cuff-lidelse, men der kræves speciel kompetence af den, som udfører undersøgelsen</li> <li>UL-skanning kan bruges til at påvise skaden, og om skaden er komplet eller partiel </li> </ul> </li> </ul> <h3>Differentialdiagnoser</h3> <ul> <li>Tuberculum major fraktur</li> <li>Proximal humerus fraktur</li> <li>Subakromielt smertesyndrom</li> <li>Tendinitis calcaria</li> <li>Frossen skulder</li> <li>Neuritis n. suprascapularis</li> <li><a href="~/link.aspx?_id=BE550619ADA34549ABD6E508B5892265&_z=z">Cervikal radikulopati</a></li> </ul> <h2>Behandling</h2> <h3>Behandlingsmål</h3> <ul> <li>Behandlingsmålet for akutte traumatiske rotator cuff-skader er bevarelse af skulderfunktion og smertelindring</li> <li> Det primære behandlingsmål for degenerative ikke-traumatiske rotator cuff-skader er smertelindring, da det ikke er sikkert, at funktionen bedres</li> </ul> <h3>Generelt om behandlingen</h3> <ul> <li>Akutte traumatiske rotator cuff-skader: <ul> <li>Diagnostik af rotator cuff-skader foretages ikke rutinemæssigt i skadestuen. Så selvom mange patienter ved tilskadekomsten er blevet undersøgt på skadestuen, er der ofte kun udelukket frakturer og luksationer, og patienterne rådgives om aflastning og smertebehandling</li> <li>Hvis patienterne fortsat har smerter og funktionsnedsættelse 2-4 uger efter et relevant traume, bør de derfor henvises til ortopædkirurg eller UL-skanning for at vurdere rotator cuffen</li> <li>Patienter med akutte traumatiske rotator cuff-skader bør tilbydes operation med sutur af seneskaden indenfor 3 måneder fra tilskadekomsten</li> </ul> </li> <li>Degenerative ikke-traumatiske rotator cuff-skader: <ul> <li>Den praktiserende læge kan starte konservativ behandling, som består af smertebehandling, steroidblokade anlagt subacromialt og træningsøvelser i minimum 3 måneder. Henvisning til fysioterapeut kan overvejes. Steroidblokader kan anlægges blindt, og ultralyd er ikke nødvendigt for korrekt anlæggelse. Et Cochrane review fra 2021 viste, at UL vejledte blokader ikke havde bedre effekt end blindt anlagte blokader. Samtidig var der ikke forskel på forekomsten af bivirkninger<a href=" " data-type="journal-reference" data-value="Zadro J, Rischin A, Johnston RV, Buchbinder R, Image-guided glucocorticoid injection versus injection without image guidance for shoulder pain. Cochrane Database Syst Rev 2021;8: CD009147" data-value-piped="Zadro J, Rischin A, Johnston RV, Buchbinder R|Image-guided glucocorticoid injection versus injection without image guidance for shoulder pain.|Cochrane Database Syst Rev|2021|8|CD009147|34435661" data-url="reference-link" data-pubmedid="34435661" title="Zadro J, Rischin A, Johnston RV, Buchbinder R, Image-guided glucocorticoid injection versus injection without image guidance for shoulder pain. Cochrane Database Syst Rev 2021;8: CD009147"><sup>2</sup></a></li> <li>Ved manglende effekt efter 3-6 måneders konservativ behandling, kan man overveje operation</li> </ul> </li> <li>Operation af rotator cuff skade <ul> <li>Ved operation er det optimale at senen syes, men det er ikke altid muligt. I disse tilfælde kan der foretages delvis sutur af senen og eventuelt overskæring af den lange bicepssene (biceps tenotomi). Dette giver ofte en væsentlig smertelindring</li> <li>Seneflytning af latissimus dorsi eller nedre del af trapezius, eller alternativt superior kapsel rekonstruktion med senegraft, kan i sjældne tilfælde tilbydes patienter med symptomer fra en rotator cuff-skade, som ikke kan syes på grund af sene retraktion og muskelatrofi. Disse behandlinger er højtspecialiserede og foretages udelukkende i Aarhus, Herlev/Gentofte eller Odense</li> <li>Operation tilbydes primært patienter med smerter. Patienter, der