Shoulder Popping?? Permanent solution for your frequent shoulder problem!

Rotator cuff is a group of muscles that surrounds the shoulder joint and gives it mobility and stability.  Due to age related degeneration, injury, overuse the muscles of the rotator cuff can tear. If rotator cuff tears are neglected, over a period of time they can progress and involve multiple tendons and may lead to permanent disability. The shoulders of these individuals can pop out with minor force application.

Signs & Symptoms Of Rotator Cuff Tear:-

Individuals with rotator cuff tears have following symptoms:-

• Pain in the shoulder when lifting and lowering your arm or with specific movements.
• Restriction of movement, 
• Difficulty in performing daily activities 
• Resting pain while sleeping at night, particularly if lying on the affected shoulder.
• Weakness when lifting or rotating your arm.
• Crackling sensation when moving your shoulder in certain positions.

Risk factors:-

The following factors may increase your risk of having a rotator cuff injury:-

• Age- As you get older, your risk of a rotator cuff injury increases. Rotator cuff tears are most common in people older than 40.
• Certain sports- Athletes who regularly use repetitive arm motions, such as baseball pitchers, archers and tennis players, have a greater risk of having a rotator cuff injury.
• Construction jobs- Occupations such as carpentry or house painting require repetitive arm motions, often overhead, that can damage the rotator cuff over time.
• Family history- There may be a genetic component involved with rotator cuff injuries as they appear to occur more commonly in certain families.

Treatment:-

The management of these massive irreparable rotator cuff tears in middle aged (55-65yrs) individuals is challenging and with very few treatment options. 

• Till now we had the option of muscle transfer surgeries that requires intensive physical rehabilitation after the surgery without which the results are poor.
• The other option is of shoulder replacement which gives good results, but its use as a treatment option in individuals < 65 yrs is controversial.

Novel surgical technique for rotator cuff repair - First of its kind Patient Case Report:-

Recently we had a 58 yrs female patient complaining of severe pain in the right shoulder since past three years and was unable to lift her shoulder. She had multiple episodes of the shoulder popping out in the past year and she had consulted many orthopedic surgeons for her problem, with no resolution in symptoms. Her arm had been in a protective sling since three months to prevent pain and dislocation.

Considering her age and minimal arthritis orthopedic surgeon was keen on a joint preserving option for her shoulder problem. The option of muscle transfer was excluded, as it would require extensive and dedicated physiotherapy from the patient. It was decided to go ahead with a novel technique called superior capsular reconstruction by taking tissue from the patient’s thigh. The joint was reconstructed and was fixed to the bone with biodegradable screws that melt over a period of time in the body. On follow-up the patient experienced minimal pain and is currently on physiotherapy for regaining strength for her hand & shoulder movements.

This procedure is a first of its kind to be performed in India.

Long time prognosis:-

• Superior capsular reconstruction recreates the torn rotator cuff of the shoulder to give additional stability to the shoulder joint.
• Patients get good pain relief with the procedure and are generally able to lift the arm till the shoulder level.
• The main aim of the surgery is pain relief in this subset of patients.
• Patient recovery is usually uneventful recovery from the surgery and was and can be discharged few days post surgery.
• Long term patient has to undergo physical therapy and rehabilitation to regain strength of hand & shoulder.

Blog by Dr Aditya Sai (Consultant Orthopaedic Surgeon at SevenHills Hospital)