Dr. Shekhar Srivastav is the senior orthopedic consultant & Robotic Knee Replacement Surgeon performing Joint Replacement & Arthroscopic Surgeries of Knee & Shoulder Joints and is HOD of the Orthopedics Department at the Delhi Institute of Trauma and Orthopaedics (DITO), Sant Parmanand Hospital. He has a keen interest in the management of Knee & Shoulder problems, Robotic Knee Replacement Surgery.

He has performed thousands of Total & Partial Knee Replacement( Primary, Revision & Unicondylar replacement) & Arthroscopic Surgeries ( ACL, Meniscus, and Cartilage surgeries). Similarly, in Shoulder, he’s an expert in performing Shoulder Arthroscopies ( Bankart repair, Arthroscopy Rotator Cuff Repair) & Shoulder replacement Surgeries ( Total & Reverse Shoulder Replacements).

Rotator Cuff Tear

A group of muscles surrounds the shoulder joint called the rotator cuff which is the most important muscle for the shoulder joint. These muscles can get torn due to injury in a younger individual. But this is mostly torn in elderly persons due to degeneration( wear & tear) without any significant trauma. The patient complains of pain, and weakness in his shoulder, and in long-standing cases, it can lead to arthritis of the shoulder joint.

Arthroscopic Rotator Cuff Repair

Rotator Cuff tears don’t heal by themselves. In partial or small tears conservative management can be tried. But if the problem persists or if the tear is large this requires surgical repair. Previously open surgery was done for the repair but now the complete repair can be done arthroscopically (keyhole technique). Tiny holes are made in the skin over the shoulder joint through which a small camera is inserted and repair is done. This relieves the pain and function is restored

About your shoulder

The shoulder joint is covered by layers of muscles that help you to move your arm. The deepest layer consists of three main muscles collectively known as the rotator cuff.

It serves many purposes but the main function of the cuff is to lift (elevate) your arm.

The rotator cuff is situated underneath a bone of shoulder known as acromion. The space for the cuff is very tight and in many patients the cuff may rub on the undersurface of the acromion.

This can lead to painful inflammation, particularly with the use of an arm or at night in bed. If this rubbing of the rotator cuff underneath the acromion continues, a small hole may be torn in the rotator cuff.

What are the symptoms?

Initially pain while using the arm or pain at night which might interfere with sleep may be the only symptom. If the tear is small then the arm may still have full function. If the tear becomes large then you may lose power in your arm, and eventually may not be lift the arm at all. In rare cases, this may lead to arthritis within the shoulder joint.

What tests are done?

The diagnosis is made on your symptoms and clinical examination which is performed by your doctor. An x-ray is done to look for any bony pathology. MRI is done to confirm the diagnosis and to determine the extent of the tear, amount of retraction, and fatty degeneration in the rotator cuff.

What is the treatment?

The treatment is done by keyhole surgery (arthroscopy). A number of small holes are made around the shoulder and the surgery is performed through these keyholes with a camera and special instruments. In the early stages of the disease, with impingement syndrome and no rotator cuff tear, the treatment is subacromial decompression.

It involves the removal of a bony spur from the undersurface of the acromion. This increases the space available for the rotator cuff and therefore the amount of rubbing on the undersurface is reduced. This allows the inflammation and pain to settle.

If the rotator cuff is torn, then more extensive surgery is required. Suture anchors are used to repairing the tears in the rotator cuff and fix them to the bone. In some cases, the surgeon may also decide to release the Biceps tendon along with repairing of torn Rotator Cuff if it is damaged. It is important to repair a torn Rotator Cuff tendon early as in long-standing cases the tendon may retract and the quality of the tendon also deteriorates thus leading to a poor outcome even after surgery. If the cuff tear is massive, repair may not be possible by any means. In these cases, a subacromial decompression is done and no other procedure is attempted.