What Is Rotator Cuff Repair Surgery?
A group of four muscles and their respective tendons present in the shoulder region which act in harmony to stabilize the shoulder are known as rotator cuff muscles. Any injury leading to a tear in the muscle or the tendon calls for an immediate treatment. Reattaching the fibers of the muscle and tendons in cases of severe tear by opening up the shoulder joint is known as rotator cuff repair surgery. The four muscles constituting the rotator cuff group are:
- Supraspinatus muscle
- Infraspinatus muscle
- Teres minor muscle
- Subscapularis muscle
These muscles originate from the scapula (shoulder bone) and are inserted on the humerus (upper arm bone), forming a cuff at the shoulder joint. These muscles bring about rotation of the upper arm and stabilize the shoulder joint.
Causes Rotator Cuff Tear:
- Trauma to the shoulder during road traffic accidents, fights, stabbing injuries, falling forcefully on the shoulder
- Rotator cuff tears are majorly common in athletes and sports indulgent who make use of the shoulder joint repeatedly
- These include players of volleyball, weight lifting, swimming, rugby, short put, throw ball where excessive wearing and tearing of the tendons and muscles can occur as a result of repeated strenuous use
Signs and Symptoms of Rotator Cuff Tear:
- Pain of various degrees in the shoulder joint radiating in the entire length of arm
- Restricted movements of the shoulder joint
- Difficulty in raising arms above 90 degrees
- Difficulty in combing hair, wearing clothes
Diagnosis of Rotator Cuff Tear:
- Physical examination and clinical judgment: The orthopedic surgeon examines the patient thoroughly beginning with taking a detailed history of the symptoms. The shoulder is observed for any visible signs such as when the patient is asked to raise hands, the degree to which it is raised is noted. It is palpated for any tenderness and clicking sounds. Any signs of radiating pain in the neck, upper arm or upper back are also checked.
- Rotator cuff impingement test: In this type of test, a local anesthetic and a corticosteroid are injected into the joint space of the shoulder joint. If the pain subsides and the range of motion is improved, it confirms that the pain has originated from the rotator cuff and is not referred from the neck or upper back. Thus the treatment plan can be taken ahead and decided upon.
- X-rays: A radiographic image will enable the surgeon to see the defects in the bone which may lead to a tear in the muscle or the tendon. Bony spines or spicules cause a constant irritation to the soft tissues leading to a tear. An x ray image will only help to visualize the bony structures and not the muscle or the tendon.
- Magnetic resonance imaging: This will help in studying the origin and insertion of the rotator cuff muscles and the tendons. This image will clearly pin point the number and extent of tear either in the muscle, tendon or both and help in the treatment plan accordingly.
- Magnetic arthroscopy: This is considered as the gold standard diagnostic approach for rotator cuff repair. A dye is injected into the joint space and a series of images are taken which very accurately and in minute details describe each muscle and tendon involved in tear. The thickness of muscles and tendons, their lengths and points of origin and insertion are also very well seen in such images.
- Ultrasound: This is a method which makes use of sound waves in order to study the soft tissues involved in the shoulder joint.
Rotator Cuff Repair Surgery:
For a surgical intervention of the rotator cuff repair, three types of approaches can be considered depending upon the number of tears, extent of the tears and the number of muscles and tendons involved in the tear. These three approaches are as follows:
- Open repair: A traditional open surgical incision (several centimeters long) is often required if the tear is large or complex. The surgeon makes the incision over the shoulder and detaches one of the shoulder muscles (deltoid) to better see and gain access to the torn tendon. During an open repair, the surgeon typically removes bone spurs from the underside of the acromion (this procedure is called an acromioplasty). An open repair may be a good option if the tear is large or complex or if additional reconstruction, such as a tendon transfer, is indicated. Open repair was the first technique used for torn rotator cuffs. Over the years, new technology and improved surgeon experience has led to less invasive procedures.
- All arthroscopic repairs: During arthroscopy, your surgeon inserts a small camera, called an arthroscope, into your shoulder joint. The camera displays pictures on a television screen, and your surgeon uses these images to guide miniature surgical instruments. Because the arthroscope and surgical instruments are thin, your surgeon can use very small incisions (cuts), rather than the larger incision needed for standard, open surgery. All- arthroscopic repair is usually an outpatient procedure and is the least invasive method to repair a torn rotator cuff.
- Mini open repair: The mini-open repair uses newer technology and instruments to perform a repair through a small incision. The incision is typically 3 to 5 cm long. This technique uses arthroscopy to assess and treat damage to other structures within the joint. Bone spurs, for example, are often removed arthroscopically. This avoids the need to detach the deltoid muscle. Once the arthroscopic portion of the procedure is completed, the surgeon repairs the rotator cuff through the mini-open incision. During the tendon repair, the surgeon views the shoulder structures directly, rather than through the video monitor.
Complications And Risk Factors Associated With Rotator Cuff Repair Surgery:
- Tingling sensation or numbness in the arm or the shoulder region can persist even days after surgery
- Nerve injury can occur at the time of surgical repair of the tear
- Infections and scarring can occur at the site of incision
Am I Good Candidate For Rotator Cuff Repair Surgery?
You are an ideal candidate for going for a surgical repair of the rotator cuff tear if you fulfill any two of the following criteria:
- The symptoms have lasted for approximately a year
- The tear is large, roughly about 3 cm
- You have constant weakness and loss of function in the shoulder joint
- The tear was due to a recent acute injury
- Medications provide only symptomatic relief
Irrespective of the type of surgical intervention opted for, a sling remains in the shoulder for a period of 6 weeks. After this period, physiotherapy is started which takes about 30 to 45 days to bring the joint back to its normal range of motions.
All types of surgical repair options have a success rate of about 84 to 86 percent. Chances of a second approach for surgical repair arise if some underlying bony pathology continues to irritate the muscles and tendons and lead to constant tearing.
Benefits of Rotator Cuff Repair Surgery:
A surgical repair will help you in the following ways:
- It will relieve you of the pain and help avoid the distress and discomfort’
- It will enable you to start doing your daily chores such as combing hair or wearing clothes which otherwise were painful for you
A surgical repair of the rotator cuff tear would cost you 1,00,000 to 2,00,000 INR in India which is at least 40 percent lesser than the charges in UK and Australia. This charge is 55 percent lesser than that of the bill you will be required to pay in the United States.
Why choose India:
Team MedcureIndia is undoubtedly an efficient platform which projects the finest medical treatments done all across the globe. We direct our clients to one of these highly qualified team of medical professionals who whole heartedly invest their time for the betterment of their patients.