Rotator Cuff Repair Treatment in Indore

Dr Murtuza Rassiwala on Assessment, Non-Surgical Treatment and Arthroscopic Repair of Torn Rotator Cuff Tendons Leading to Shoulder Pain, Night Pain and Weakness.

A rotator cuff tear often announces itself in a quiet way. At first it may be a dull ache on the outside of your upper arm when you reach for a high shelf. Then the pain wakes you in the night, especially when you turn onto that side. One day you lift a bucket, hang clothes, comb your hair, or reach behind to tuck in a shirt, and it hurts or feels weak. For some people the tear happens suddenly – a fall onto an outstretched hand, a heavy lift or a jerk holding on to a bus rail – and then pain and an arm that suddenly won’t quite lift properly.

The rotator cuff is made up of a group of tendons that help the shoulder move smoothly. Treatment can involve targeted physiotherapy or arthroscopic surgery to reattach the tendon to the bone if one or more of these tendons ruptures. Dr. Murtuza Rassiwala, an arthroscopic and orthopedic surgeon in Indore will assess the size and type of your tear, the condition of your tendon and muscle, and your everyday needs to suggest the treatment that is most likely to benefit you.

Short answer: Rotator cuff repair is surgery to put a torn shoulder tendon back onto the upper arm bone. This surgery is most commonly done arthroscopically (small incisions, suture anchors). It is considered when a tear results in persistent pain or weakness, especially in the setting of an injury or in active patients. Many smaller or degenerative tears in older adults get better with physiotherapy alone.

Rotator Cuff Repair at a Glance

These are general ranges from shoulder surgery practice. Your recovery depends on tear size, tendon quality, age, general health and rehabilitation.

What Is the Rotator Cuff?

The rotator cuff is made up of four muscles that start on the shoulder blade and are attached to the top of the upper arm bone (humerus) by tendons:

• Supraspinatus – Runs along the top of the shoulder under the acromion; helps lift the arm out to the side and is the most common to be torn.
• Infraspinatus – The back of the shoulder; rotates the arm outward.
• Tere Minor – A smaller muscle below the infraspinatus that also rotates outward.
• Subscapularis – In front of the shoulder; rotates the arm inward and helps with tasks like tucking in a shirt.

Together these tendons form a cuff around the ball of the shoulder joint. They don’t simply move the arm, they maintain the ball in the center of the shallow socket so that the large deltoid muscle can lift the arm efficiently. The cuff is torn. The balance is destroyed. The ball may go up, the motion hurts and you get weak.

Types of Rotator Cuff Tear

Tears are characterized in different ways and the characterization influences treatment.

• Partial Thickness Tears: One part of the thickness of the tendon is torn, either on the joint side, the bursal (upper) side or within the tendon. Many partial tears respond to physiotherapy but larger painful tears may be repaired.
  Full Thickness Tears: The tear goes all the way through the tendon, either creating a hole or detaching the tendon from the bone. Full thickness tears do not heal on their own back to bone and some will get bigger over time.
  Size: Depending on their size and the number of tendons involved, tears are often classified as small, medium, large or massive. Two or more tendons are commonly involved in massive tears.
  Acute traumatic rupture: They can happen suddenly from an injury, sometimes in a shoulder that was previously healthy. They are often associated with sudden weakness and may respond to relatively early repair.
  Degenerative Tears (Chronic): They develop slowly as the tendons age and lose strength. They are very common in people over the age of 60, and many are found on scans of people who have few symptoms.
  Tears – Acute-on-Chronic: Worn out tendon tears more after a minor injury . Sudden increase in pain and weakness.

Causes of Rotator Cuff Tears

• Age-Related Degeneration As we age, blood flow to tendons decreases and tendon fibers weaken. Degenerative tears become more common from the fifth decade onward.
• Injured: The cuff can be torn by falling on an outstretched arm, by catching a heavy falling object, or by a sudden pull on the arm or shoulder dislocation (especially after age 40).
• Overhead Used Repeatedly: Tendons are subjected to repeated strain in jobs and sports that involve the arm being raised above the head often – painting, electrical work, construction, swimming, tennis, fast bowling.
• Bone Spurs and Impingent: Bony spurs on the underside of the acromion may be a factor in some people who develop tendon irritation, but their role in producing tears is controversial.

