Shoulder

Rotator cuff repair

Uszkodzenie stożka rotatorów

The rotator cuff is a group of tendons and muscles that support the shoulder joint and allow for complete movement while keeping the ball of the arm bone in the shoulder socket. These tendons and muscles may become torn or otherwise damaged from injury or overuse and can lead to pain, weakness and inflammation.

Causes of damage

  • Degenerative rotator cuff tendinitis – often chronic damage which initially may even occur without significant discomfort.
  • Acute injury, for example a fall on an upright limb or lifting a heavy object with sudden rotation of the arm.
  • Repetitive activities and work with a raised arm (painters, bricklayers).
  • Calcified inflammation. The inflammatory process causes the collection of calcium within the tendons, which causes severe shoulder pain and weakens the strength of the tendon.

Symptoms

  • pain and limitation of joint mobility;
  • increasing shoulder pain during physical activity;
  • Shoulder pain may also occur suddenly (eg lifting a weight or twisting the arm) or escalate gradually;
  • pain associated with specific activities, especially with the arm lifted, such as reaching for a high shelf.
  •  symptoms may also occur at night and disrupt sleep;
  • pain is often accompanied by weakness of the arm or limitation of motion;
  • sometimes crackling and skipping of the shoulder is observable.

Diagnosis

  • Diagnosis is based on a medical examination , supplemented by imaging studies: x-ray, ultrasound or magnetic resonance imaging ( MRI);
  • radiological examination in most cases does not prove changes, but the examination may be necessary to exclude other damage (damage to bones, degenerative changes);
  • ultrasound or MRI can show damage to tendons, the extent and location

Treatment

In some types of damage non-operative treatment is applied, which can bring pain relief. Treatment includes modifying daily activities, implementing an exercise program of the shoulder girdle muscles, whereas analgesics and anti-inflammatory treatment is recommended at moderate ailments and minor injuries.

Surgical treatment – is recommended especially if we are dealing with an acute injury, severe pain or when non-operative treatment does not result in improvement. The aim of surgery is to repair the damaged tendon or restore their function by muscle transfers.

Surgery techniques

  • Reconstruction of the open (open or mini- open) , performed by several cm incision around shoulder , for direct access to the original field attachment of damaged tendons. This technique is preferred when it is not possible to use arthroscopic techniques .
  • Arthroscopy allows insight into the pond by introduced into the camera and seamless execution tendons watching the operated area on a television monitor . The advantage of this type of surgery is low invasiveness , enabling faster recovery and earlier initiation of rehabilitation of the patient.

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