ARTHROSCOPIC REPAIR OF SHOULDER TENDON RUPTURES

What is the Structure of The Shoulder?

The shoulder joint is a joint formed between the slightly concave face of the shoulder blade and the spherical surface of the arm bone. Unlike the hip joint, the shoulder head does not stand in the pit of the joint, but on the face of the joint. Therefore, the bone stability of the joint is poor, while the tendon and ligaments provide the main stability. Thanks to this anatomical structure, the shoulder is the joint with the greatest range of motion. On the other hand, tendon and ligament structures are the most common problem in the shoulder joint with poor stability and wide range of motion.

As the muscles moving the shoulder joint approach to the shoulder, they tend to the tendon structure and adhere to each other and to the shoulder capsule. This structure is called the rotator cuff of the shoulder. The task of this structure is to provide shoulder movements by keeping the shoulder in place.

Shoulder Rotator Cuff (RK) How do tears occur?

In young people, cuff tears occur due to falls or severe trauma, while tendons that are worn at an advanced age may be torn as a result of slight stresses or daily use.

What Are the Findings of Shoulder Rotator Cuff Tears?

Shoulder pain is present during compelling activities in the day, but it actually causes discomfort at night. The patient cannot lie on his uncomfortable shoulder. The pain starts from the shoulder and spreads to the upper arm. At the beginning, patients experience difficulty at movement of overhead activities and heavy loads, but in time they experience difficulty to raise their hands on the head. Cuff tears may be in the form of full-thickness or partially thickness. There is additional power loss in full-thickness tears. The patient does not raise his arm above his head or if he is asked to keep it at shoulder level, he will have to release his arm after a short time. Long-term unrepaired full-thickness tears disrupt the movement mechanics of the shoulder joint causing arthritis and loss of motion over time.

How is Shoulder Rotator Cuff Tear diagnosed?

In case of difficulty in lifting the arm after shoulder trauma or a few weeks of shoulder pain which doesn’t stop, consult a physician.

After the joint movement examination, your doctor will perform some special examination tests for the rotator cuff tear for diagnosis. Additional x-rays or computed tomography may be required for different diagnoses. If rupture is considered, the final diagnosis is confirmed by MRI of the shoulder, surgical operation may be planned by examining the tear size.

How Shoulder Rotator Cuff Tear is Treated?

Non-surgical or surgical treatment is decided according to the age of the patient and the type of rupture.

In partial or small tears, pain can be relieved by physical therapy, pain medication, ice treatment and PRP, then the range of motion is increased. All these treatments have no chance of healing. Tear should be followed with MRI controls. If the patient does not relieve pain or increase in tear is developed in MRI, surgical treatment is required.

Direct surgical treatment is preferred in patients with; full-thickness tears, young patients, those who do heavy labor for the arm, and patients with loss of strength in the arm. Because the tear which doesn’t be sutured will grow in time. In fact, if the tear is not repaired for a long time, unused muscle gains fat and lose its function over time. In this case, as the sutured muscle will not function, also the tear may be torn again in the early postoperative period.

Depending on the age and activity of the patient, surgical treatment can be performed as closed surgery in the form of arthroscopic repair or as open surgery as tendon transplantation. If the patient age with advanced and neglected muscle tears that have no chance of repair,and if there is pain in shoulder, shoulder prosthesis may be preferred. Shoulder prosthesis can relieve pain, even though movements are not exactly as before.

How Arthroscopic Shoulder Rotator Cuff Tear is repaired?

Mostly general and sometimes local anaesthesia (nerve block anaesthesia) is applied to the patient. The shoulder is entered through the 0.5 cm holes drilled on the back and sides of the shoulder with camera system which is called arthroscope. The shoulder examined by seeing inside of its. Torn shape and size are determined. One or two more holes are opened where the tools to be used for suturing will reach into the joint, the ends of the tears and bone adhering parts are refreshed. 0.5 cm anchors made of titanium or fusible materials which we call a suture anchor are placed in the bone. The tendon is sutured to the bone with the threads behind the anchors.

Staying time in hospital is one or two days.

How long does it take to recover after Arthroscopic Shoulder Rotator Cuff Tear Repair?

Supported (padded) arm sling is used for 3 to 6 weeks depending on the postoperative repair strength. Exercises are started immediately, and physical therapy is continued for a minimum of 3 months. Shoulder usage in daily activities is possible after 6 weeks. However, active sport is allowed after 6-9 months.

What complications can occur after Rotator Cuff Repair?

Does not heal of the rupture or reoccur: The rupture may not heal or recur due to the advanced age of the patient, presence of large rupture and weakness of the muscle, smoking, excessive compulsive movement in the early period, new trauma, inadequate repair, and poor bone tissue. In this case, reoccuring tears are usually smaller and painless, so they do not require re-operation. Surgery should be renewed in case of loss of strength and severe pain.
Shoulder movement limitation: Early postoperative rehabilitation and correct and adequate exercise will prevent this complication.