Risk Factors

• Age > 40, with risk increasing even more after 60 years.
• Smoking which decreases blood flow to the tendons and slows healing.
• Diabetes and high cholesterol, both associated with tendon problems.
• A family history of rotator cuff disease.
• Strenuous manual work or repetitive lifting overhead.
• Previous shoulder injury or dislocation.
• Weakness of shoulder-blade muscles.
• Bad posture.

Symptoms of a Torn Rotator Cuff

• Pain on the outer side of the upper arm that tends to travel away from the shoulder toward the elbow rather than stay at the top of the shoulder.
• Night pain, especially when lying on the side of the affected area – this is one of the most characteristic complaints.
• Pain when elevating your arm to the side or in front of your body, especially between shoulder and head height.
• Weakness while lifting objects, reaching up, or rotating the arm outward.
• Problems with tasks like combing hair, fastening a bra, reaching for a back pocket or putting on a shirt.
• Cracking or catching when moving the shoulder.
• Large tears may be acute with a sudden inability to lift the arm following injury.

The symptoms are very variable. Some people have big tears with little pain, and some people have little tears with a lot of pain. The treatment is based on symptoms and function and not just the scan.

Rotator Cuff Tear or Something Else?

A rotator cuff tear can resemble a number of other shoulder problems. It’s important to know the difference, because the treatments are very different.

You may also have more than one problem at a time – a cuff tear with a stiff shoulder, or a cuff tear with neck-related pain – and treatment is sequenced accordingly.

Calcific Tendinitis – A Related Tendon Problem

Sometimes calcium deposits build up in the tendons of the rotator cuff, most commonly the supraspinatus. The deposit may be quiescent for years, then cause an attack of severe, sudden pain, often at nite, when the body begins to reabsorb it. Usually treatment is non-surgical using pain relief, physiotherapy, sometimes an injection or ultrasound guided procedures. If these measures are unsuccessful, arthroscopic removal of the deposit is considered.

Diagnosis

• History and Examination: Dr. Rassiwala will ask about the onset of pain, any injury, nite pain, work and sports demands, and any previous injections or treatment. The examination involves comparing both shoulders for muscle wasting above and behind the shoulder blade, measuring active and passive movement and testing the strength of each cuff muscle individually. Specific tests such as resisted elevation, external rotation strength, the belly-press and lift-off tests for the subscapularis are useful to determine which tendons are involved. Frozen shoulder, arthritis and neck problems are also reviewed as they can mimic or be associated with cuff tears.
• X-Rays: X-rays will show the shape of the acromion, calcium deposits, arthritis and whether the ball has migrated upward which is a sign of a long standing large tear.
• U/S (ultrasound): Ultrasound can show full-thickness and some partial tears, and it shows the tendon as the arm moves.
• MRI: MRI demonstrates the size and location of the tear, the degree of retraction of the torn tendon, and whether the muscle has wasted or been replaced by fat. These features have a strong influence on the possibility of repair and its chance of healing.

When to See a Shoulder Specialist

If the pain lasts for a couple of weeks, keeps you awake at nite, limits your ability to lift, or if you notice weakness, see a doctor. If you suddenly can’t lift your arm after an injury, it’s especially important to get evaluated early, because acute traumatic tears may do better if repaired before the tendon retracts and the muscle weakens.

NON-INVASIVE TREATMENT

Most problems of the rotator cuff can be treated non-operatively, especially partial tears and degenerative tears in older or less active individuals.