udelukkende har funktionsnedsættelse, kan risikere, at de efter operation får smerter, og prognosen i forhold til bedring af funktionen er uforudsigelig</li> </ul> </li> </ul> <h3>Håndtering i almen praksis</h3> <ul> <li>Der foretages røntgen af skulderleddet før henvisning til ortopædkirurgisk vurdering af rotator cuff-skade</li> <li>Patienter over 40 år, som har haft et relevant traume, og som stadig har smerter og funktionsnedsættelse efter 2-4 uger, har sandsynligvis en akut traumatisk rotator cuff-skade og bør henvises til udredning</li> <li>Konservativ behandling af degenerative ikke-traumatiske rotator cuff-skader opstartes i almen praksis</li> <li>Patienter over 75 år med en rotator cuff-skade tilbydes meget sjældent operation med henblik på syning af senerne, da det har en dårlig prognose i denne alderskategori</li> </ul> <h3>Råd til patienten</h3> <ul> <li>Der anbefales træning af rotator cuffens muskler - eventuelt vejledt af en fysioterapeut</li> <li>Belastninger anbefales inden for smertegrænsen, og det anbefales at bruge skulderen dynamisk</li> <li>Der gives råd om aktivitets modifikation, så belastninger der udløser smerter undgås. Belastninger med armen over skulderhøjde og med armene væk fra kroppen bør undlades, hvis det udløser smerter, da det belaster rotator cuffen</li> <li>Belastninger med albuerne ind i mod siden belaster ikke rotator cuffen </li> </ul> <h3>Medicinsk behandling</h3> <ul> <li>Smertebehandling med [DliActiveSubstance;6381;paracetamol] og <a href="https://pro.medicin.dk/Laegemiddelgrupper/Grupper/171030">NSAID</a></li> <li><a href="https://pro.medicin.dk/Laegemiddelgrupper/Grupper/171050">Kortikosteroid blokade</a> i subacromial rummet (anlægges blindt)</li> </ul> <h3>Anden behandling</h3> <ul> <li>Skulderøvelser eventuelt vejledt af fysioterapeut</li> <li>Behandlinger som shockwave, laser, ultralyd og lignende har ingen dokumenteret effekt i behandlingen af rotator cuff-lidelser</li> </ul> <h3>Kirurgi</h3> <ul> <li>Akutte traumatiske rotator cuff-skader: <ul> <li>Patienter med akutte traumatiske rotator cuff-skader bør tilbydes operation med sutur af seneskaden indenfor 3 måneder fra tilskadekomsten. Operationen kan foretages ved artroskopisk eller åben teknik. Der er ikke forskel på resultaterne ved de to metoder</li> </ul> </li> <li>Degenerative ikke-traumatiske rotator cuff-skader: <ul> <li>Hvis konservativ behandling svigter, kan man tilbyde operation. Operationstypen afhænger af rotator cuffens status, som præoperativt er vurderet ved MR-skanning</li> <li>Operation tilbydes primært patienter med smerter. Patienter, der udelukkende har funktionsnedsættelse, kan risikere, at de efter operation får smerter, og prognosen i forhold til bedring af funktionen er uforudsigelig</li> </ul> </li> </ul> <h4>Operations typer:</h4> <ol> <li>Sutur af rotator cuffen ved artroskopisk eller åben teknik. Foretages hvis senen kan trækkes ud til insertionsstedet, og muskulaturen ikke er for atrofisk</li> <li> Delvis sutur af rotator cuffen. Tilbydes hvis dele af senerne er mobile og kan trækkes ud til insertionsstedet</li> <li> Artroskopisk bicepstenotomi, synovektomi og bursectomi tilbydes, hvis patienterne har ondt, og rotator cuffen ikke kan syes</li> <li> Latissimus dorsi eller nedre trapezius seneflytning tilbydes patienter, som har komplet suprapinatus og infraspinatus rupturer, som ikke kan syes. Det kræver dog at subscapularis er intakt, og at der ikke er artrose/artrit forandringer i glenohumeralleddet</li> <li> Superior kapsel rekonstruktion tilbydes patienter med symptomer fra en komplet supraspinatussene ruptur, der ikke kan syes. Dog må der ikke være glenohumeral artrose/artrit</li> <li> Reverse skulderprotese