Low Cost Rotator Cuff Repair Surgery in India

Introduction

The term “rotator cuff”refers to a group of four tendons that attach four shoulder muscles to the upper arm. Tendons are stringy tissues that attach muscle to bone.

A healthy shoulder is the most versatile joint in the human body. It has a wider “range of motion,” which means it can move more freely, and in more directions, than any other joint. The shoulder’s versatility enables us to retrieve soup cans from the cupboard, to hammer nails, swing golf clubs, roll bowling balls, and perform thousands of other activities.

The shoulder’s flexibility is due to its unique structure. Like the hip, the shoulder is a “ball-and-socket” joint – a “ball” at the top of the upper arm bone (the humerus) fits neatly into a “socket” formed by the shoulder blade (scapula).

But unlike hip joints, where the ball sits in a deep, well-protected socket, the shoulder socket is very shallow. As a result, the shoulder is the most frequently dislocated major joint in the body. It’s also prone to a variety of other injuries and chronic problems that can be painful and hinder a person’s ability to perform ordinary tasks.

Why it is done?

Surgery to repair a rotator cuff is done when:

• A rotator cuff tear is caused by a sudden injury. In these cases, it’s best to do surgery soon after the injury.
• A complete rotator cuff tear causes severe shoulder weakness.
• The rotator cuff has failed to improve with 3 to 6 months of conservative nonsurgical treatment alone (such as physical therapy).
• You need full shoulder strength and function for your job or activities, or you are young.
• You are in good enough physical condition to recover from surgery and will commit to completing a program of physical rehabilitation.

What to expect after surgery?

Discomfort after surgery may decrease with taking pain medicines prescribed by your doctor. The arm will be protected in a sling for a defined period of time, especially when at risk of additional injury. Physical therapy after surgery is crucial to a successful recovery. A rehabilitation program may include the following:

• As soon as you awake from anesthesia, you may start doing exercises that flex and extend the elbow, wrist, and hand.
• The day after surgery, if your doctor allows, passive exercises that move your arm may be done about 3 times a day (a machine or physical therapist may help the joint through its range of motion).
• Active exercise (you move your arm yourself) and stretches, with the assistance of a physical therapist, may start 6 to 8 weeks after surgery. This depends on how bad your tear was and how complex the surgical repair was.
• Strengthening exercises, beginning with light weights and progressing to heavier weights, can start a few months after surgery.

Candidates for rotator cuff repair surgery

• Persons who have tears to the rotator cuff tendon that don’t respond to treatment are candidates for surgery.
• Surgery is usually needed if there is a complete tear in the tendon.
• A complete tear results in a person being unable to raise the arm. Surgery may also be needed for a partial tear of the tendon, if the tear causes continued pain and weakness.
• In a complete tear, repair is usually done within 3 months of the injury.
• There are two typical types of people who suffer from a rotator cuff tear.
• Younger, athletic people often have an injury that tears the rotator cuff. Middle-aged or elderly people usually have repeated stress of the shoulder muscles over time that eventually causes the tendon to tear.

Advantages of rotator cuff repair surgery

• When combined with a good rehabilitation effort, rotator cuff surgery allows people to regain much of the lost comfort and function in shoulders with cuff disease.
• If the quantity and quality of the tissue is good, surgery can help repair the tendon back to the bone from which it has been torn. This is most likely to succeed, soon after a cuff tear in otherwise healthy shoulders of non-smokers who have not had multiple cortisone injections.
• Rotator cuff surgery will improve the mechanics of the shoulder.
• When performed by an experienced surgeon, rotator cuff surgery usually leads to improved shoulder comfort and function.
• The greatest improvements are in the ability of the patient to sleep, perform activities of daily living, and engage in non-contact recreational activities.

Symptoms

An acute rotator cuff tear as a result of trauma can occur on its own or in conjunction with another shoulder injury, such as a fracture or dislocation. An acute tear usually causes a sharp pain in the front of the shoulder that radiates down the side of the arm.

Rotator cuff tears caused by repetitive overhead activity or by wear and degeneration of the tendon usually have a more gradual onset of symptoms. In such cases, the pain may at first be mild and only present with overhead activities such as reaching or lifting, but as time passes, pain may result from little or no stressful activity at all, including just lying in bed on the affected side at night. Stiffness and loss of motion are also common, making it difficult to perform simple daily tasks such as combing your hair or twisting your arm behind your back to fasten a button on a blouse, or reaching up to adjust a hat or the hood of a coat.

Some of the signs of a rotator cuff tear include thinning (atrophy) of the shoulder muscles and pain or weakness when you lift your arm or when you lower it from a fully raised position. There may also be a crackling sensation (crepitus) when the shoulder is moved in certain ways.

Why the procedure is performed?

Reasons rotator cuff repair may be done include:

• You have shoulder pain when you rest or at night, and it has not improved with exercises over 6 – 12 months.
• You have a large or a complete rotator cuff tear.
• You are active and use your shoulder for sports or work.
• You have a lot of weakness and are unable to do everyday activities.

Surgery is a good choice in a person whose tear was caused by a recent injury. It is also a good choice when the tendons of the rotator cuff were not already frayed from chronic rotator cuff problems.

