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 rotator cuff muscles sustain injuries by fall on an outstretched arm, accident or during sport activities or get affected by degenerative conditions that result in intense pain or weakness and limitations while performing overhead arm movements, they result in tendonitis, partial or complete tear and require immediate medical treatment.
Approach Considerations:
When the pain and weakness does not improve in spite of being treated by nonsurgical techniques, the symptoms have been present for a very long period of time i.e. more than 6 months or a year, the rotator cuff injury has resulted in tears more than 3 cm and the patient is unable to perform daily activities with the affected shoulder then the surgeon undertakes repair of rotator cuff tendons by surgical intervention.
The patient should consult our medical team >>click here for appointment
Preparation for Surgery:
The decision of the surgery is a joint decision of the surgeon and the patient. The patient is informed about the risks and benefits of the various surgical repairs and why the particular technique is most effective for the patient to ease his mental anxiety before the surgery with an emphatic and clinical assurance. The shoulder specialist recommends the patient to undergo a few general tests to ensure that the patient is medically fit to undergo surgery. Before the patient is admitted for surgery the patient is prohibited intake of certain drugs, food and drinks so that no problem during the surgery may arise.
Repair by open surgery:
The surgeon usually undertakes repair by mini or arthroscopic surgery as nowadays most of the repairs are arthroscopic with open technique being seldom used except for very large tears. After appropriate anesthesia the shoulder surgeon makes a large incision over the shoulder to detach the shoulder muscle to gain proper access to the rotator cuff tendon. The specialist then removes the bone spurs and repairs the torn tendon and also performs reconstruction of the tendon if required by the technique called tendon transfer technique.
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Post Surgery:
After stitching back the rotator cuff tendons and deltoid muscle the wound is bandaged properly for protection and the shoulder is immobilized by placing the arm in a sling. The stitches are removed after a certain period of time or they are self dissolvable and the patient is advised to avoid heavy work activities or lifting for at least 6 weeks. Though pain and enervating symptoms begin to subside, the soreness in the shoulder around the rotator cuff stays for a much longer period even after it. The specialist monitors the progress of the patient at every step with regular follow up visits and pain management techniques aided by medicines and rehabilitation protocols.
Complications during and after open surgery:
Some patients may experience complications after rotator cuff surgery such as –
- Injury to the associated nerves
- Infection in the incisions after the surgery
- Persistent postoperative stiffness
- Probability of tendon retears
Deltoid muscle that is detached prior to the surgery is stitched back after it, thus it needs to be properly taken care of and protected so that it could heal else it may become problematic
Benefits of open surgery:
Rotator cuff tendon repairs usually have a high success ratio when taken up by open surgical intervention. Benefits that patients are provided by open surgery are-
- Relief in the intense and underlying pain
- Substantial improvement in strength
- Restoration of functional movements
Rehabilitation after open surgery:
Surgery is inadequate to reduce stiffness and restore flexibility in the shoulder unless accompanied by a well formulated rehabilitation program that comprises of passive exercises to begin with just after the surgery. It is so because the tear has been repaired but the muscles around are still weak to bear the pressure of active exercises. After a period of 6 weeks the therapist recommends active exercises to increase strength gradually and improve arm movements.
Complete recovery of movement in the joint is restored only after 6 months to a year and exercises are recommended to be continued for still a longer period for problem free joint and movements.
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.