tilbydes patienter med rotator cuff-artropati</li> </ol> <h4>Postoperative forløb</h4> <ul> <li>Oftest immobiliseres armen i en armslynge de første 2-4 uger efter sutur af rotator cuffen</li> <li>Patienterne tilbydes efterfølgende et progressivt genoptræningsforløb</li> <li>Det er væsentligt, at patienterne laver tidlige bevægeøvelser, eftersom stivhed er et hyppigt problem efter rotator cuff-kirurgi</li> </ul> <h3>Forebyggende behandling</h3> <ul> <li>Dynamisk vedligeholdelsestræning </li> </ul> <h2>Henvisning</h2> <ul> <li>Ved klinisk mistanke om akut traumatisk rotator cuff-skade bør patienterne henvises til ortopædkirugisk vurdering, forudgået af røntgenundersøgelse</li> <li>Patienter, som fortsat har smerter og funktionsnedsættelse 2-4 uger efter et relevant traume, bør henvises til ortopædkirurgisk afdeling </li> <li>Hvis der ikke er effekt af minimum 3 måneders konservativ behandling af degenerativ ikke-traumatisk rotator cuff-skade </li> </ul> <h2>Opfølgning</h2> <ul> <li>Patienter med et akut skuldertraume uden knogleskade bør vurderes 2-4 uger efter tilskadekomsten, så rotator cuff-skade kan udelukkes</li> </ul> <h2>Sygdomsforløb, komplikationer og prognose</h2> <h3>Sygdomsforløb</h3> <ul> <li>Skader på rotator cuffen opstår som regel på degenerativ baggrund. Derfor er det sjældent, at patienter under 40 år får rotator cuff-skader</li> <li>Mindre gennemgående rotator cuff-skader udvikler sig gradvist, og læsionen bliver større hos 40% af patienterne efter 10 år<a href=" " data-type="journal-reference" data-value="Moosmayer S, Lund G, Seljom US, Haldorsen B, Svege IC, Hennig T, Pripp AH, Smith HJ, At a 10-Year Follow-up, Tendon Repair Is Superior to Physiotherapy in the Treatment of Small and Medium-Sized Rotator Cuff Tears. J Bone Joint Surg Am 2019;101: 1050-1060" data-value-piped="Moosmayer S, Lund G, Seljom US, Haldorsen B, Svege IC, Hennig T, Pripp AH, Smith HJ|At a 10-Year Follow-up, Tendon Repair Is Superior to Physiotherapy in the Treatment of Small and Medium-Sized Rotator Cuff Tears.|J Bone Joint Surg Am|2019|101|1050-1060|31220021" data-url="reference-link" data-pubmedid="31220021" title="Moosmayer S, Lund G, Seljom US, Haldorsen B, Svege IC, Hennig T, Pripp AH, Smith HJ, At a 10-Year Follow-up, Tendon Repair Is Superior to Physiotherapy in the Treatment of Small and Medium-Sized Rotator Cuff Tears. J Bone Joint Surg Am 2019;101: 1050-1060"><sup>3</sup></a> </li> <li>Rotator cuff-skader kan udvikle sig til rotator cuff-artropati, hvor patienterne udvikler svære artrit/artrose forandringer i glenohumeralleddet samt pseudoparalyse af armen på grund af globale rotator cuff-skade</li> </ul> <h3>Komplikationer</h3> <p>Komplikationer til konservativ behandling: </p> <ul> <li>Smertefuld skulder</li> <li>Nedsat styrke og funktion</li> <li>Progression af rotator cuff-skaden</li> <li>Progression til rotator cuff-artropati</li> </ul> <p>Komplikationer til operation:</p> <ul> <li>Fornyet ruptur af senen (30 %)</li> <li>Nerveskade af nervus axillaris ses meget sjældent</li> <li>Infektion (under 1 %)</li> <li>Frossen skulder</li> <li>Stivhed</li> </ul> <h3>Prognose</h3> <p>Akutte traumatiske rotator cuff-skader: </p> <ul> <li>Det tager ca. 1 år at komme sig efter operation af akut traumatisk rotator cuff-skade</li> <li>Skulderfunktionen normaliseres sjældent, og patienterne vil oftest have en mén grad efter rotator cuff-skade</li> <li>Patienterne opnår i det væsentligste smertefrihed, men kan have belastningsrelaterede smerter</li> <li>Oftest vil patienterne have forskellige grader af nedsat bevægelighed i skulderleddet efter rotator cuff-operation</li> <li>Patienter, som har et manuelt arbejde, får ofte brug for