A Guide To rotator cuff repair At Any Age

Rotator Cuff Repair

The rotator cuff is a combination of muscles and tendon which link upper arm bone, humerus to your shoulder blades. The rotator cuff holds the upper arm bone in right place in shoulder socket. There are four muscles in rotator cuff which are supraspinatus, infraspinatus, teres minor and subscapularis. Each muscle is connected to the arm bone by tendons. The rotator cuff surgery is used to repair any tear in any of these tendons.

Symptoms

The rotator cuff injury can happen to anyone. You can hurt your rotator cuff through wear and tear or poor movement over time. As you get aged, the rotator cuff gets irritated by calcium deposits in shoulder area or bone spurs due to arthritis. The symptoms of rotator cuff include:

·       Shoulder Weakness.

·       Pain in shoulder when you lift or pull.

·       Decrease in range of motion in shoulder joint.

Diagnosis Of Rotator Cuff Injury

A physical exam and medical history is very important for the proper diagnosis of the injury. A complete medical history is needed. Doctor will perform physical exam. The doctor will give some tests to be performed to confirm the diagnosis.

After getting the results, doctor will decide whether the surgery is required or not. If the surgery is required, the surgeon will examine the shoulder using an arthroscope. It is not always required. During an arthroscopy, a small camera is inserted to check the shoulder. During the procedure, anesthesia is given at first. The doctor will make a cut and insert camera linked to video monitor. The doctor will use the camera to take a look on tendons, ligaments, and cartilage to check whether the surgery will solve the problem or not.

Deciding On Rotator Cuff Repair Surgery

Surgery is not the first recommended treatment for shoulder injuries. Doctors recommend rest, ice packs, and some exercise. If the injury is not so severe, these treatment approach will be enough. If the tendon is torn, then surgery is required.

          You can go for the shoulder surgery if:

·       You have shoulder pain for more than 6 months.

·       You have shoulder weakness.

The rotator cuff surgery will work best on any recent injury rather than any chronic condition.

Preparing For Rotator Cuff Surgery Repair

Rest and cold packs are best to ease the shoulder pain while waiting for surgery. The doctor will recommend some exercise to help with pain. Some over-the-counter drugs such as aspirin, ibuprofen and naproxen are given. Some pain killers are also given.

Rotator cuff Repair Procedure

First you will receive a general anesthesia. After that it is done with either an arthroscope, open or small incision. If the doctor want to do the surgery with arthroscope, they will put a small camera in one hole and will make one to three small cuts for instruments. The surgeon will use these instruments to reattach tendon to bone. Once the tendon is at the right place, surgeon will attach it with sutures. Surgeon will often use small rivets called as suture anchors. These rivets can be metal or material which will dissolve eventually. The sutures attach to the rivet, reattaches the tendon from where it was torn.

If the rotator cuff tear is large, then you will need a open incision instead of arthroscopic approach. The cut can be 2.5 to 4 inches long for regular open repair or 1.25 to 2 inches for mini-open repair.

Mini-open surgery is required if the doctor wants to remove calcium deposits or bone spur. Bone spur can also develop as people grow old. When the cuts are stitched, then a clean dressing is applied.

Risks

Every surgery carries some risk which include nerve damage, infection, and excessive bleeding. In some cases, the patient may be allergic to anesthesia or suffer from breathing problems during procedure.

Recovery

After surgery, doctor can instruct you to keep arm in sling for 4-6 weeks. You may need to wear shoulder immobilizer. This will help shoulder to hold at 1 place. Some pain medications and exercises are also recommended. Recovery may take 3-6 months depending on nature of shoulder injury.

Craniotomy: Do You Really Need It?

Craniotomy is the surgical process to remove a part of bone from skull to expose to brain. Special tools are used to remove the section of bone called as bone flap. The bone flap is removed temporarily, and then replaced after the surgery is performed.

For some procedures, computer and imaging are used to reach the exact location in brain which is to be treated. The technique require the use of frame placed onto skull using superficially placed markers on scalp. When any of the imaging process is used with craniotomy procedure, called as stereotactic craniotomy.

