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Rotator cuff of shoulder is a complex of ligaments and muscles that is joined with the head of humerus and ensures movement and rotation of shoulder. Functioning of rotator cuff allows making all movements of shoulder joint. In fact, shoulder joint is the most mobile joint in human body: it can make the spectrum of movements other joints are not capable of. Thanks to this very joint, a human arm has so many functions.
However, high mobility of shoulder joint promotes different kinds of damage and degenerative changes of joint capsule. Frequent injuries trigger instability of shoulder joint and damage its structures. Tearing of rotator cuff is one of the most widespread kinds of damage.
There are many different causes of diseases and damage of rotator cuff. It’s important to know basic reasons to avoid them and prevent damage and some conditions of rotator cuff.
- Hard physical exercises that put load on the upper limbs, especially, shoulder joints and their ligament apparatus;
- Long-lasting overloading of ligaments of rotatory cuff (when arms are always elevated, for instance, among builders or painters);
- Chronic injury of elements of shoulder joint (muscles, joints, ligaments);
- Acute traumas of shoulder (fractures);
- genetic predisposition to diseases of rotatory cuff, or pathologies of connective tissues;
- poor or insufficient blood supply of ligaments and joints of rotatory cuff. It is typical of all people: this is a peculiarity of tendon-joint apparatus. This is what affects human body considerably, because poor blood supply often leads to degenerative changes in rotatory cuff.
There are several causes of damage of rotatory cuff:
- Pain in damaged rotatory cuff;
- weakening of arms;
- Inability to make full movements, or restriction of movements (arm retraction to the sides, elevation of arms);
- permanent pain in the shoulder and restriction of movements affect overall well-being and lifestyle (inability to perform all habitual movements and actions, that may also affect professional abilities);
- pain in shoulder joint at night or during sleeping.
Symptoms of rotatory cuff damage are usually pronounced, so patients usually visit doctors in time. It’s crucial to be treated by qualified and experiences specialists who can state the right diagnosis and start specific therapy. Precise diagnosis makes up for successful and efficient treatment.
Treatment of rotatory ciff damage can be conservative and operative. Conservative treatment is assigned when the rotatory cuff is not seriously damaged, and function of the joint can be restored without surgery.
Conservative treatment can be performed by immobilization of shoulder joint with a special bandage (orthosis) and includes physical therapy procedures, anti-inflammatory drugs and pain killers. If pain is severe, it’s blocked by repository glucocorticoids. Intraarticular injections of plasma enriched in hematoblast (growth factors, PRP) gives a very good clinical effect.
If conservative treatment has been performed for 2-3 months, and it does not give positive outcomes, a surgery should be definitely considered.
Restoration of tendon rupture of rotatory cuff is a pretty difficult operation. Reconstruction of rotatory cuff can be made either with an open approach (via cut on the shoulder), or by arthroscopy.
The main disadvantage of open surgery is the need to make huge traumatic cuts on shoulder to get access to damaged tendons, which poses high risk of side effects and requires long-term recovery after the operation.
In German clinics, surgical treatment of damage of rotatory cuff is performed with modern approaches without cut of joint. Operation are performed under arthroscopic control, so you can be sure in their safety and efficiency.
Instead of a cut, small incisions are made, and arthroscope with a camera is put in one of them, and instruments for performing manipulations are put through other incisions. The image from camera is enlarged and displayed on a monitor for the surgeon to perform the operation watching all structures of the joing and defining the location of damage.
When it comes to an arthroscopic operation, the cut is stitches, and if tendon has torn away from the place of fixation, a stitch with special „spud legs“ is made.
At the first stage of shoulder surgery, the joint is cleaned: all dead and degenerate tissues of the rotatory cuff are removed. After that, the area of shoulder bone where the rotatory cuff torn or damaged, is cleaned from the rest of soft tissues to that the tendon will grow together with it quickly. As a rule, 2-3 „spud legs“ are required for fixation of torn tendon. The fixator consists of an anchor and fibers. The anchor is fixed to bone, and fibers are used to underrun the tendon.
The choice of anchor fixator is made by the surgeon, but patient must be informed on which type of fixator is used in his case. We recommend using fixators of globally acknowledged brands that have proved to be reliable and safe. Consult with your doctor and ask about the options available: you will figure out a suitable fixator that fits your demands and budget.
A correctly performed operation allows starting quick and active rehabilitation to prevent development of complication and optimize recovery period. Therefore, it’s crucial to find a surgeon and team of doctors you can trust. German clinics are highly reliable: they provide efficient treatment and guarantee individual approach to every single patient.
After shoulder arthtoscopy, patient’s arm is immobilized in leads position for a few weeks with the help of a special splint. Immobilization reduces tension of tendons and minimizes risk of secondary tearing, creating optimal conditions for better recovery of the tendon. Duration of immobilization is defined by the surgeon who performed operation: only the doctor can estimate the condition of tendons and rigidity and stitches.
First weeks after arthroscopy of shoulder, patients are recommended to perform special exercises aimed at development of movements in shoulder joint. However, their intensity and order should be figured out by the surgeon and an experienced rehabilitation specialist. A patient should maintain minimal regular physical activity to ensure normal blood flow in the area of shoulder joint and exclude the risk of thrombosis.