skånehensyn</li> </ul> <p>Degenerative ikke-traumatiske: </p> <ul> <li>Succesraten med konservativ behandling er uklar, men mange patienter opnår smertefrihed, og en del formår at kompensere for deres rotator cuff-skade</li> <li>Operation har en god prognose i forhold til smertelindring</li> <li>Operation af rotator cuffen giver for de fleste patienter god smertelindring, men resultaterne er mere usikre, når det gælder bedring af styrke og funktion i skulderen</li> </ul> <h2>Baggrundsoplysninger </h2> <h3>Definition</h3> <ul> <li>Læsion af en eller flere af rotator cuffens fire sener: <ul> <li>Supraspinatus</li> <li>Infraspinatus</li> <li>Subscapularis</li> <li>Teres minor</li> </ul> </li> <li>Rotator cuff-skader opdeles i akutte traumatiske og degenerative ikke-traumatiske skader</li> </ul> <h3>Forekomst </h3> <ul> <li>Gennemsnitsalderen for rotator cuff-skader er 58 år</li> <li>Supraspinatus er den hyppigste sene, der beskadiges i rotator cuffen</li> <li>Med alderen stiger prævalensen af rotator cuff-skader i befolkningen</li> <li>En undersøgelse af asymptomatiske borgere uden tidligere skuldertraumer viste en høj andel af uerkendte rotator cuff-skader: 60-70 år: 20 %, 70-80 år: 31 % og over 80 år: 50 % </li> </ul> <h3> Klinisk anatomi</h3> <ul> <li>Rotator cuffen består af de fire muskler; supraspinatus, infraspinatus, teres minor og subscapularis </li> <li>Rotator cuffen er en dynamisk stabilisator for skulderleddet</li> <li>Rotator cuffen sikrer et stabilt rotationscentrum ved at presse ledhovedet ind i glenoidkaviteten. Herved kan deltoideus virke som en elevator og abduktor af armen</li> <li>De individuelle muskler i cuffen giver styrke til forskellige armbevægelser: <ul> <li>Subscapularis ved indadrotation </li> <li>Supraspinatus ved elevation </li> <li>Infraspinatus og teres minor ved udadrotation</li> </ul> </li> </ul> <h3>Ætiologi og patogenese</h3> <p>Akutte traumatiske rotator cuff-skader opstår oftest ved fald på fald på strakt arm, som for eksempel ved et cykelstyrt, skistyrt, fald ned ad trappe eller ved et kraftigt træk i armen</p> <ul> <li>Ætiologien for rotator cuff-skader er multifaktoriel. Faktorer af betydning for udvikling af rotator cuff-læsion er genetisk disposition, impingement syndrom, aldersrelateret degeneration i senerne, mikro/makro traumer og nedsat blodforsyning til senehæftet</li> <li>Med alderen opstår der degenerative forandringer i rotator cuffens sener. Forandringerne resulterer i en mere skrøbelig og uelastisk sene, hvor der gradvist kan opstå partielle skader. Herved øges belastningen på den øvrige del af senerne, og læsionen vil gradvist progrediere</li> </ul> <h3>Disponerende faktorer</h3> <ul> <li>Rygning</li> <li>Genetik</li> <li>Erhverv som medfører stor belastning på skuldrene for eksempel slagteri arbejde</li> </ul> <h3>ICPC-2</h3> <p>[ICPC]</p> <h3>ICD-10/SKS-koder</h3> <p>[ICD10]</p> <h2>Patientinformation</h2> <h3>Hvad findes der af skriftlig patientinformation</h3> <ul> <li><a href="~/link.aspx?_id=48A95046785A427F84EEA12B784B8B63&_z=z">Skade på rotatorkappen</a></li> <li><a href="~/link.aspx?_id=53CEA00218DB44EEBD4E17E8E92AA51E&_z=z">Skulderøvelser introduktion</a></li> </ul> <h3>Træningsfilm for skulderen</h3> <ul> <li><a href="~/link.aspx?_id=CC188691765C40D1A150CDA2CC2056BF&_z=z">Øvelsesprogram, 3 øvelser</a><br> <br> <a href="~/link.aspx?_id=53CEA00218DB44EEBD4E17E8E92AA51E&_z=z"><img alt="" height="84" width="135" src="F29C024F18294B948DCBD5C5BE19CD28-135-84" style="height: 84px; width: 135px;"></a></li> <li><a href="~/link.aspx?_id=9F6E392D800F48B18D827DF35EF95F3C&_z=z">Øvelsesprogram, 3 øvelser med arabisk tale - فيديوهات تمارين رياضية باللغة العربية</a><br> <br> <a href="~/link.aspx?