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:
Shoulder joint is made of four rotator cuff tendons that are functional as stabilizers and enable free overhead mobility in the joint. When injury or tear in the rotator cuff tendons starts to interfere in the performance of daily simple activities, is intensely painful, persistent weakness in the joint results in gradual loss of mobility and
Considerations inducing replacement:
In spite of all techniques of treatment when no improvement in the rotator cuff is observed and the tear / injury becomes long standing developing into tear arthropathy, it becomes essential to replace the shoulder joint with an artificial prosthesis.
Preparing for Surgery:
After the decision of replacement surgery is jointly taken by the patient and the shoulder specialist, after evaluation and physical examination, the patient is sought to be reassured regarding the contingencies and benefits of the surgery. The patient is asked to undergo a few general medical tests to ascertain that he is healthy for the surgery. Information regarding medications, allergies and reactions to compositions and anesthesia are gathered from the patient to facilitate the specialist during prescription of medications and application of anesthesia thereof.
Implementing the surgery:
After sedating the patient with anesthesia the specialist performs the surgery. It is an extremely technical surgery which takes almost 2 hours to complete.
The specialist decides which type of replacement technique will be most effective depending on the severity of the injury or tear. The specialist may replace only the ball and not the socket when the rotator cuff tendons are severely torn (stemmed hemiarthroplasty) or by switching the metal ball and socket thus allowing the patient to use the deltoid muscle instead of the torn rotator cuff (reverse shoulder replacement).
The patient should consult our medical team >>click here for appointment
Protocols for recovery:
It is essential to protect the shoulder for a period of 2 to 4 weeks after the surgery.
The patient should ensure that the surgical wound remains dry and sealed until the staples get removed and sutures dissolve. The wound should be covered with a protective bandage until the uncomfortable sensation subsides.
The shoulder and arm should not be exerted pressure upon by overusing it, by lifting any heavy object other than a glass of water for a few weeks, by keeping the shoulder in a position that increases the discomfort or pain level.
Rehabilitative program should be diligently followed to restore mobility.
Simple activities like eating or dressing can be resumed by the patient within two weeks of the surgery with driving being permitted after 3 to 4 weeks of the surgery. The patient feels mild pain at night on resuming activities which is normal and the patient should not be over anxious about it.
Benefits of replacement surgery:
Shoulder replacement rejuvenates the shoulder joint of the patients and provides them with an improved strength and functional mobility. The patients are relieved of the enervating pain after replacement and are able to perform simple tasks and gradually all their pre operational activities.
Complications of the surgery:
As with any surgical technique, the replacement surgery is also prone to certain complications which on an average are successfully treatable. These complications may be sustenance of associated nerve injury during the surgery, infection in the metal implant or wearing down and loosening of the prosthesis.
Rehabilitation after replacement surgery:
Well designed and effective rehabilitation program is an essential prerequisite for restoration of strength and mobility in the shoulder joint after the replacement. The physiotherapist begins with gentle exercises and therapy sessions to relax the muscles around the joint and then slowly increases the exercises to be performed twice or thrice daily to extract optimum results.
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.