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:
Rotator cuff tendons are a network of four muscles and tendons that provide stability and overhead movement facility in the shoulder joint. When rotator cuff tendons sustain massive injury or tear which is irreparable by an arthroscopic or open surgery they are effectively considered to be relieved by tendon transfer surgery. This procedure is usually referred to as salvage procedure because it is almost like a last resort to restoring lost shoulder joint back, to being normal again.
Approach considerations:
Tendon transfer technique is a procedure which requires meticulous and extremely skilled hands keeping in mind the technical aspect of the surgery. The technique is not suitable to every patient as it is effective only on patients who-
- Has a shoulder joint that is normally working without arthritis
- Muscular force in opposition is in good strength
- Quality of the bone that will hold the fixation is good
- Patient’s agreement to undergo a long period of rehabilitative protocols
- Pain in the rotator cuff is related to muscle loss
- Adequacy of muscle tendon unit to be transferred
The patient should consult our medical team >>click here for appointment
Pre-surgical evaluation:
When it becomes diagnostically evident that rotator cuff tendons are irreparable and require over the edge technique with special skill i.e. tendon transfer technique, then the specialist has an in depth discussion about it with the patient. It is a complex technique and requires an extremely skilled and experienced surgeon to perform it. After gathering all necessary information and implementing pavement for a successful surgery, the surgeon goes ahead with it.
The technique:
When a muscle and tendon gets severely damaged and cannot be repaired by any technique then a tendon with its muscle is moved from another part of the body to replace it. It acts as a stabilizer and substitute to restore mobility and functionality in the debilitated joint.
After sedating the patient with adequate anesthesia the specialist makes a long surgical incision to expose the torn muscle and tendon. Then by taking out a tendon muscle unit from another part of the body replaces the torn tendon muscle unit in the rotator cuff.
After performing the surgery the specialist stitches back the incision and applies a protective bandage on it thereafter placing the arm in a sling for a definite period to enable healing.
Post- surgical follow up:
After performing the surgery the specialist stitches back the incision and applies a protective bandage on it thereafter placing the arm in a sling for a definite period to enable healing. With instructions regarding prohibited activities, postoperative care, rehabilitative protocols and follow up visit to the surgeon’s clinic, the patient is released from under the close monitoring of the surgeon.
The patient should consult our medical team >>click here for appointment
Complications of the technique:
As with any other surgical technique, tendon transfer technique is a lengthy surgical procedure which is prone to certain complications higher than rotator cuff repairs by minimally invasive techniques. Probable complications are-
- Infection
- Nerve injury
- Stiffness after surgery
- Failure of the tendon transferred
Benefits of the technique:
In cases where the tendon transfer is the most optimum technique, it is extremely advantageous. The benefits of the technique are-
- Significant improvement in muscle strength
- Reduction in pain
- Restored partial functionality
Complete restoration of functionality is unlikely but the shoulder joint almost starts to work prior to the rotator cuff injury or traumatic condition.
The patient should consult our medical team >>click here for appointment
Post surgical Rehabilitation:
The therapist starts to work on the shoulder with gentle passive exercises after the surgery but since Tendon transfer takes time to heal and rehabilitation with active and strengthening exercises is not permissible till 4-6 weeks. With various therapies the shoulder joint is rejuvenated but the patient has to bear with the slow procedure that may continue for a long period of time.
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.