The normal shoulder consists of three joints. These are the glenohumeral joint (this is the joint that actually moves our shoulder and is ball-and-socket type joint), the acromioclavicular joint, the sternoclavicular joint, and the scapulothoracic joints between the chest cavity and the scapula. The rotator cuff consists of four muscles that connect the scapula to the humerus. These muscles are called the rotator cuff because they wrap around this ball-and-socket-shaped joint in the form of a cuff. The rotator cuff muscles press the ball into the socket during shoulder movements and provide a stable platform for rotational movements.
The rotator cuff muscles are the upper Supraspinatus, the anterior Subscapularis, the posterior Infraspinatus and Teres minor.
Our muscles adhere to the bone where they will work via the tendons. Shoulder tears usually occur in the supraspinatus muscle.
The rotator cuff muscles are compressed during certain movements between the shoulder bone and the acromion. This event is called jamming or "impingement" in medical language.
Rotator cuff tears occur in advanced stages of impingement. Apart from this, the tears of the shoulder, namely the rotator cuff muscles, can also occur as a result of the continuation of repetitive daily compelling movements (such as housework or knitting or heavy lifting) or a sudden trauma (for example, sudden strain of the arm after sudden braking on the bus).
Tears can come in a variety of shapes and sizes, usually triangular.
Arthroscopic shoulder interventions are performed by entering the problem areas of your shoulder joint directly through small holes called PORTAL from the anterior-posterior and lateral sides of your shoulder and providing vision with the help of a monitor.
General care recommendations:
- Surgical wounds (incisions) should be kept dry for 2-3 days after surgery.
- Stitches can usually be removed between 7-10 days.
- Rehabilitation after impingement surgery should begin immediately: Exercises begin in the first week after surgery and continue for approximately 6 weeks. At the end of the 6th week, when the patient regains full range of motion, the strengthening exercises and home exercises program begins.
- Although full recovery depends on the surgery, most of the patients feel a serious improvement at the end of the 3rd month and return to normal in the 6th month.
Rotator cuff recovery is usually slow and requires more therapeutic support than impingement surgery.
To achieve a full and rapid recovery after surgery:
Controlled and careful physiotherapy for the first 6-12 weeks for the tendon to attach to the bone and heal. The primary goal for the first 3 months after the surgery is to achieve a near full range of motion. Especially in the first 6 weeks (1.5 months), active movements (movements performed by the patient with his own power without assistance) are not allowed. When the initial recovery is achieved after 6 weeks, the stretching and strengthening program is started, respectively. Sports activities are allowed after 6 months. Full recovery will usually take 1 year.
How Did The Tear On My Arm Occur?
Common causes of a tear on your shoulder: loss of strength and degeneration (aging) of your muscles with advancing age - repetitive compelling movements due to housework or work (such as wiping windows at home, excessive cleaning effort, knitting, repetitive heavy lifting...)
What Are the Symptoms of a Tear?
The tear on your shoulder is caused by the friction of the compressed shoulder tendon or tendons over time and / or the abrasive effect of the inflammatory tissues. When the tear occurs, it manifests itself with symptoms such as weakness in shoulder movements (eg, dropping a glass in hand), especially night pain (such as not being able to lie on the shoulder and waking up when changing position).
How Should I Be Sleeping (After Surgery)
Unfortunately, my only suggestion for this would be for the patient to determine his/her own comfortable position.
When Can I Do Housework?
Considering that you will use a shoulder strap for about 6 weeks and then you will receive physical therapy for about 6 weeks, it is recommended that you do not return to your routine daily work before 3-4 months. However, you can do easy tasks which are not challenging (without actively lifting your shoulder yourself).
When Can I Eat by Myself?
From the first day after the operation, you can easily eat your food while keeping your shoulder strapped.
How Long and How Should I Apply Ice?
Unless your doctor recommends otherwise, applying ice to cover your entire shoulder for the first two days (48 hours) after surgery is a very useful application for your pain control and swelling in your shoulder.
How Long Will the Shoulder-Sling Stay After Surgery?
Unless your doctor tells you otherwise, it will stay on your arm for an average of 6 weeks (1.5 months) after the tear repair. The pillow should not be removed for about 6 weeks unless your doctor tells you otherwise. This period is a standard accepted period of time that must pass for your repaired tissue to heal.
