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:
Having trouble while sleeping at night on a particular side of the shoulder, having intense pain when trying to reach for something behind your back, weakness while playing sports involving overhead arm movements, are indicative of a problem in the shoulder joint which could significantly affect mobility and strength of the joint.
Approach considerations:
When pain at the front of the shoulder down to the arm or around the shoulder blade becomes persistent, it is a significant sign of rotator cuff injury or tear. The rotator cuff injuries may result in partial of complete tears where the muscle is detached from the bone. The group of muscles located between the shoulder blade and collarbone are physically examined and diagnostically tested to conclusively determine the presence of rotator cuff injury.
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Technique:
Also known as Subacromial decompression, it involves cutting off or removing bone spurs from the end or bottom of the acromion and smooth it out to prevent acromion from impinging on the rotator cuff tendon.
Preparing-Performing-Follow up:
Diagnostic tests are evidence to the damage incurred on the rotator cuff tendons. The specialist after taking decision of the technique discusses its benefits and limitations with the patient and completes all formalities regarding medical history, allergy to medicines and reaction to anesthesia and moves ahead with the surgical procedure.
The patient is placed such that the surgeon can get a clear view of the front of the shoulder. After sedating the patient with anesthesia the surgeon makes very small incisions to insert an arthroscopic camera and view inside. Then with a small cutter like instrument he removes a very small portion of the acromion to facilitate easy movement of rotator cuff tendons.
The incision is then closed with sutures and bandaged aptly for protection. The arm of the patient is then placed in a sling to immobilize the joint to enable quick healing.
Benefits and Complications:
When non operative treatments fail to provide relief to the rotator cuff tendon injuries or repair then bone spurs removal is conducted arthroscopically by the surgeon. It is the most effective technique to smooth out the acromion that is hindering the tendon so that impingement syndrome could be prevented. It is a minimally invasive technique which does not require an overnight stay and the patient is saved from anxieties of an open surgery. The incisions are very small hence no visible scar is observed and the healing is much quicker than from an open surgical intervention.
Complications are rare but probable. The incisions may become infected or damage may be done to any nerve or vessel while removing the bone spurs. The technique may fail to alleviate the pain and the patient may complain of stiffness.
Rehabilitation after bone spurs removal:
The rehabilitation program is an essential tool to restore mobility and strength in the shoulder joint. Under the guidance of a skilled therapist, the rehabilitative program is executed in three phases.
Phase I comprises of rest, ice and restricted activity. Phase II consists of slow return to activities with gentle shoulder range of motion exercises. Phase III consists of exercises that are active and applied more forcefully with shoulder range of motion exercises, strengthening exercises and returning to work activities.
Rehabilitative program is formulated keeping in mind personalized requirement of the patient and teach the patient skills of pain management as well as becoming self sufficient to perform exercises and follow routine that enables working of a rejuvenated shoulder joint.
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.