The rotator cuff is the set of tendons that cover the humeral head. The tendon that most frequently ruptures is the supraspinatus tendon.
Most of the tears of the rotator cuff are of degenerative origin. They can also be post-traumatic after a fall on the lateral arm flange.
The rupture of the tendons of the rotator cuff is usually established after a detailed clinical history and an exhaustive physical examination. The diagnosis is confirmed by an ultrasound or an MRI, which gives us much more information about other types of prognostic factors to fully evaluate the shoulder and decide on the best treatment.
Generally the treatment of this pathology is performed by arthroscopy.
A. SUTURE OF THE SUPRASPINATUS AND INFRASPINATUS OF THE ROTATOR CUFF
The most frequent tendon rupture in the shoulder is the rupture of the supraspinatus tendon, which can be associated with infraspinatus or subscapular rupture.
In this operation, a television camera is used, which passes through the skin through a small hole. It is introduced to the glenohumeral joint or into the subacromial bursa according to the problem to be treated. The instruments are introduced through other working portals. This does not require an open approach to reach the shoulder, so that nearby structures are maximally respected. This offers, on the one hand, important cosmetic benefits, and on the other, the postoperative pains are minor. The use of serum for arthroscopy allows visualization and the postoperative infection rate is very low. It would be desirable to perform all the shoulder operations via arthroscopy. But it has been shown that the advanced fatty degeneration of the muscles that act on the tendons of the chronic rotator cuff makes it impossible, in some cases, an arthroscopic repair of supraspinatus or infraspinatus. And in this case, it is necessary to opt for another surgical technique. Through MRI, the extent of the rotator cuff tear and fatty degeneration can be clearly assessed.
The optic is usually placed in the subacromial bursa, and a bursectomy is necessary for a good visualization of the rupture of the supraspinatus and other tendons of the rotator cuff. (Illustration 5) A light decortication is then performed in footprint of the humeral head with a burr to favor a bleed that allows a good healing. Subsequently, the necessary anchors are inserted into the bone. These anchors have sutures that will be passed through the rupture of the supraspinatus / infraspinatus / subscapularis / biceps tendons. Later the knotting of the different sutures passed through the tendons allows them to return to their anatomical insertion, which allows closing the defect of the supraspinatus rupture.
b) SUTURE OF THE SUBSCAPULARIS:
Figure 7 shows a rupture of the subscapularis tendon, which is located in the anterior part of the shoulder and makes it impossible to bring the elbow forward when the hands are placed in the belly:
The repair of this tendon is also done arthroscopically. The stable suture of the subscapular tendon is fundamental to recover the functionality of the shoulder and eliminate pain, mainly due to its stabilizing role.
c) SUTURE OF RERUPTURESS OR MASSIVE TEARS OF THE ROTATOR CUFF IN YOUNG PEOPLE:
It is possible that if your tissue is of poor quality and your age is not very advanced, the suture of the rotator cuff is associated with a reinforcement patch as shown in the image. This technique is also performed by arthroscopy at Alai Sports Medicine Clinic.
d) SUBACROMIAL BALLOON: ARTROSCOPIC TECHNIQUE IN IRREPARABLE MASSIVE TEARS TEARS OF THE ROTATOR CUFF IN ELDERLY PEOPLE:
In cases in which the massive rupture is not repairable due to the tendinous retraction and poor quality of the tissues in elderly people, in which a prosthetic surgery may involve too much interventionism, it is possible to perform a technique of interposition of a subacromial balloon that It is filled with physiological saline solution and acts as a cushion interposing between the humeral head and the acromion, which relieves pain significantly.
A PRECISE ASSESSMENT IS REQUIRED IN CONSULTATION OF THE INDICATION OF EACH CASE, WHERE ALL INFORMATION WILL BE EXTENDED.
e) ACROMIOPLASTY OF THE SHOULDER IN SUBACROMIAL SYNDROME:
The compromise of space between the acromion and the humeral head, where the supraspinatus and infraspinatus tendons of the rotator cuff run, is called the subacromial syndrome. In well selected cases, to correct this subacromial syndrome, an acromioplasty is performed, which is the filing of the inferior tip of the acromion, to avoid friction on the supraspinatus and infraspinatus tendons of the rotator cuff on its upper part.
f) ACROMIOCLAVICULAR SHOULDER RESECTION FOR ARTHROSCOPY IN ACROMIOCLAVICULAR ARTHROPATHY:
Another source of pain in the shoulder is the acromioclavicular joint. In many cases a degeneration of this joint is associated, whose friction causes pain. This pathology is treated by an arthroscopic acromioclavicular resection, that is, a filing of the joint to eliminate pain.
g) LATTISIMUS DORSI TRANSFER IN NON-REPARABLE POSTEROSUPERIOR TEARS:
In cases of non-repairable ruptures with severe atrophy of the supra and infraspinatus tendons, it is possible to carry out a transfer of the latissimus dorsi to improve the antepulsion and eliminate the pain due to its interposition effect. This technique must be well indicated and in well selected cases to obtain a satisfactory result.
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