• Physiotherapy: A structured program strengthens the remaining cuff muscles, the deltoid and shoulder-blade stabilizers, restores movement and improves posture and shoulder mechanics. Well conducted physiotherapy over three to six months significantly decreases pain and improves function in many degenerative tears.
• Activity change: While strengthening helps to settle down irritated tissue, reducing repetitive overhead work and heavy lifting.
• Drugs: Pain relief and short courses of anti-inflammatory medicines help to control the pain so that exercises can be continued.
• Injections: An injection of steroid into the sub-acromial space will settle pain and inflammation and provide a window of opportunity for effective physiotherapy. Repeated injections of steroids are usually limited as they can affect the quality of the tendon. Other injection therapies are discussed separately with an honest explanation of the evidence for them.
• Monitoring: If managed non-operatively it is sensible to review the patient periodically. If a tear enlarges or becomes more disabling, surgery may be the preferred treatment.

When to Consider Rotator Cuff Repair

Surgery is usually considered in the following cases:

• Full thickness traumatic tear in an active person with acute weakness.
• No improvement with appropriate non-surgical treatment for three to six months – A full thickness tear in a younger or active patient, with potential for the tear to grow over time.
• Painful large partial thickness tears despite conservative care.
• Occupational or athletic requirements for reliable overhead strength.

Factors that reduce the chances of successful repair include a long-standing massive tear with severe retraction, severe fatty change in the muscle, significant shoulder arthritis, and heavy smoking. Other procedures might be discussed for shoulders like these.

When Repair May Not Be Suitable

Very large chronic tears with significant muscle wasting that cannot be retracted to bone.

• Advanced shoulder joint arthritis combined with a large cuff tear.
• Frozen shoulder, which is stiff and is usually first treated to regain movement
• Medical problems that make anesthesia unsafe.
• Failure to comply with post-operative sling and rehabilitation program.

Additional physiotherapy, partial repair, biceps procedures, superior capsular reconstruction or, in a few patients with arthritis, reverse shoulder replacement may sometimes be options. 

Timing of Surgery – Early Repair or Trial of Physiotherapy?

Timing depends on the cause of the tear and who it affects.
Many shoulder surgeons prefer to repair a sudden traumatic tear in an active adult who can no longer lift the arm properly within the first few weeks to months before the tendon retracts and the muscle weakens. If you wait too long in this situation you can turn a simple fix into a difficult or impossible fix.
If it is a gradual degenerative tear then often a structured physiotherapy program of approximately three months is tried first especially in patients over 60 with moderate symptoms. If function and pain improve, surgery might not be necessary. If symptoms persist or weakness progresses, repair may be considered.

Conservative management is usually the first line of treatment for partial tears, with surgery considered only for persistent symptoms or larger partial tears.
The best way to decide whether to repair now or proceed with rehabilitation is to talk with your surgeon about your own tear type, age, work and priorities. Regardless of the option you choose, follow-up review at agreed intervals ensures that a non-responding tear is identified before it becomes more difficult to treat. 

Arthroscopic Versus Open Repair

The choice of technique depends on tear characteristics and surgical judgement; both require the same protected rehabilitation.

Surgical Procedures

• Rotator Cuff Repair, Arthroscopic: Today most repairs are done arthroscopically. The shoulder is punctured in several places and a camera and instruments are passed through the punctures. The surgeon examines the joint, prepares the bone where the tendon attaches, and reattaches the tendon using suture anchors.
• Single and Double Row Repair: A single-row repair has one row of anchors holding the tendon. Two rows of anchors are used in double-row or “suture bridge” techniques to spread the tendon over a larger area of bone and may be preferred for larger tears. It is determined by the size, shape, quality of the tear and the tissue.
• Mini Open Repair: Some surgeons will do part of the repair through a small open incision after arthroscopic evaluation. This could be used in some cases.
• Associated Procedures: The surgeon can also fix other problems in the same surgery, such as removing an inflamed bursa (bursectomy), smoothing a bony spur (acromioplasty) if needed, releasing or reattaching a damaged biceps tendon, or treating AC joint arthritis.