Shoulder-arm sling pillow is a frequent cause of discomfort in patients. This pillow not only helps the screws we use to hold the repaired tendon securely to the bone while it heals, but also serves to prevent the formation of permanent stiffness in your shoulder to some extent. For this reason, this pillow should not be removed for about 6 weeks, unless your doctor tells you otherwise.
Are the Small Screws You Put Inside Permanent?
The placed screws are very small and occupy very little space in the bone. These screws serve to reattach the torn tendon to its original place in the bone. Since they are very small and remain in the healed tendon, there is no harm in staying in the body. In some cases, according to the surgeon's decision, screws that can dissolve in the body within a period of 6-9 months are used.
What are the Chances of My Shoulder Tearing Again? And What Should I Do So That It Doesn't Happen?
The issue of re-torn tendon is controversial. Recurrent tear can occur especially in elderly people, people with low tissue quality and comorbidities such as diabetes, rheumatism, smokers, and those who have had a serious shoulder trauma. Smoking! In other words, it should be emphasized that tobacco use delays the healing of the tear and is a proven factor in the recurrence of the tear.
Will My Tear Heal If I Don't Have Surgery?
If you have a tear accompanied by symptoms and visualized on MRI, it is not possible for the torn tendon to heal on its own. In the future, your tear will grow with a high probability. In addition, it has been shown by scientific studies that other unruptured tissues will be affected badly, your complaints will continue to increase, your weakness will increase, and moreover, it will cause calcification in your shoulder joint.
Another point I would like to emphasize here is that the tear tends to expand rapidly in a period of 4-6 months, especially in tears that occur after trauma (as a result of falling or sudden reverse movements).
When can I take a bath after the surgery?
Since the operation is not open, but arthroscopic, that is, closed, your wound will be 3-4 and 0.5-1 cm in size, so it is possible to take a bath in the early period. On the 5th postoperative day, our patients can easily take an assisted bath with warm water using a stretch film-style transparent cover.
Should I Have Physical Therapy After Surgery? And how?
Post-operative physical therapy is an indispensable continuation of your treatment. In other words, if physical therapy is not performed, the success of your surgery decreases significantly. Physical therapy, that is, post-operative rehabilitation, is applied by adhering to the principles of restoring range of motion and strengthening the shoulder. The rehabilitation phases follow each other. The patient's compliance and contribution to rehabilitation is the most important key to success. Strengthening is started after 3 months. Weight lifting and contact sports (such as football, basketball) are not allowed before the 6th month. The rehabilitation program recommended by your doctor after the surgery plays a key role in the success of your treatment.
What kind of anesthesia will I be put to sleep with? And when will I be discharged after the surgery?
You will be put to sleep with general anesthesia. Your surgery is performed in a sitting position called the sunbed position. After you enter the operating room, your surgery can start after 1-1.5 hours under the best conditions due to required anesthesia and positioning.
After the surgery, ice application, which will last for two days, is immediately started on your hospital bed and painkillers are administered. After closed, that is, arthroscopic repair, most of our patients (unless there is a medical obstacle) can be sent home on the same day in the evening with a shoulder-arm sling. Your wounds are dressed every other day. Generally your stitches will be removed on the 9th-10th day. The post-operative rehabilitation program can be started on the 4th-5th weeks in line with your doctor's recommendations. The calendar I mentioned above is generalized and can be changed by your doctor.
How long will it take for my recovery after surgery?
In general, most patients experience a noticeable improvement, especially in their pain and daily movements. In other words, 90% of our patients, when asked at the end of one year, state that they have benefited greatly from the surgery and are satisfied. Restoring the strength of the shoulder depends on the quality of the tendon, the completion of the tendon healing and the completion of the physical therapy process.
Is Surgery the Only Treatment Option for a Torn Tendon?
The answer to this question depends on the condition of the other shoulder muscles and the age of the patient. Although most of the elderly patients have rotator cuff tears, they can continue their lives without pain and disability because they do not have any complaints. In one study, although a rotator cuff tear was detected in 40% of patients over 70 years of age, no symptoms (signs/signs) were observed. On the other hand, surgical treatment is recommended in the young age group and especially if the tears are caused by an injury.
Is Steroid Injection in Impingement Harmful?
Usually 3-4 limited (3-4) injections of steroids into the bursa in the space are safe and often markedly reduce local inflammation and pain. These local steroids do not have the same risks as chronic, continuous oral steroids, as they are not absorbed systemically in the body. On the other hand, it has been shown that repetitive steroid injections adversely affect the quality of the tendons.
