Remodeled Joint: the Rotator Cuff

Rotator Cuff Remodeled

 
The shoulder is an intricate part of the body and is very prone to injury. One of those common injuries is the torn rotator cuff. What is a torn rotator cuff? It is when either the tendon is partly torn or the tendon has completely disconnected from the humerus. Since that injury is common, I have proposed a new and renovated rotator cuff that will prevent the harm of a tear in the tendon. That is, the supraspinus tendon will become the “supraspinus brachial” tendon meaning that it has two heads so that there is less stress on the tendon and is less likely to tear. Also, there are arteries such as the axillary artery that sends blood throughout the muscles but adding in a second axillary artery would pump even more blood into the muscles which will strengthen the tendon. In this article, more depth of the structure of the shoulder and the result of the “fixed” rotator cuff will be provided.
The shoulder is a complex structure in the human body and many other organisms. In the human body though, the main structures are as followed. There is the clavicle that is a long horizontal bone that is superior to the scapula. Then there is the scapula; a flat bone that is inferior and posterior to the clavicle, and the humerus that is another long bone that is lateral to both the clavicle and scapula. There are three different joints that make up the shoulder; the Glenohumeral (GH) joint, the acromioclavicular (AC) joint, and the Sternoclavicular (SC) joint. In the GH joint there is the capsular, coracohumeral, glenohumeral, transverse humeral, and the glenoid of humerus ligament. The AC joint connects the humerus to the chest and includes the ligaments capsular, superior and inferior acromioclavicular, articular disk, coracoclavicular (trapezoid and conoid). Then in the SC joint, the humerus is attached to the clavicle and the ligaments include the capsular, anterior and posterior sternoclavicular, inter- and costo- clavicular, articular disk. Next, includes the tendons and there are four tendons that are in relation to the rotator cuff. There is the supraspinus that attaches the humerus to the shoulder muscle and this tendon helps the shoulder move abductively and adductally. This is usually the tendon that is torn, along with the infraspinatus, during a rotator cuff tear but there are three others that could be torn but are less likely. Those include the infraspinatus, the tendon on the anterior side of the supraspinus and next to the supraspinus, the teres minor muscle is on the anterior side of the infraspinatus, and lastly, the subscapularis is the muscle on the posterior side of the supraspinus. The supraspinus and the infraspinatus are the most torn because of those muscles aid in rotation of the shoulder during sports such as basketball or softball. The wear and tear of those tendons that attach the muscle to the bone can become weakened which can lead to a torn rotator cuff of just a weak one. But a torn rotator cuff can also be sudden and occur all at once when the tendon is completely disconnected from the bone due to one action. As for the nerves in that area, there is the radial nerve, the ulnar nerve, and medial nerve. The nerve for the shoulder includes the brachial plexus nerve which goes through the four different muscles in the shoulder. Though nerves are very important, damaged nerves usually result in dislocated shoulders not a torn rotator cuff, but blood vessels do have an impact. The subclavian artery and vein keep the blood moving through the shoulder from the pecks and the axillary artery branches are arteries that branch off from the large axillary artery and the branches go to the different muscles and give the blood supply. A torn rotator cuff can result in the loss or slow supply of blood to those muscles. Now that enough of the shoulder is understood, the “remodeling” comes next.

The remodeling of the rotator cuff is meant to help prevent the tearing of the rotator cuff while still giving it function to move the same ways as before. To make the supraspinus tendon more secure on the humerus and in attachment to the supraspinus muscle, the supraspinus tendon needs to have two heads and become the “supraspinus brachial tendon” so that there is less stress on the one head for that tendon when a pitcher throws the ball with full force each time. All the other tendons have less impact but this will also put less stress on them because when the supraspinus tendon has less stress, the others do not have to work as hard to be a replacement for it. Also, a way to strengthen the tendons would be to have a second Axillary artery and its branches because that would create more blood flow into the tendons which will strengthen the tendon, making it much harder to tear and will let it withstand the wear and tear. Along with making the tendon stronger, if there were to be a minor tear in the tendon, more blood flow could help the tendon heal faster because of the immune system bacteria that circulate through the blood.
I arrived at this renovation of the rotator cuff because the main point was that the tendon breaks either right away or over time, and I needed to find a way to create a stronger and more resistant tendon. Pulling with two hands is stronger than pulling with one, which is the “supraspinus brachial tendon”. In class, we learn that blood flow has been used to help remodel bone along with help inflation. If there was more blood flow to these muscles, the tendon would have more aid when there is impact on it with the extra blood supply. Also, we learned that is one part is out of balance the whole thing falls apart which is why the blood must go to all four muscles that contribute to the rotator cuff.

Since the rotator cuff is not able to take my suggestions due to the evolution of humans and their structure, the way to prevent a torn rotator cuff is to ensure that the muscles in the shoulder are strong. Though that may sound counterintuitive because if a person tore his or her rotator cuff working out that would not help. But working the shoulder muscles out pumps more blood into that area which will help strengthen the tendon that is attaching the shoulder muscle to the humerus. Also, stretching the shoulder before workouts will keep the muscle and tendon a bit loose so that sudden movements does not cause a tear.

Work Cited:

Armstrong, April D. "Rotator Cuff Tear." Rotator Cuff Tears-OrthoInfo - AAOS. OrthoInfo, 01 Mar. 2017. Web. 08 May 2017. <http://orthoinfo.aaos.org/topic.cfm?topic=a00064>.

Schmidler, Cindy. "Shoulder Structure, Function and Common Problems." HealthPagesorg Anatomy Surgery Pregnancy Nutrition Fitness. HealthPages.org, 04 Mar. 2017. Web. 08 May 2017. <https://www.healthpages.org/anatomy-function/shoulder-structure-function-and-problems/>.

Tortora, Gerard J., and Bryan Derrickson. Introduction to the Human Body: The Essentials of Anatomy and Physiology. New York: Wiley, 2007. Print. 

Tempfer, Herbert, and Andreas Traweger. "Tendon Vasculature in Health and Disease." Frontiers in Physiology. Frontiers Media S.A., 2015. Web. 08 May 2017 <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4650849/>.