Step-by-Step Arthroscopic Procedure

1. Anesthesia and position: You will receive a general anesthetic and usually a nerve block to numb your shoulder and arm for several hours afterward. You are sitting up (beach-chair position) or lying on your side
2. Co-inspection: The arthroscope is passed through a small posterior portal. The surgeon inspects the cartilage, the labrum, the biceps tendon and the underside of the rotator cuff.
3. Subacromial Interval: The camera is then positioned over the cuff. The inflamed bursa is removed to give a clear view of the tear.
4. Excision and mobilization: The size, shape and mobility of the tear are assessed. Adhesions are released to allow the tendon to be returned to its footprint on the bone without excessive tension.
5. Creating the Footprint: The bony surface to which the tendon attaches is lightly roughened to promote healing.
6. Placement of Anchor and Suturing: Suture anchors are placed within bone. The sutures are then passed through the tendon and tied or fixed so as to firmly attach the tendon to the bone.
7. Final review and close out: The repair is checked by the range of motion of the arm. The small incisions are closed and dressed and the arm is put in a sling, often with an abduction pillow.

Technology and Prosthetics

We perform rotator cuff repair using high-definition arthroscopy systems and fluid pumps to give the best possible view, along with specialized suture-passing instruments and suture anchors made from metal, bioabsorbable material or PEEK.

Your rehab is as important as the implants, as is the skill of the surgeon.

Advantages of Rotator Cuff Repair

• Relief of pain, particularly nite pain, in many patients.
• Enhanced strength for lifting and overhead work.
• Improved shoulder function in daily life, work and sport.
• Possibility to prevent tear propagation and further muscle weakening in appropriate tears.
• Smaller incisions using arthroscopic techniques versus traditional open surgery.

Risks and Potential Complications

• Re-tear or failure to heal, more likely with large tears, older age, poor tendon quality and smoking. However, some patients with a retear still achieve good pain relief.
• Stiffness – this is common in the early months and usually improves with physiotherapy.
• Uncommon infection.
• Nerve injury or complications from the nerve block (rare).
• Uncommon issues, such as loosening of the anchors.
• Pain continues after the surgery.
• Anesthetic complications and infrequent blood clots.

What determines whether or not a repair heals?

Rotator cuff healing after repair is a biologic process and there are several factors which influence the reliability of tendon-to-bone healing.

• Size and Retraction of the Tear: It is easier to repair smaller, non-tensioned tears that have not retracted much, and these tend to heal more reliably than larger, retracted tears.
• Muscle Quality: When a torn tendon has been off for a long time, the muscle can shrink and be replaced with fat. This change, visible on MRI, reduces the ability to heal and regain strength. It is usually not reversible after repair.
• Length of the Tear: Repair of traumatic tears is generally favored within a reasonable time after injury, before significant retraction and muscle change.
• Tendon quality and age: As we age, our tendons become thinner and less elastic – and that’s one reason that retear rates are higher in older patients.
• Smoking and Health Problems: Nicotine decreases blood flow to healing tissue. Tendon healing can also be affected by high cholesterol and diabetes. If you quit smoking and get these conditions under control, it will help the healing environment.
• Rehabilitation Compliance: The first few weeks of protection of the repair and progression of exercises as recommended allow the tendon the best chance to heal safely.

Preparing for Surgery

• Pre operative tests and medical clearance.
• Optimize management of diabetes, hypertension.
• Stop smoking – this is one of the most important steps in healing your tendon.
• Perform daily tasks with one arm with the other hand.
• Make arrangements for help at home with cooking, dressing and bathing for the first few weeks.
• Wear loose-fitting clothes that open in the front. Sleep in a reclining chair or with extra pillows.

