Rotator cuff is the group of tendons in the shoulderjoint providing support and enabling wider range of motion. Major injury tothese tendons may result in tear of these tendons and the condition is calledas rotator cuff tear. It is one of the most common causes of shoulder pain inmiddle aged adults and older individuals. It may occur with repeated use of armfor overhead activities, while playing sports or during motor accidents.Rotator cuff tear causes severe pain, weakness of the arm, and cracklingsensation on moving shoulder in certain positions. There may be stiffness,swelling, loss of movements, and tenderness in the front of the shoulder.
Rotator cuff tear is best viewed on magnetic resonanceimaging. Symptomatic relief may be obtained with conservative treatments –rest, shoulder sling, pain medications, steroidal injections and certainexercises. However surgery is required to fix the tendon back to the shoulderbone.
Surgery to repair the rotator cuff has traditionally beendone through a large shoulder incision, about 6-10cm long, and the muscle overthe rotator cuff was separated. Newer,advanced surgical techniques have been developed to minimize pain and recoverytime. Arthroscopic rotator cuff repairis a minimally invasive surgery performed through tiny incisions, about 1 cmeach, with an arthroscope.
The arthroscope is a small fiber-optic viewing instrumentmade up of a tiny lens, light source and video camera. The surgical instrumentsused in arthroscopic surgery are very small (only 3 or 4 mm in diameter) butappear much larger when viewed through an arthroscope.
The television camera attached to the arthroscopedisplays the image of the joint on a television screen, allowing the surgeon tolook throughout the shoulder-at cartilage, ligaments, and the rotator cuff. Thesurgeon can determine the amount or type of injury, and then repair or correctthe problem.
The benefits of arthroscopy compared to the alternative,open shoulder surgery, include:
Shoulder reconstruction is a surgical procedure performedin patients with shoulder instability to improve stability, restore thefunction and prevent recurrent dislocations of the shoulder joint.
Shoulder instability is a problem of loose shoulder jointthat occurs when the structures that surround the shoulder joint such asthe ligaments, capsule and cartilage become overstretched or injured. When thisoccurs you may have shoulder joint dislocation. A dislocation occurs when the headof the upper arm bone (humerus) is forced out of the shoulder socket (glenoid). Shoulder dislocation canbe partial or complete. A partial dislocation occurs when theball of the upper arm comes partially out of the socket. It is referred to as a subluxation. Acomplete dislocation occurs when the ball comes all the way out of the socket.
Shoulder instability mostcommonly occurs as a result of a Bankartinjury or tear. Bankart tear is a specific injury to a part of theshoulder joint called the labrum. Labrum is a ring of fibrous cartilage thatsurrounds the glenoid and stabilises the shoulder joint. Bankart tear leads torecurrent dislocations, feeling of looseness, lack of strength, pain orclicking and arthritis of the shoulder.Shoulder instability may becaused by injury, falling on outstretched hand, repetitive overhead sports suchas basketball, volley ball or weight lifting. Patients with shoulderinstability may have severe pain, swelling, popping or grinding sound, partialor complete dislocation, loss of sensation or partial paralysis and loss offunction.
If conservative treatment such as immobilization,prescription medicines, physical therapy, closed reduction or manipulation andoccupational therapy fails to relieve the shoulder instability, your surgeonmay recommend reconstruction surgery.
Shoulder reconstruction surgeryinvolves repair of the torn or stretched ligaments so that they are better ableto hold the shoulder joint in place. During the surgery the torn labrum isreattached back to the shoulder socket with the help of special anchors and theoverstretched capsules and ligaments are tightened.
Shoulder reconstruction surgerycan be done arthroscopically that involves use of smaller incisions and tinyinstruments to perform the repair. Some patients may need an open surgicalprocedure which involves a larger incision over the shoulder to perform therepair.
Following surgery your arm iskept in a sling for four to six weeks to facilitate healing. Yourphysiotherapist will show you use of the sling and instruct on simpleexercises. You may have slight pain after surgery for which pain medicationsare prescribed. Apply ice packs on the shoulder to help reduce the swelling.You can use a pillow under your shoulder while lying in bed. Avoid heavylifting and driving during the first 6 weeks. You will be given specificinstructions regarding activity and a rehabilitation program of exercise andstrengthening.
Complications are rare aftershoulder reconstruction surgery. Some of the common complications includeinfection, stiffness or restricted movement, nerve and vessel injury, failureof the procedure and side effects of general anaesthesia.