ROTATOR CUFF INJURIES / TEAR
Web of four tendons and muscles:
That surround the shoulder joint and firmly intact the upper arm bone in the shallow shoulder socket are called Rotator Cuff. They enable the joint to function by assisting in their all direction movement and holding the arm bone firmly in place by surrounding it. Shoulder joint being the most flexible but unstable can sustain injury even with very minute stress making the tendon in the rotator cuff either pull away or get torn.
Age and overhead motions:
Are the biggest contributories to rotator cuff injuries as repeated stress and overuse might trigger off the tendon to be torn apart from the cuff and this susceptibility increases with age. Weakness, extreme pain, inability to move the shoulder and arm normally, crackling sound in moving the shoulder and difficulty in sleeping on the side of the affected shoulder are the common signs that signify that the rotator cuff might have been injured.
Thorough examination and evaluation:
Are tools which aid the prognosis of the orthopedic surgeon to adopt to methodology to reduce pain and rehabilitate the rotator cuff. The rotator cuff injuries might vary from being mild to complete and severe tears thus helping in determining whether the injury has to be treated surgically or by conservative techniques. Without treatment the rotator cuff injury can impair the movement of the shoulder permanently.
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Rationale:
When the patient sustain an injury or tear on the rotator cuff they are started treatment with conservative techniques as first line of treatment. The type of surgery that requires being undertaken depends on a number of factors such as the size of the injury, the quality of the bone and tissue, associated injuries and lastly the surgeon’s skill and experience.
Approach considerations:
Rotator cuff injury is recommended by the specialist when non surgical techniques fail to provide any relief in the enervating symptoms. Besides this surgery is also opted by the shoulder surgeon when the symptoms have been present for almost a year, there is a large tear in the rotator cuff, the shoulder joint has become weak and there is a loss of functionality or the injury to the rotator cuff is recent and severe.
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Preparation for Arthroscopic Repair:
After evaluating the tear or injury in the rotator cuff, decision of repair by Arthroscopy is taken by the shoulder surgeon accordingly. He inquires into the past medical history of the patient, bad habits, allergies / reactions to anesthesia or chemical compositions that might have an adverse effect on the surgery.
The patient is then recommended to undertake a few medical tests to ensure that he is healthy for Arthroscopy. Prior to the surgery a set of instructions is given to the patient regarding prohibitory activities, consumption of medications, food or alcohol so that they do not interfere with the surgery.
Technique:
Under arthroscopic tendon repair a small camera (arthroscope) is inserted into the shoulder joint after making an incision, to view and inspect the rotator cuff from inside. Then with thin and small surgical instruments, the rotator cuff injury / tear is repaired. It is the least invasive surgery thus takes almost an hour or so to be complete. The surgeon places the shoulder and arm in a sling to immobilize it and enable healing in the tendons.
Postprocedural Follow up:
After arthroscopic repair the tendons are covered with protective bandage and then the arm is placed in a sling to immobilize it. The patients are made to understand postoperative precautions that they shall have to follow. A follow up appointment with the shoulder specialist is scheduled and the patient is provided physical therapy as essential prerequisite for recovery.
Complications of Arthroscopic repair:
Arthroscopic tendon repair technique even though a minimally invasive surgery is prone to some common complications such as injury to adjoining nerves while repair, risk of infection by anesthesia or by surgical instruments, possibility of persistent stiffness after surgical repair and the tendon may re tear even after being repaired.
Benefits of Arthroscopic repair:
Arthroscopic repair, being a minimally invasive surgery saves the patient from the anxieties of open surgical intervention and leaves no visible scars on the shoulder. The patient is relieved from pain, has improved strength and function and is also released from the hospital without an overnight stay.
Rehabilitation after repair:
Besides arthroscopically repairing the rotator cuff injury or tear, a well formulated rehabilitation program is an essential prerequisite to restore strength and mobility in the shoulder joint. The program is started by passive exercises which begin within the first 4 to 6 weeks after the surgery, under which the arm is supported and moved gently in all directions.
After the passive exercises the patient starts doing exercises on his own and manages arm control and active exercises. The therapist then initiates strengthening exercises in the regime which is recommended for 4 to 6 months to gradually restore functional range of the shoulder joint.
The patient should consult our medical team >>click here for appointment
More about shoulder specialist:
Dr. Vikas Gupta, an eminent and skilled professional is the best hand and shoulder specialist in India today. Being in the field of upper extremity for more than 25 years and having conducted over 6000 successful surgeries, Dr. Gupta ensures complete provision of relief by principles- diagnosis- deliverance- rehabilitative care.
Completing his graduation as MBBS and MS in Orthopedics from All India Institute of Medical Sciences, New Delhi, he went on to USA and Germany to complete his fellowship. He rejoined AIIMS as an associate professor and has served patients from various hospitals over this long period such as Consultant Hand & Upper Extremity Surgery (orthopedics) At Fortis Hospitals, Director, Hand & Upper Extremity Surgery (orthopedics) At Medanta – The Medicity, Gurgaon and at present as head of Hand and Shoulder division at Max Healthcare, Gurgaon and Saket.
Max Healthcare is considered to be the best hospital in Delhi- NCR region because of their strife and dedication to bring a revolutionary change in the techniques of treatment. With an ingenious team of professionals and a highly technological set up for treatment techniques Max is the best in deliverance of painless and cost effective techniques.