Shoulder tendon repair surgery

A rotator cuff is a group of muscles and tendons that make a cuff over the shoulder joint. These muscles and tendons help in holding the arm in its joint and the shoulder joint to move. These tendons can get torn due to an injury or overuse, and may require treatment.

Causes: The different causes of shoulder tendon damage or rotator cuff injury include:

• Wear and tear of tendon tissue with an increase in age
• Repeated bouts of heavy lifting
• Repetitive overhead activity
• Falls, accidents, or injuries

Purpose: Shoulder tendon repair surgery is recommended when the non-surgical methods have failed to be effective. Surgery is generally recommended in the following cases:

• If the symptoms persist for more than 6 months
• If the tear is more than 3 centimeters
• If the tear is due to a recent injury or traumatic incident
• When there is a loss of function in the shoulder region or serious weakness
• If the person has a job or plays sports that require maneuvering the arms and shoulders a lot

Symptoms

The symptoms associated with an injured rotator cuff are:

• Shoulder pain
• Weakness in the shoulder region
• Difficulty in sleeping on the side of the affected shoulder
• Feeling of the shoulder being unstable
• A popping or cracking sensation while moving the arm
• Inability to have a full range of motion

Diagnosis

1. Physical examination: The surgeon will press on the different parts of the affected shoulder and move the arm into different positions. The strength of the muscles around the shoulder and in the arms is also tested.
2. X-rays: It helps in the visualization of bone spurs or other possible causes for shoulder pain, such as arthritis.
3. Ultrasound: Sound waves are used to obtain images of the structures within the body, especially the soft tissues like tendons and muscles. The test allows the assessment of the structures of the shoulder during movement and is helpful in comparing the affected shoulder and the healthy shoulder.
4. Magnetic resonance imaging (MRI) scans: Radio waves and a strong magnet is used to obtain detailed images of the shoulder structures.

Treatment

The surgery is usually performed under general anesthesia, that is, the patient is put to sleep during the procedure. Sometimes the procedure may be done under regional anesthesia, that is, the shoulder and arm area will be numbed.
The surgery may be performed using any one of the following techniques:

1. Open repair surgery:

• The procedure is done for large or complex tendon tears.
• The doctor makes an incision or cut near the shoulder region.
• The deltoid muscle (a large muscle in the shoulder region) is gently moved out of the way to perform the surgery.
• The tendons are re-attached to the bone.
• Small suture anchors, known as rivets, may be used to attach the tendon to the bone.
• These suture anchors are made up of metal or material that will dissolve over time and do not require removal.
• Sutures or stitches will be attached to the anchors to tie the tendon back to the bone.
• The incision is closed and a dressing is applied.

2. Arthroscopy:

• The doctor makes one to three small incisions in the treatment area.
• An arthroscope (a tube having a camera on one end) will be inserted through one of the incisions made.
• Other small surgical instruments are inserted through the other incisions to carry out the procedure of tendon repair in a manner similar to that of open repair surgery.

3. Mini-open repair surgery:

• Any damaged tissue or bone spurs that may be present are either removed or repaired using an arthroscope.
• Later as an open part of the surgery, a two-to-three-inch incision is then made for repairing the rotator cuff.

Risks

The complications associated with shoulder tendon repair surgery include:

• Infection
• Bleeding
• Blood clot formation
• Allergic reaction to the medicines used
• Nerve injury
• Blood vessel injury
• Injury to a tendon
• Failure to relieve symptoms 
• Stiffness or loss of motion of the shoulder joint
• Re-tear of shoulder tendon
• Detachment of the shoulder muscle (deltoid)
• Need for repeat surgery

After Procedure

• It is normal to have some pain and discomfort after the surgery.
• You will be given medicines to relieve your pain.
• You will need to wear a sling and avoid using your operated a for the first four to six weeks after surgery.
• A physiotherapist will start with certain passive exercises while supporting your operated arm and moving it in different positions within the first four to six weeks after surgery.
• After four to six weeks, you may start with active exercises without the help of the physiotherapist. Movement of the muscles on your own will gradually increase the strength of the shoulder and improve arm control.
• At eight to twelve weeks the physiotherapist will start with a strengthening exercise program.
• Complete recovery following a shoulder tendon repair surgery may take up to four to six months.

Home remedies:

• Avoid any pulling, pushing, or lifting motions for the first four to six weeks following the surgery.
• Avoid driving till your doctor permits the same.
• Apply an ice-pack to the site of surgery for two to three days after the surgery, two to three times a day.
• Either take a sponge bath till your sutures are removed, or cover your operated shoulder with plastic while having a shower to prevent it from getting wet.
• Change your bandage about four to five days after the surgery.
• Move your shoulder as much as you can and use your hands to write.
• Avoid sleeping on the side of the surgery.

Cost of Shoulder  tendon repair surgery in India- 

The cost of shoulder tendon repair surgery in Mumbai is between INR 60,000 to INR 3,50,000.
The cost of shoulder tendon repair surgery in Delhi is between INR 55,000 to INR 3,00,000.
The cost of shoulder tendon repair surgery in Bangalore is between INR 55,000 to INR 3,00,000.
The cost of shoulder tendon repair surgery in Chennai is between INR 50,000 to INR 2,50,000.