Main function of rotator cuff is to stabilize & move the shoulder. A rotator cuff tear can occur from repetitive overhead activity, stressing rotator cuff muscles or bad technique of throwing while playing sports. Heavy weight lifting over a prolonged interval of time & development of bone spurs in bones around the shoulder may damage or irritate the tendon as well. According to health magazines, 75 percent of rotator cuff tears originate from serious injury to shoulder or to progressive wear & tear or declination of tendon tissue. Generally, throwing athletes are prone to shoulder injuries as a result of high forces allotted on shoulder during the throwing motion. Rotator cuff repair surgery is an efficient method to overcome these limitations.
What is Rotator Cuff Repair Surgery?
Rotator cuff is made up of four muscles, teres minor, infraspinatus, supraspinatus & subscapularis. Rotator cuff repair surgery is basically used to treat a ruptured rotator cuff when shoulder injury is very serious or in case non-surgical conservative treatments have failed to sufficiently enhance shoulder stability & movement. Rotator cuff repair surgery is a surgical procedure designed to improve & repair a torn tendon in shoulder. This surgery can be done with an open incision or with the help of shoulder arthroscopy which uses little buttonhole-sized incisions for operation. Rotator cuff repair surgery will eventually fulfill major goal of returning the injured shoulder to its optimal function.
Rotator cuff tears & ruptures increase in incidence with the age factor. Major causes of injured rotator cuff are given as follows.
- Deterioration of cuff
- Using arm to break a fall
- Lifting heavy weights
- Directly falling on shoulder
Athletes who are more prone to getting rotator cuff injuries include the following.
- Tennis Players
- Baseball Players
- Football Players
Signs & symptoms of rotator cuff tear include the following.
- Prolonged Shoulder or Arm Pain – Severe pain in arm & shoulder, which varies depending upon how serious the tear is.
- Weakening of Shoulder – Tenderness or weakness in the shoulder.
- Restricted Movement – Trouble moving shoulder, specifically while trying to lift the arm above head.
- Crackling Sound – Crackling or snapping sounds while moving the shoulder.
- Difficulty in Performing Activities – It may become difficult to perform simple tasks like combing hair or reaching behind back.
- Sleeping Inability – Discomfort in sleeping on the shoulder.
Most rotator cuff injuries & tears develop gradually over time. But they might happen suddenly & patient may feel a pop, harsh pain & weakness in arm. These symptoms can also be worse when the shoulder or arm is inflated overhead, especially when doing daily tasks such as picking up plates out of a cabinet.
During physical evaluation, orthopedic surgeons will press on various parts of patient’s shoulder & move their arm into various positions. They will also test elasticity & strength of the patient’s muscles around arms & shoulder. Following imaging tests may also be recommended by orthopedic surgeons.
- History & Physical Assessment – This is the best method to initially begin evaluation of patient’s health. It is extremely important for surgeons to identify root cause of pain & underlying discomfort.
- X-rays – X-rays are beneficial to look for arthritis, calcifications or bone issues that have caused rotator cuff tears.
- MRI Scan – This is the most effective imaging technique to diagnose intrinsic rotator cuff tears. It can help surgeons to look for inflammation of tissues & to figure out size & character of rotator cuff tear in order to suggest proper treatment.
- Arthroscopy – Several injections or arthroscopy may be helpful in diagnosing rotator cuff injuries as well.
There are three major & most commonly used techniques for rotator cuff repair surgery, namely open repair, mini-open repair & arthroscopic rotator cuff repair. These techniques are able to relieve arm or shoulder pain, provide strength enhancement & overall satisfaction of patients.
- Open Repair – This is a conservative open surgical incision technique & is often needed when tear is complex or large. Surgeons mark incision over shoulder & disconnect shoulder muscle known as deltoid to clearly see & gain passage to the injured tendon. During an open repair technique, surgeons typically pull out bone spurs from underneath of acromion. This procedure is referred to as Acromioplasty. Open repair surgery may be the best alternative if tear is complex or if supplementary reconstruction, like tendon transfer, is required. Open repair is the oldest method being used for treating torn rotator cuffs.
