Rotator
cuff rupture
The rotator cuff is the
complex of the four muscles (with the respective tendons) which contributes to
the movement of the shoulder joint in the various planes of the space and which
keeps the joint between the scapula and humerus (the bone that belongs at the
upper part of the arm).
The "lesion"
of the rotator cuff is the partial or complete rupture of one (or more) between
the tendons that constitute it.
What
is rotator cuff tear?
The rupture of the
rotator cuff is a widespread condition, especially in elderly patients; in case
of breakage that can be both partial and complete, generally, both pain and
functional limitations are present. Dr. Prakash M Doshi, who has 30 years of
experience and works at Nanavati Super Speciality Hospital, is the best orthopedic
surgeons in Mumbai.
What
are the causes of rotator cuff tear?
The rupture of the
rotator cuff can occur either due to a traumatic event, as a result of a wrong
movement, an excessive load or an impact, or by degenerative, more slowly, due
to continuous stress of the joint or as a result of aging-induced degeneration.
More frequently it is a
combination of these two elements that lead to tendon rupture: due to degenerative
phenomena, a tendon "thinning" phenomenon starts, which can then
evolve either spontaneously or following trauma or even trivial efforts in a
complete rupture.
What
are the symptoms of rotator cuff tear?
The rupture of the
rotator cuff is usually characterized by pain in the front part of the
shoulder, especially if the cause of the break is of a traumatic nature. The
patient feels pain, which can also be radiated to the whole arm, especially
when it makes movements such as lifting the elbow over the shoulder or resting
it on a surface such as the arm of an armchair or the surface of a table or
desk.
When the rupture
derives from a chronic condition, the pain manifests itself with varying
intensity over time and is often present at night; it is also accompanied by
greater difficulty in making movements, which have a more limited radius, and
the impossibility of lifting even modest weights.
Diagnosis
The rupture of the
rotator cuff is usually diagnosed by physical examination, followed by
confirmation by an MRI scan.
The x-ray, however,
although it does not show the rupture, can be used to find any alterations
affecting the skeletal components.
Treatments
Often the surgical
option is not the first choice for the treatment of rupture of the rotator
cuff, as it is possible to have relief the symptoms even with rehabilitative
therapies.
The surgical approach
is often considered as the first option only in cases of total rupture in young
patients when it is suspected that it may lead to an alteration in the
conformation of the joint itself.
Surgical
therapy
When there is an
indication for a surgical approach, due to the negative outcome of non-surgical
treatments (usually not accessible before 8-12 weeks) or other factors, the
specialist may decide to operate.
Arthroscopy, in this
case, is the most used intervention as day surgery, under regional anesthesia
and through three small "little holes" through the skin leading to
the direct visualization of the lesion and its repair.
Surgery has proven
effective in therapy for rotator cuff tear, although the pathology may recur
throughout the life of the same individual. In very severe cases it is possible
to replace a part or the entire joint with a prosthesis.
After surgical therapy,
whatever the approach adopted, a rehabilitation procedure is usually necessary,
divided into three phases:
First
phase: immobilization of the arm for about 4
weeks, to allow the muscle tissue to repair itself.
Second
phase: assisted physiotherapy, to recover the
movement of the joint (about 4-8 weeks).
Third phase:
strengthening of the muscles through assisted physical exercise and no (about 8
weeks).
Cost of rotator cuff
surgery in India is USD 3200 with 2 days stay in hospital and 7 days stay in
all.
