The shoulder joint consists of a ball (humeral head) and socket (glenoid).The main muscles which help to elevate the shoulder are called the rotator cuff muscles. They are four in number : the supraspinatus, infraspinatus, teres minor and the subscapularis.The Supraspinatus is the most commonly torn rotator cuff muscle tendon.
Rotator cuff tears occur mainly in two ways :
Rotator cuff tear : Diagram (left) & Arthroscopic view (right)
Conservative : - includes mainly anti- inflammatory drugs & physiotherapy This may be tried for very small tears and very old patients ( not fit for suregery).In patients with larger tears, some do become relatively pain free with only conservative treatment but this usually lasts only for some time. All studies show that most large tears usually progress over time so that a small tear today becomes a large tear tommorrow and some may deteriorate to the extent that it becomes irreparable.A surgical repair of the tear usually gives good and consistent results provided the condition of the torn muscle and the bone is reasonably good.
SURGICAL REPAIR OF THE ROTATOR CUFF :
We usually do this as a key-hole surgery (arthroscopy). Few tiny holes (3mm) are made around the shoulder for viewing inside the joint and passage of the instruments. First, the tear is assessed and rest of the joint closely inspected to rule out any other problems.Then bone is prepared to enable the tendon to heal to it. Suture Anchors (tiny devices with sutures or “thread” attached) are inserted into the bone and the tendon is repaired to the bone with these sutures.
Arthroscopic Rotator Cuff Repair can be done by different techniques
In this technique, the torn rotator cuff is repaired using a single row of suture anchors
Advantages of SR RCR :
Here, the cuff is repaired using two rows of anchors. It tries to restore the original anatomy of the rotator cuff as closely as possible.This repair is much more secure than a single row repair
Advantages of DR RCR :
Disadvantages of DR RCR :
It is to be noted that even with the best techniques, rotator cuff repairs have a failure rate of 10-20%.That is because,the success of the surgery depends on some patient specific factors like :
( the longer the muscle remains torn,the more it undergoes degeneration , therby affecting the strength of the subsequent repair)
But it is encouraging that in our experience, most patients are much better in terms of pain relief as well as shoulder strength after the surgery than before.
DR RCR : Diagram (left) & Arthroscopic view (right)