Rotator Cuff Repair
The rotator cuff is made up of a group of muscles and tendons surrounding the shoulder. Their function is to hold firmly the top part of the arm inside the deep shoulder cavity, keeping it stable when moving the arm in any direction.
Rotator cuff injuries are common. Most of them are the result of the wear caused by repeating the same arm movements over and over, which eventually leads to tissue breaking and injury.
These injuries are more frequent in people that do repetitive movements in their sports or work, increasing the risks of suffering a rotator cuff injury as they age.
Rotator cuff injuries sometimes do not cause pain. When they do, the pain usually appears in the upper arm or the shoulder. You may feel pain in activities like:
- Laying on the injured shoulder.
- Lifting your arm or lowering it to the front or the side.
- Stretching your arm behind your back.
Other symptoms that may arise due to a rotator cuff tear are:
- Loss of arm strength.
- Cracking sounds when moving your arm.
Many people recover by means of physical therapy exercises that improve the flexibility and strength of the muscles surrounding the shoulder joint.
Rotator cuff tears can also be the result of a single injury. If that is the case, seek medical attention as soon as possible. More extensive tears could require surgical repair.
Repair surgery is usually an outpatient procedure, by means of arthroscopy or a minimally invasive method.
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Shoulder Instability Treatment
Shoulder (glenohumeral) instability is the abnormal and excessive movement between the head of the humerus and the glenoid cavity of the scapula. This injury may be the result of trauma or overuse, and it is generally related to young patients who practice contact sports.
Shoulder stability is the product of elements called stabilizers, which are present in the joint. Their function is to keep the head of the humerus attached to the glenoid cavity of the scapula.
Instability occurs when the humeral head exits the glenoid cavity of the scapula causing a luxation, or dislocation, when the detachment is complete and a subluxation when it is partial.
The most frequent injuries as a result are:
- Tearing of the labrum and the glenohumeral ligaments of the scapula, also known as Bankart lesion
- Lengthening of shoulder ligaments due to forced stretching, causing laxity
- Significant fracture of the edge of the glenoid cavity
- In older patients, major shoulder tendon or rotator cuff tearing
Patients notice shoulder pain when adopting certain positions. On occasion, they mention a popping sound and the feeling that the joint “comes out of its socket”.
The shoulder becomes unstable in several directions: anterior, inferior and/or posterior.
Some patients may have a congenitally lax ligament tissue, which conditions the onset of instability.
Injured patients will require rehabilitation strengthening the rotator muscles of the shoulder as well as the periscapular muscles.
If the rehabilitation treatment has not provided the desired results, you will be advised to undergo surgical instability repair, either arthroscopically or by means of conventional open surgery.
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Tenodesis is the implantation of a tendon to a bone in the same place where it detached from or in a different place from the original. Biceps tenodesis may be operated arthroscopically with anchor fixing by resectioning the intraarticular portion of the long head of the biceps in the shoulder and surgically fixing the tendon end to the humerus.
Situations where biceps tenodesis could occur:
- Pre-tendon rupture
- Dislocation or subluxation of the biceps tendon from the humeral groove
- Intraarticular entrapment due to hypertrophy of the long biceps head for preserved tendons of the rotator cuff
- Biceps tenodesis may involve arthroscopic repair of the rotator cuff or may be done together with a debridement of a non-reparable rotator cuff.
Patients will mainly feel acute pain in the shoulder area and loss of functionality.
Surgical intervention is required for an implantation of tendon to bone, since there are no preventive treatments that can improve the quality of life of the patient.
Acromioclavicular Joint Injury Treatment
The acromioclavicular joint (AC) connects the clavicle with the acromion (end of the shoulder blade spine). When an acromioclavicular dislocation happens, both these bones become dislocated and lose contact with each other, settling in an abnormal position.
This injury may be considered mild, moderate or severe. These levels may condition the patients symptoms based on the injury grade in question:
Grade I (mild): simple AC ligament stretching, no actual separation.
Grade II (moderate): AC ligament rupture with coracoclavicular ligament stretching.
Grade III (severe): complete rupture of AC and coracoclavicular ligaments, showing deformity in the top part of the shoulder.
The symptoms that appear in acromioclavicular joint injury are as follows:
- Localized joint pain
- Deformity (for severe cases)
- Increase of volume in the top part of the shoulder
The grade of the injury will condition the recommended treatment for each case. Mild, moderate and severe cases that show no deformity may be treated non-surgically by means of painkillers, rest and rehabilitation.
In case of severe dislocations, a surgical procedure will be required to recover function in the area.
Learn about the Fergus solutions to treat acromioclavicular joint injury.