The rotator cuff consists of four muscles and their tendons which surround the ball (humeral head) of the shoulder joint. The muscles fine tune the movements of the shoulder and help keep the ball of the shoulder joint in its socket. The tendon of the rotator cuff passes through a narrow space between the top of the arm bone and a prominent bone on the shoulder blade (the acromion).
The tendon is very vulnerable to being pinched here when the arm is moved, especially above the head. Over time this pinching can lead to tears of the tendon; the chance of this increases as we get older. When repeated tearing occurs, the fabric of the tendon becomes weakened and finally, like the cloth at the knees of old trousers, splits. This leads to altered biomechanics, which can lead to pain, weakness and shoulder arthritis.
Different forms of treatment such as injection and physiotherapy are available for incomplete tears and low demand patients, but sometimes it is necessary to repair the tendon.
When to do the surgery ?
Surgery has to be done at the earliest before muscle get atrophied, fatty replacement of the muscle fibers occurs and cartilage degenerative changes sets in.
Once the above said changes starts reverse shoulder replacement surgery will be essential.
The operation is usually performed through the keyhole/arthroscopy. The tendon is repaired by stitching it to original area of foot print to the bone. Various techniques are employed depending on the tear morphology - single row, double row. The arm is then placed in a sling and physiotherapy initiated within a week and progressed as per protocol until complete recovery which may take 8-12 weeks.