2024-04-12 22:40:23
Recently, the number of patients visiting hospitals with ruptures of the rotator cuff, a shoulder tendon, has been increasing. Experts cite aging and an increase in the sports population as the causes. It is reported that 7 out of 10 patients with shoulder pain, and about half of those in their 60s or older, experience rotator cuff tears.
Looking at the health insurance treatment status of patients with shoulder diseases announced by the National Health Insurance Corporation, the number of patients with the disease increased by about 7% from 2.26 million in 2018 to 2.42 million in 2022. The composition of patients with shoulder disease by age group was 27.8% in their 60s, 27.2% in their 50s, and 14.9% in their 40s, with people in their 40s or older accounting for 70% of all shoulder disease patients. This is mainly due to the fact that degenerative changes begin after the age of 40, weakening the muscles and tendons around the shoulders, and an increase in the number of people who enjoy sports that put a strain on the shoulders, such as golf, tennis, and swimming.
● If a shoulder tear is left untreated, treatment may become difficult.
A representative degenerative shoulder disease is rotator cuff rupture, or shoulder tendon rupture. Since the shoulder rotates 360 degrees and has a wide range of motion, it has great instability and is prone to degenerative diseases.
When the rotator cuff is torn, pain occurs in the arm and shoulder and movement is limited. The rotator cuff has four muscles and tendons: the subscapularis, supraspinatus, infraspinatus, and teres minor. It is a very important structure in stabilizing the shoulder joint. If one or more of these ruptures, pain occurs in the arm and shoulder and movement is limited. Depending on the degree of rotator cuff rupture, a state in which the tendon is completely punctured is called a full-thickness rupture, and a state in which only a portion of the tendon is torn is called a partial rupture.
Mild partial tears are treated conservatively. Pain control and anti-inflammatory treatments such as medication, physical therapy, and extracorporeal shock waves are provided. Because a partial rupture has a high probability of progressing to a full-thickness rupture over time, it is necessary to continuously monitor the progression of the rupture.
In particular, if the extent of the partial rupture exceeds 50% of the tendon thickness, there is a high risk of it progressing to a full-thickness rupture. Therefore, surgery is usually performed at this time. When the size of the rupture is small, it is best to surgically close it as soon as possible. If the size of the rupture gradually increases, there is a high possibility of re-rupture after surgery and shoulder strength may weaken. It is generally known that if a rupture above a certain level is not treated, the rupture grows by about 4 to 6 mm per year.
The surgery is performed through an arthroscope using stitches, taking into account the degree and location of the tendon rupture. However, if the timing for surgery is missed and the tendon is completely torn and it is difficult to return it to its original state, artificial joint surgery has no choice but to be performed.
● Treatment of partial rotator cuff tear with ‘collagen injection’
Himchan Hospital Shoulder Clinic Director Yoo Sun-yong (orthopedic specialist) said, “The number of patients with rotator cuff tears is increasing, but there has been no clear solution for the ‘middle stage’ where pain is difficult to control with medication and it is too early to undergo surgery.” He added, “If you endure with painkillers and reach your limit, “In the end, it was common to have surgery,” he said.
Recently, ‘collagen injection’ has been attracting attention as a conservative treatment for these intermediate-stage ruptures. Collagen injection is a treatment that increases the regenerative effect of damaged tissue by injecting atelocollagen into the lesion area. Atelocollagen is a collagen that is a component of tendons and ligaments and is made harmless when used in the human body. It has been used in plastic surgery for a long time and has been approved by the Ministry of Food and Drug Safety, so it is safe and has a low risk of side effects. Compared to regular collagen, it has an excellent cell regeneration effect and promotes the regeneration of damaged tissues.
In 2020, the Catholic University of Korea’s research team introduced the world’s first non-surgical treatment for rotator cuff tears using ‘atelocollagen’ through the American Journal of Sports Medicine. According to the paper, in a magnetic resonance imaging (MRI) test performed 6 months after atelocollagen injection treatment for patients with partial rotator cuff tear, 36.7% of the patients who received 1 ml of atelocollagen injection showed a partial tear of the rotator cuff. Appeared to have recovered. Significant improvements were also seen in pain scores and shoulder function scores surveyed over the course of a year.
Himchan Hospital Joint Medical Research Institute also disclosed the results of comparing the treatment effects of 39 patients who received collagen injection treatment.
Himchan Hospital compared the results an average of 3.2 weeks before and after collagen treatment based on the UCLA Shoulder Score. The UCLA Shoulder Score is a test that compares before and after the procedure by examining five detailed items, including pain level, function, satisfaction, forward bending, and forward bending strength (muscle strength). It is used as a standard for evaluating successful shoulder surgery.
As a result of comparing the scores before and after the procedure, it was found that the total score of the five items improved by about 51% from 19.9 points before the procedure to 30.1 points after an average of 3.2 weeks after the procedure. A total UCLA Shoulder Score of 29 or higher is considered good.
Comparing the scores before and after the procedure for each item, the pain level was 5.9 to 7.8 points (32% improvement), function was 6.0 to 8.2 points (37% improvement), and satisfaction was 0 to 4.9 points (98% satisfaction). , forward flexion increased from 3.8 points to 4.5 points (18% improvement), and forward flexion strength increased from 4.1 points to 4.7 points (15% improvement), showing improvement in all items including shoulder pain, function, patient satisfaction, shoulder range of motion, and muscle strength. Showed improved results. In particular, 98% of patients responded that they were satisfied after collagen injection treatment.
Himchan Hospital Shoulder Clinic Director Choi Kyeong-won (orthopedic specialist) said, “It is a useful treatment in that collagen injections can regenerate the tissue at the ruptured area and prevent deterioration.” He added, “Himchan Hospital in particular uses a high concentration of collagen to enhance the treatment effect.” “We are working to raise it further,” he said.
Director Yoo said, “Timely timing of treatment is important for rotator cuff tears. Since the shoulder is a part that is always moving, once it is torn, it is a ‘progressive’ condition and inevitably carries the risk of a full-thickness tear.” He continued, “If collagen injection treatment is performed in a timely manner, it will help relieve pain and improve function without requiring surgery.”
After collagen injection treatment, it is best to avoid exercising or lifting objects for one month to avoid putting any strain on the treated area.
Reporter Hong Eun-sim [email protected]
2024-04-12 22:40:23