_id=8425CFC13C1647309B1A14D3B31AF98D&_z=z"><img alt="" height="84" width="135" src="ECD34BA7D13E4B0BA41E5E9B16E3E3D7-0-0"></a></li> </ul> <h3>Animationer</h3> <ul> <li><a href="~/link.aspx?_id=4FF6561CEBD8415DB5D822C74F229FB3&_z=z">Skulderens anatomi</a></li> <li><a href="~/link.aspx?_id=12A341D540E84F5F97C78AFAD148ED45&_z=z">Rotator cuff-skade</a></li> </ul> <h2>Link til vejledninger</h2> <ul> <li>Forløbsbeskrivelser og pakkeforløb [ICPC] </li> </ul> <h2>Illustrationer</h2> <ul> <li>Denne <a href="https://www.shoulderdoc.co.uk/section/22">artikel</a> har gode illustrationer</li> </ul>]]></HtmlField> <HtmlField Name="Resume"><![CDATA[<h2>Resumé</h2> <h4>Diagnose</h4> <ul> <li>Optagelse af sygehistorie for at afklare skadesmekanismen, så man kan afklare, om skaden er akut traumatisk eller degenerativ ikke-traumatisk</li> <li>Klinisk undersøgelse: 1) Aktiv og passiv bevægelighed 2) Styrken i rotator cuffen vurderes og sammenlignes med raske side 3) Lag signs vurderes i forhold til supraspinatus, infraspinatus og subscapularis</li> <li>Røntgen af skulderen for at afklare, om der er fraktur, slidgigt eller rotator cuff-artropati</li> <li>UL-skanning af rutineret specialist</li> <li>MR-skanning er guldstandard og kan kun bestilles af speciallæge i ortopædkirugi. MR giver information om omfanget af rupturen, graden af sene retraktion og atrofi af rotator cuffens muskler. Herved kan man afklare, om skaden kan syes med en god prognose, eller om skaden ikke kan syes</li> </ul> <h4>Behandling</h4> <ul> <li>Akutte traumatiske rotator cuff-skader bør tilbydes eratiopon med sutur af seneskaden indenfor 3 måneder fra tilskadekomsten</li> <li>Degenerative, ikke-traumatiske rotator cuff-skader behandles konservativt med steroid blokade, anlagt subacromialt, og træningsøvelser i minimum 3 måneder <ul> <li>Ved manglende effekt efter 3-6 måneders konservativ behandling af ikke-traumatiske skader, kan man overveje operation. Ved operation er det optimale at sene syes, men det er ikke altid muligt. I disse tilfælde kan der foretages delvis sutur af skaden og eventuelt overskæring af den lange bicepssene. Dette giver ofte en væsentlig smertelindring</li> </ul> </li> <li>Operation af rotatorcuff skade <ul> <li>Latissimus dorsi eller nedre del af trapezius transfer (seneflytning) eller alternativt superior kapsel rekonstruktion med sene graft kan i sjældne tilfælde tilbydes patienter med symptomer fra en rotator cuff-skade, som ikke kan syes på grund af sene retraktion og muskelatrofi. Disse behandlinger er højtspecialiserede, og foretages udelukkende i Aarhus, Herlev/Gentofte eller Odense</li> <li>Operation tilbydes primært patienter med smerter. Patienter, der udelukkende har funktionsnedsættelse, kan risikere, at de efter operation får smerter, og man kan ikke være sikker på, at funktionen bedres</li> </ul> </li> </ul> <h4>Henvisning</h4> <ul> <li>Patienter med et relevant traume bør henvises til røntgenundersøgelse af skulderen for at afklare, om der er fraktur</li> <li>Patienter med et akut traume uden fraktur bør henvises til UL-skanning eller ortopædkirurg, hvis de ikke har genvundet førligheden i skulderen 2-4 uger efter tilskadekomst</li> <li>Patienter uden traumer med gener efter minimum 3 måneders konservativ behandling, og som har fået foretaget skulderrøntgen, kan henvises til ortopædkirurgisk vurdering</li> </ul>]]></HtmlField> <LinkListField Name="Spot2"> <LinkField linktype="internal">{99A85AFD-2F7A-4B5D-A1C9-C2701D5E7D30}</LinkField> </LinkListField> <TextField Name="DoctorsHandbookID">14046</TextField> <TextField Name="PageTitle">Rotator cuff-skade</TextField> <TextField Name="NavigationTitle">Rotatorcuff 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