- Arthroscopic Repair – While performing this procedure, orthopedic surgeons instill a small camera, known as an arthroscope, into shoulder joint of patients. Camera displays intrinsic photos on a monitoring screen & the surgeon uses these detailed images to guide narrow surgical tools & instruments. As these instruments & arthroscope are thin in dimension, orthopedic surgeons can use very small cuts, rather than using longer incisions required for the standard open surgery. Arthroscopic repair is usually least invasive procedure to repair a broken rotator cuff.
- Mini-Open Repair – This technique uses comparatively newer technology & tools to perform rotator cuff repair through a smaller incision. Length of incision is normally 4 to 5 cm long. This method uses arthroscopy to determine & treat damage to all structures within the shoulder joint. For example, bone spurs are often eliminated arthroscopically. This prevents the need to remove deltoid muscle. Once arthroscopic part of the procedure is finished, orthopedic surgeons will repair torn rotator cuff via mini-open incision. Surgeons view inmost shoulder anatomy directly during tendon repair, rather than monitoring through video.
While each of these available techniques have their own advantages, nevertheless all of these methods have similar goals of getting the tendon to heal.
Patients should tell their orthopedic surgeons what medicines they are consuming on a regular basis. A clear communication between patients & surgeons is the key to getting expected outcomes following rotator cuff repair surgery.
Two Weeks before Rotator Cuff Repair Surgery
- Medication Limitations – Patients may be advised to stop taking medicines which may result in bleeding after surgery. Some of them may include aspirin, naproxen, ibuprofen & other drugs. In addition to this, patients should ask their surgeons which medicines they should take regularly.
- Complete Health Evaluation – When patients have medical problems like diabetes, heart disease or other serious health worries, they should get a check-up done prior to their rotator cuff repair surgery.
- Alcohol Intake – Patients should frankly tell surgeons if they have been consuming a lot of alcohol, more than 2 or 3 drinks per day as it can create problems in recovery.
- Smoking – Patients who smoke should quit smoking prior to surgery. If they find it difficult, they should take professional help because it slows down bone & wound healing.
On the Day of Rotator Cuff Repair Surgery
- Food – Patients must follow all instructions on when to stop eating & drinking before surgery.
- Medicines – Patients should take prescribed medicines which the surgeon told them to with a small sip of water before undergoing surgery.
- Time – Patients should arrive on time in hospital on the day of surgery & stay relaxed.
- Can my rotator cuff injury be healed without undergoing surgery?
- What alternatives are available for rotator cuff repair?
- Are there any medical websites that you suggest would be informative?
- What are the risk factors involved in rotator cuff repair surgery?
- What type of improvement can I expect from my operation?
- If I delay rotator cuff surgery, what would be the implications of this?
- How many years of experience do you have in performing rotator cuff surgery?
- What is the ratio of complications that you had experienced with this operation?
- Can I talk to your old patients who had undergone rotator cuff repair surgery?
- Where will you carry out my rotator cuff surgery?
- Are there any back-up health provisions, if something goes wrong during my surgery?
- What happens if I require another operation due to some complication? Who will pay for additional surgical costs?
- How many days will I have to wait or stay in the hospital?
- How much time does it take to complete this surgery?
- Which type of anesthesia are you going to use? Are there any risks related with this kind of anesthesia?
- Can you precisely tell me about the complications that I may face with rotator cuff repair surgery?
- Will I require physiotherapy after rotator cuff repair surgery? For how many days?
- What support will I require at home after my operation?
- How long will post-operative pain last?
- How much time will it take before I can go back to office?
- What limitations will be there on my routine activities after rotator cuff repair surgery? For example, will I be able to climb stairs/drive/run/have sex/play sport/or take a bath?
- When should I come for follow-up appointment?