Some patients with a partial tear may choose not to have surgery, using rest and exercise instead. The best candidates for this approach are those who have only a partial tear and do not place a lot of demand on their shoulder.

• Shoulder pain will improve with this approach.
• However, any weakness will not improve, the tear become larger over time, and you may be limited in the sports or other act ivies you can do.

Diagnosis

Despite all the clues, diagnosing a rotator cuff tear isn’t always easy, because a number of conditions in the bones and soft tissues of the shoulder can present with similar symptoms, and a number of tests may be required for a conclusive diagnosis. A doctor will begin by taking the medical history, and then perform a physical examination, looking for tender areas, deformity, and restrictions in strength and motion. The physician may also examine the patient’s neck to ensure a “pinched nerve” in the cervical spine isn’t the pain source and to rule out other conditions, such as osteo- or rheumatoid arthritis.

Beyond that, he or she may request imaging tests, usually beginning with x-rays. Other tests may be ordered, including an ultrasound or a CT scan (computerized tomography) or MRI (magnetic resonance imaging), all of which can better visualize soft tissue structures such as the rotator cuff tendon.

An MRI is the gold standard, since it can even distinguish between a complete (full thickness) tear of the tendon and a partial tear, and whether the tear is within the tendon itself, or if the tendon is detached from the bone.

Rotator cuff surgery

During rotator cuff surgery, the patient is put in a half-sitting position, with the head supported. Most operations are performed under general anesthesia, where the patient is asleep. Sometimes a regional (or local) anesthetic is used to block the nerves leading to the arm. In that case, the patient is conscious but cannot feel pain. Usually a sedative is also given, putting the patient in a conscious but dreamy state. Rotator cuff surgery usually takes one to two hours.

Types of procedures include:

1. Open Surgical Rotator Cuff Repair: Prior to the development of arthroscopic surgery, all rotator cuff tears were repaired by looking directly at the torn tendon through an incision about 6 to 10 centimeters in length. The advantage of open rotator cuff repairs is the rotator cuff tendons are easily seen by this method. It is straightforward to repair the tendons down to the bone, and many surgeons find this a more secure repair. The downside is that the incision is large, and the recovery can be longer and more painful.
2. Mini-Open Rotator Cuff Repair: The mini-open method of repairing a rotator cuff involves an arthroscopic portion of the surgery, and a short incision to get direct access to the torn rotator cuff tendon. By using the arthroscope, the surgeon can also look into the shoulder joint to clean out any damaged tissue or bone spurs. Preparation for the rotator cuff repair can be performed arthroscopically. Once the arthroscopic portion is complete, a shorter incision is made to repair the tendon back to the bone. The incision used in a mini-open rotator cuff repair is about 3 cm, and the recovery may be less painful than the open cuff repair.
3. All-Arthroscopic Rotator Cuff Repair: An arthroscopic rotator cuff repair is done through small incisions, and the repair is done with the surgeon looking through a small camera to see the torn rotator cuff tendons and their repair on a television monitor. This is a more recent development in the treatment of rotator cuff tears, and not all types of tears can be treated by this method. Furthermore, arthroscopic rotator cuff repairs can be technically difficult and require experience in this method of repair. Not all surgeons are convinced the repair done arthroscopically is as strong as repair done through an open incision.
4. Shoulder Replacement Surgery: In large rotator cuff tears that have been neglected for a number of years, the cartilage of the shoulder joint may eventually wear out. This is a problem called rotator cuff tear arthropathy, and is a dual problem of shoulder arthritis and a large rotator cuff tear. Because the rotator cuff is no longer intact, a standard shoulder replacement is usually not adequate. Special implants help accommodate for the fact that the rotator cuff does not work normally. One of these special implants is called a reverse shoulder replacement.

Rehabilitation

After surgery, the arm is immobilized to allow the tear to heal. The length of immobilization depends upon the severity of the tear. You will be given an exercise program to help regain motion and strength in the shoulder. This begins with passive motion. It advances to active and resistive exercises. Your orthopaedic surgeon may recommend that you work with a physiotherapist. Complete recovery will take at least several months.

After surgery, the patient is taken to a recovery room for an hour or two. The injured arm is kept in a sling, often with a pillow behind the elbow. Patients initially drink only clear liquids before eating regular food. Ice is applied to the shoulder for comfort. Patients are encouraged to get out of bed with the arm in a sling. The sling can usually be released, but not removed, allowing the elbow to straighten without moving the shoulder. Patients who had open surgery usually stay in the hospital for a day or two. Patients who had arthroscopic surgery can often return home on the same day.

A strong commitment to rehabilitation is important to achieve a good surgical outcome. The doctor will advise you when it is safe to return to overhead work and sports activity.

Why Choose Joint Replacement Surgery Hospital India for Rotator Cuff Repair Surgery?

Joint Replacement Surgery Hospital India offers highest quality bone and joint health care with attentiveness, care and compassion to meet the needs of the patients and their loved ones. The medical team includes board-certified orthopedic surgeons who are familiar with all the aspects of the musculoskeletal system. Our hospital uses the most advanced technologies available for the orthopaedic procedures and has a lower complication rate.

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