Endoscopic craniotomy is another type of craniotomy which involve the insertion of lighted scope with camera in brain through a small cut in skull.

Aneurysm clipping is a surgical process which may require craniotomy. The cerebral aneurysm is bulging weakened area in wall of artery in brain, which results in abnormal widening. Due to the weakened area in wall, there is a risk of rupture of aneurysm. A metal clip is placed across the neck of aneurysm, which isolates it from rest of circulatory system by blocking blood flow, and preventing the rupture.

Craniectomy is similar process in which a part of skull which is permanently removed or replaced later during second surgery after the swelling goes down.

Types of Craniotomy

Extended Bifrontal Craniotomy

          It is a traditional skull base approach used to target difficult tumors toward front of brain. It involve making a cut in scalp behind hairline and removing the bone which form the contour of orbits and forehead. The bone is replaced at the end of surgery.

Minimally Invasive Supra-Orbital "Eyebrow" Craniotomy

          It is sometimes called as eyebrow craniotomy. It is a procedure which is used to remove brain tumors. In this procedure, neurosurgeon will make a small cut within eyebrow to access pituitary tumor. Since it is minimally invasive procedure, the eyebrow craniotomy can offer:

          1. Minimum scar.

          2. Less pain.

          3. Faster recovery.

Retro-Sigmoid "Keyhole" Craniotomy

          It is sometimes called as keyhole craniotomy. It is a minimally-invasive surgical procedure done to remove the brain tumors. The process allow the removal of skull base tumors by a small cut behind ear, which provides the access to cerebellum and brainstem.

          This can be performed on following types of brain tumors-

          1. Meningiomas.

          2. Spine tumors.

          3. Acoustic neuromas.

          4. Skull base tumors.

Orbitozygomatic Craniotomy

          It is a traditional skull base approach which is used for difficult tumors and aneurysms. It is used for those lesions which are too complex to remove by minimally invasive approach. It involves making a cut in scalp behind hairline and removing the bone which forms the contour of orbit and cheek. The bone is replaced at end of surgery. The temporary removal of bone helps surgeon to reach the difficult areas of brain and minimizing the damage to brain.

Translabyrinthine Craniotomy

          It is a procedure which involve making a cut in scalp behind ear, and then remove the mastoid bone and some inner ear bone. The surgeon will find and remove tumor.

Reason for surgery

A craniotomy may be done for various reasons, including

·        Removing blood or blood clots from leaking blood vessels.

·        Repairing skull fracture.

·        Repairing or clipping of an aneurysm.

·        Relieving pressure within brain by removing swollen areas of brain which is caused by stroke.

·        Draining brain abscess.

Risks

Risks include:

·        Infection.

·        Blood clots.

·        Bleeding.

·        Blood pressure.

·        Swelling in brain.

·        Seizures.

·        Coma.

·        Paralysis.

·        Memory problem.

Surgery

          A craniotomy require three to seven days stay in hospital. The procedure vary depending on the patient's condition. An intravenous line will be inserted in arm or hand..To drain urine, a urinary catheter will be inserted. Head will be shaved and skin over surgical site will be cleaned with antiseptic solution. Cut will be made according to the affected area of brain. If the cut is small, then an endoscope is used. The scalp will be clipped and pulled up to control bleeding while accessing the brain. A medical drill can be used to make burr hole in skull. Bone flap will be removed and saved. The excess fluid will be flown out of brain, if needed. Microsurgical instruments helps surgeon to see better view of brain structure and differentiate between healthy and unhealthy tissues. A special type of monitor is placed to check the pressure inside skull. After the surgery is complete, surgeon will sew the tissues layers together. Bone flap will be reattached using plates or wires. If tumor is found in bone, flap will not be replaced. The scalp will be closed with sutures. A sterile bandage will be applied over the cut. The patient will be under observation for some time, and  then discharged.     

-SurgeryXchange is an online platform for medical second opinions and advisory services for hospital admission.

  To know more click here.