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 More About Repair of Shoulder Rotator Cuff

Types of Rotator Cuff Tears

  • Acute Tear-If you fall down on your outstretched arm or lift something too heavy with a jerking motion, you can tear your rotator cuff.

  • Degenerative Tear- Most tears are the result of a wearing down of the tendon that occurs slowly over time. This degeneration naturally occurs as we age.

  • Partial tear-This type of tear is also called an incomplete tear. It damages the tendon , the tendon no longer fully attaches to the head of the humerus.

  • Full-thickness tear-This type of tear is also called a complete tear,  With a full-thickness tear, there is basically a hole in the tendon.

 

Symptoms of Rotator Cuff Tears

  • Pain at rest, specially if lying on the affected shoulder

  • Pain  and weakness when lifting and rotating  arm

  • crackling sensation during shoulder movements  in certain positions

 

Diagnosis

  • Medical History -The physician will discuss your symptoms and medical history.

  • Physical Examination – physician will check tenderness, measure the range of motion of your shoulder, also will  test your arm strength.

  • Imaging Tests-  these  tests aid in confirming the diagnosis

  • Magnetic resonance imaging (MRI) -  can show soft tissues like rotator cuff as well as where the tear is located within the tendon and the size of the tear.

 

Procedure for Rotator Cuff Repair Surgery

The type of repair performed depends on several factors considering type of tear, age, activity level, general health, surgeons experience with  a particular procedure. The surgeon  will discuss with you the best procedure to meet your individual health needs.

Techniques most commonly used for rotator cuff repair include

  • Open repair,

  • Arthroscopic repair

  • Mini-open repair.

 

  1. Open repair - An open surgical incision is performed  if the tear is large or complex. The surgeon makes the incision over the shoulder and detaches one of the shoulder muscles (deltoid) to gain access to the torn tendon.

  2. Arthroscopic Repair-This is less invasive procedure. During arthroscopy, surgeon inserts a small camera, called an arthroscope, into shoulder joint to guide through the surgery , other miniature surgical instruments are inserted  to repair the torn rotator cuff.  

  3. Following the repair fluid allowed to drain from shoulder, sterile bandage is applied In order to keep the shoulder muscle immobile while it heals a sling is provided .

  4. Mini-Open Repair Repair is performed through a small incision. The incision is  typically  3 to 5 cm long. While performing the tendon repair, the surgeon views the shoulder structures directly, rather than through the  monitor.

 

Recovery

Complete recovery may take several months.

  • Pain Management- After surgery, you will feel pain which will be controlled by use of NSAIDs

  • Rehabilitation- Rehabilitation is important  in getting you back to your daily activities. Physiotherapy will help you regain shoulder strength and motion.            

  • Immobilization –initially the repair needs to be immobilized while the tendon heals , to avoid using your arm for the first 4 to 6 weeks you will be given a sling

  • Passive exercise- Usually,  passive exercise are started within the first 4 to 6 weeks after surgery.

  • Active exercise- After 4 to 6 weeks, you will be doing active exercises.

 

Factors Affecting Cost Of Rotator Cuff Repair Surgery

The cost to the patient depends on a variety of factors like:

  • The hospital, the patient chooses

  • Room –Standard single room, deluxe room, super deluxe room for the number of nights specified (including nursing fee, meals, room rate and room service)

  • Fee for the team of doctors and OT charges  

  • Standard test and diagnostic procedures

  • Cost of the follow –up care required after the procedure

  • Physiotherapist cost

Frequently Asked Questions Involving repair of shoulder rotator cuff

  • Is Rotator cuff injury common ?

  • Yes , rotator cuff tear is a common cause of pain and disability among adults.
  • What will happen if I have a torn rotator cuff ?
  • A torn rotator cuff will weaken shoulder,  making it difficult and painful to perform  many daily activities, like combing  hair or getting dressed. 
  • What happens during surgery for Rotator cuff repair ?
  • Surgery to repair a torn rotator cuff most often involves re-attaching the tendon to the head of humerus.
  • What is prognosis after Rotator Cuff Repair surgery ?
  • Most  of patients have improved shoulder strength and less pain after surgery for a torn rotator cuff.
  • Which is the most common tendon for Rotator cuff injury ?
  • Supraspinatus tendon, the most common location for rotator cuff tears

 

  • What are the indications for Surgery ?

    • Continued pain not improving by conservative therapy is the main indication for surgery.

    • If you are a sports person and actively  and use your arms for overhead work

    • symptoms lasting for  6 to 12 months without relief

    • a large tear (more than 3 cm)

    • significant weakness and loss of function in your shoulder

    • acute  injury causing tear

 

  • What are the risks after rotator cuff repair surgery?

    • Infection

    • Nerve injury

    • Deltoid Detachment. During an open repair, this shoulder muscle is detached to provide better access to the rotator cuff.

    • Stiffness

    • Tendon re-tear- There is a chance for re-tear following all types of repairs.

 

  • What are the causes of Rotator Cuff  tears ?

  • Main causes of Rotator cuff tears:

    • Acute Tear due to injuryIf you fall down on your outstretched arm or lift something too heavy with a jerking motion, you can tear your rotator cuff.
    • Degenerative Tear-Most tears are the result of a wearing down of the tendon that occurs slowly over time. This degeneration naturally occurs as we age.

 

  • What are the factors contributing to degenerative rotator cuff tears?

    • Due to overuse  

    • Lack of blood supply.  Without a good blood supply, the body's natural ability to repair tendon damage is impaired. This can ultimately lead to a tendon tear.

    • Bone spurs. As we age, bone spurs (bony overgrowth) often develop , these spurs rub on the rotator cuff tendon, over time this will weaken the tendon and make it more likely to tear.

 

  • What are the Nonsurgical Treatment options for torn rotator cuff ?
  • Non surgical treatment options may include:

    • RestActivity modification- Avoid activities that cause shoulder pain.

    • NSAIDs medication -to reduce pain and swelling.

    • Physiotherapy -  Specific exercises will restore movement and strengthen your shoulder.

    • Steroid injection-   an injection of a local anesthetic and a cortisone preparation might be helpful.

 

  • What are the disadvantages of non surgical repair ?

  • The disadvantages of nonsurgical treatment are that size of tear may increase over time and activities may be restricted.

 

  • What can be the reason for poor prognosis after surgery ?

  • The patient might not have satisfactory results if :

    • The tendon quality is poor

    • Large tears

    • Poor  rehabilitation after surgery

    • Patient with advanced age

    • Smoking

 

 

  • What are the phases of physiotherapy after Rotator Cuff surgery ?

  • Rotator cuff surgery recovery usually consists of:

    • Immobilizing the shoulder in a sling for seven to ten days,

    • physical therapy with passive motion for six weeks,

    • physical therapy with active motion for six weeks

 

  • Is Rotator cuff surgery painful ?

  • Surgery to repair a rotator cuff tear usually produces significant pain and stiffness.

 

  • How long should I take off work after shoulder surgery?

  • Depending on the job profile ,after surgery you will be able to resume  light activity after 7-14 days, but will have to keep your arm in a sling  for 4 -6 weeks .

 

  • How long will I need the sling after repair surgery ?

  • The duration depends upon the severity of  injury, usually for 4- 6weeks .

 

  • How long does it take to recover from a torn rotator cuff?

  • Recovery can take 4 to 6 months, depending on the size of the tear and other associated  factors.