A Common Shoulder Problem.
What is rotator cuff?
Shoulder joint is the most mobile joint in our body. It is a ‘ball and socket’ type of joint formed between the arm bone and the shoulder blade. There are 4 muscles that originate from the shoulder blade and get attached on the ball of the arm bone. These muscles act like different gears of the shoulder joint and are responsible for proper functioning and movement of the shoulder joint. These four muscles together form the “Rotator Cuff’.
How does rotator cuff tear (RCT) occur?
Rotator cuff tear is a problem of the older population aged around 60 years and above .The tendon becomes weak due to ageing and a small household fall on the hand or a jerk, while lifting a bag or while doing some kitchen or garden work can cause the rotator cuff tendons to tear.
Signs and Symptoms of Rotator Cuff Tear
There is severe pain in the shoulder and midarm area. Pain increases at night and many patients with Rotator cuff tear cannot sleep lying flat on the bed.
There is inability to lift the arm over 90 degrees. Weakness in the shoulder is profound.
Diagnosis
There is a strong misconception in our population that every shoulder problem is ‘Frozen Shoulder’, hence RCT patients get diagnosed quiet late. Early diagnosis is critical, because as time passes without treatment, the cuff tear increases in size and muscles become very weak and tear may become irreparable.
A thorough clinical examination by an expert Shoulder surgeon is most important in diagnosing Rotator cuff tear.
X-ray, MRI scans and sonographer helps in confirming the diagnosis.
Treatment of RCT
We will discuss treatment of repairable cuff tears here. These patients need to undergo Arthroscopic Rotator Cuff Repair surgery.
Arthroscopy is a precise ‘Key Hole’ surgery technique of the shoulder joint.
Around three to four holes of 5-8 mm diameter are made in the shoulder and using specialized instruments and techniques the torn cuff tendon is repaired to the bone using special screws called ‘suture anchors’. These suture anchors are around 5 mm in diameter and get absorbed in the bone after a few years.
Only 2 days of hospital stay is needed.
Post-surgery, there is almost no pain, because of improved anesthesia methods. No plaster needed, just a simple arm sling for few weeks.
The patient starts hand and arm movements on the very next day of surgery. He/she can start activities like eating, writing, typing, in one week, after surgery.
Physiotherapy is an important part of the complete treatment and full recovery takes around 2-3 months depending on the severity of the cuff tear.
The overall success rate of Rotator cuff repair surgery is 95-98%.
Take home message Don’t self-diagnose shoulder problems.
Every shoulder problem is not frozen shoulder.
Examination by an expert shoulder surgeon is the most important step in the successful diagnosis and management of Shoulder problems.
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