Rotator cuff is composed of tendons & muscles that form a cuff over the shoulder joint. These tendons & muscles properly hold the arm & help shoulder joint to move easily. Tendons can be injured from overuse or following a serious shoulder injury.
- Anesthesia – Patients are most likely to be given general anesthesia before surgery. Patients will then be asleep & will not feel any pain. They may have regional anesthesia as well where arm & shoulder area will be deadened so that patients do not experience any pain at all. Moreover, this operation can be performed by one of the three common techniques – open repair, arthroscopy or mini-open repair.
- Open Repair – When open repair is performed, an incision is made & deltoid is gently pulled out. It is done for large or more complicated tears.
- Arthroscopy – During this procedure, an arthroscope is inserted with the help of a small incision & it is connected to a video screen. This allows surgeons to see inside details of the shoulder & perform the operation.
- Mini-Open Repair – During this method, any injured tissue or bone spurs are taken out or repaired with the help of an arthroscope. 3 to 4 inch incisions are made to restore rotator cuff.
- Rotator Cuff Repair – Tendons are again attached to bone. Suture anchors are commonly used to attach tendon to bone. They can be made of material that can dissolve over time. Stitches are done to anchors, which tie tendon with bone.
- Closing Incisions – At the end, these incisions are closed & a bandage or dressing is done efficiently.
Patients must follow any discharge & self-care instructions given by orthopedic surgeons. Patients will need to wear a sling when they get discharged from the hospital. Some of the patients may also be told to wear a shoulder immobilizer. This prevents the shoulder from moving inappropriately. How long patients wear the immobilizer or sling will depend upon the kind of surgery they chose to undergo. Complete recovery can take up to 6 months of time, depending upon tear & other medical conditions of the patients. Moderate pain following surgery can be managed with proper medicines as prescribed by surgeons. Physical therapy is necessary in order to regain complete motion & strength of shoulder. Positive attitude & will-power of patients is important for speedy recovery.
Few percentage of patients experience some complications after rotator cuff repair surgery. Along with general risks of surgery such as blood loss or adverse effects of anesthesia, complications of rotator cuff repair surgery may include the following.
- Severe Nerve Injury – This generally involves nerve that mobilizes patient’s shoulder muscle.
- Infection – Antibiotics are given to patients during surgery to lessen risk of any infection. An additional surgery or antibiotic treatment may be needed in case of infection.
- Deltoid Detachment – During procedure of an open repair surgery, shoulder muscle is removed in order to gain better access to rotator cuff. At the end of surgery, it is again stitched back into proper place. It is very essential to protect this region after surgery to allow it to heal.
- Stiffness – Permanent stiffness or loss of motion can be sometimes caused after surgery. However, most of the time, this stiffness will improve with exercises & physical therapy.
- Tendon Re-Tear – There is a risk for tendon re-tear. Revisional surgery is required in such cases.
Majority of patients report enhanced shoulder mobility & less pain following rotator cuff repair surgery. Every surgical repair method has the same results in terms of relieving pain & progress in functioning of arm. The surgeons expertise & patient’s dedication are the important factors in achieving satisfactory outcomes. Patients can be able to perform various activities freely once they recover completely. Outcomes will be durable & long-lasting as long as proper care is taken by the patient.
Benefits of Medical Tourism in India for Rotator Cuff Repair Surgery
Spectacular natural beauty, colorful culture & engrossing history are few aspects of India that attract a number of tourists from all over the world. Apart from this, India has also become one of the most popular medical tourism destinations in the world. India offers world-class & affordable orthopedic surgeries to international patients as compared with any other western country. India has a great network of orthopedic hospitals that are well-organized & orthopedic professionals efficient in performing rotator cuff repair surgery. Travcure Medical Tourism is one of the best medical tourism facilitators in India which offer the best treatment for rotator cuff repair. Team at Travcure is well-experienced to guide international guests throughout the medical journey. To ensure speedy recovery, Travcure also provides rejuvenation packages to overseas patients to make their medical trip to India a memorable experience.
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