Rotator Cuff - FAQ's Answered!

Why essential to know?
Rotator cuff pathologies are commonly misdiagnosed and overlooked as a frozen shoulder in elderly patients. It is essential to get to the diagnosis early on in patients presenting with shoulder pain and restriction of range of movements.

What are the symptoms of rotator cuff tears?
Most patients present with a typical painful restriction of active range of movements and relative pain-free passive movements. Typical complaints are loss of power due to pain and shoulder dyskinesis.
Neck pains with radiation down the affected arm are the first symptom. Typically these pains become of throbbing nature while the patient goes to lying down posture.

What is the difference between a frozen shoulder and rotator cuff tears?
Most of the symptoms overlap and it's imperative to get examined by a sports medicine/arthroscopy surgeon to exactly evaluate the diagnosis.
Loss of passive rotations is the first most important clinical finding in a frozen shoulder in comparison to a rotator cuff lesion. However, there is nothing absolute that can be said without clinical examination and detailed history. Frozen shoulder means inflammation in the capsule of the joint leading to restricted movements and pain. Whereas rotator cuff tears indicate a loss of muscle strength due to primary tear in muscle tendons.

What can be the reason for a rotator cuff tear?
Most cuff tears in the elderly are basically degenerative in nature. Simple words, we may attribute this to repeated activities causing minor swelling in these small muscles with time and poor quality of the muscle tissue due to lack of exercises.
Some tears may be associated with a significant trauma like a fall or a trivial trauma like a jerk.

What is the role of radiology in detecting these tears?
Xrays, dynamic ultrasound and MRI have a substantial role in confirming:

• Size nature and morphology of the tear
• Quality of muscles that need repair
• Need of implant (which anchor/ how many anchors)
• Assessment of repairability
• Defining the nature of the surgery required
• Prognosis of surgical results.
• Various surgeons may have a different experience with different radiological modalities and may find one more important than the other. These modalities help surgeons to confirm the plan of further action.

What is the approximate cost of the surgery?
Cost straight forward y depends on the nature and number of implant used in the surgery. Implants may vary from titanium anchors to bioabsorbable anchors which have a difference in prices. All implants more or less have similar results with no gross postoperative difference. Also, hospital cost and insurance coverage make a major difference in the final cost.

Which is the best implant for me?
As mentioned above, almost all implants have similar postoperative results as per the literature. Special circumstances may lead to a preference of one type of implant over the other in various surgeons. It's not hard and fast until a patient specifically chooses one variety of implant over the other.

What is the procedure like basically?
The procedure is performed under general anesthesia and makes use of small holes made over skin to insert the camera and instruments into the joint. Usually, 4 to 5 stitches are usual which are removed at two weeks time. The procedure usually takes about 1 hour to complete and an hour in getting patient into and out of anesthesia.
The anchors are basically drilled in the bone from where the muscles have torn. The threads from the screw head are passed from the torn tissue and a knot is tied. As the knot tightens the torn tissue comes and sits on the inserted anchors. The repair is considered complete with a watertight closure achieved.
Your doctor will counsel and guidance regarding the procedure using illustrative images.

When can I be discharged?
The surgical patient can be discharged the next day of surgery after a change of dressing. We advise a 5-week shoulder immobilizer in all patients.

What is the rehabilitation protocol?
Post any surgery, most important is rest for a specific time for the tissues to heal up. This time duration is taken roughly as 5 to 6 weeks after which the shoulder immobilizer will be removed and the range of movements will be established. This goes for a period of 6 weeks to establish a painless passive/assisted range. After a total period of 3 months, strength training exercises are initiated and this is followed by joint sense training. Patients can do everything by the end of 6 months with good rehabilitation.

What are the risks associated with the surgery?
There are absolutely no risks as far as the surgical procedure is concerned. Anesthesia-related complications may be seen in rare cases though.