Rotator Cuff Problems in Different Patient Groups

• Sportsmen and Gym Users: Swimsuits, fast bowlers, tennis and badminton players and those who lift heavy weights overhead commonly get tendon irritation and partial tears, especially on the side of the joint of the tendon. Treatment is aimed at correcting technique, training load and shoulder-blade control. Surgery is only considered for tears that remain painful or cause weakness despite this.
• Manual & Over Head Workers: Degenerative tears tend to occur more frequently in electricians, painters, carpenters, construction workers and loaders who have their arms elevated for long periods of time. For these patients planning is necessary for return to work after repair because the repaired tendon needs months before it can withstand sustained overhead loading.
• Office Employees: Sitting at a desk for long periods of time with rounded shoulders can irritate tendons. Workstation modifications and postural exercises are frequently used for both prevention and rehabilitation.
• Patients with diabetes: Diabetes is linked to both tendon problems and frozen shoulder. Those who have diabetes may be more likely to develop stiffness following repair and so regular physiotherapy and good control of sugar levels are particularly important.
• Older Persons: Degenerative tears are very common with age and many are asymptomatic. Decision making by the surgeon will factor in pain, weakness, quality of the tendon and overall health. Many older patients do fine with care that is based on exercise.
• Hospitalization: After the pain is controlled and the nerve block starts to wear off, many patients go home the same day or after one night.  You will be taught how to put on and take off the sling, how to wash and dress safely and which exercises to start.

Recovery Timeline

Larger tears and repairs with poorer tissue may follow a slower programme.

Post-Operative Care

• Using the sling: Wear the sling as instructed, including during the night. It protects the repair as it heals to the bone. Take it off only to wash it and to do your prescribed exercises.
• Pain Management: Usually the first few nites are the most uncomfortable. Ice packs, regular pain medicines as prescribed Also sleeping semi-upright helps.
• Training: Initial exercises may include pendulum swings and passive range of motion exercises assisted by a physical therapist or family member. Do not actively raise arm until told to.
• Wound Care: Follow instructions on showering, keep small wounds clean and dry.
• Warning Signs: If you develop a fever, discharge or redness from the wounds, numbness or color change in the hand or sudden severe pain, contact the clinic.

Daily Life in the Sling Period – Practical Tips

The most difficult part of the recovery is often weeks in a sling, especially when the dominant arm has been operated. These tips help in practice:

• Dressing: first put the operated arm into the sleeve and take it out last. Loose shirts and kurtas with buttons at the front and an elasticated waist are easy to wear.
• Washing: lean forward and allow the operated arm to hang down gently away from the body, supporting the forearm if needed. Keep the wound covered as directed.
• Eating and cooking: pre-cut vegetables, lightweight utensils, keep daily items at counter height. Do not lift pressure cookers, water cans or heavy pans with the operated arm.
• Sleeping Pain at night can be reduced by a reclining chair or several pillows behind the back and one under the forearm.
• Using phones and computers: use the other hand or voice typing; keep your operated elbow supported.
• Travel: Avoid crowded busses and riding pillion on two wheelers as a sudden jolt could make you grab with the operated arm.
• Family help: a member of your family can learn the passive exercises with the physiotherapist so that they can help at home.

Principles of Exercises at Home After Repair

Individually prescribed specific exercises and their timing, but a few principles apply to most patients:

• Relax the shoulder muscles during passive exercises, the aim is movement without the cuff muscles working in the early weeks.
• Frequent short sessions – Several short sessions a day tend to work better than one long session.
• Mild discomfort is OK, sharp pain is not – if exercises cause sharp or lasting pain stop and tell your physiotherapist
• Only progress when advised – moving to active lifting or resistance too soon can stress the healing repair.
• Don’t forget the shoulder blade and posture – upper back and shoulder blade muscle exercises help to support the cuff.
• Be consistent – a lot of the functional gains are built in the months between six weeks and six months.
  Getting back to work and activities
• Desk work (one-handed): generally 1-3 weeks.
• Driving: normally once the sling is off and you can steer safely, typically 6–8 weeks.
• Light household duties: slowly from 6-8 weeks, below shoulder level.
• Manual or overhead work: typically 4–6 months or longer.
• Swimming, racquet sports, gym weights: usually 4–6 months, progress carefully.

Questions to Ask Regarding Your Rotator Cuff Injury

• Is my tear partial or full thickness and what tendons are involved?
• Is the tendon repairable and what is the condition of the muscle?
• How likely is improvement with physiotherapy alone?
• Will the tear become larger or more difficult to repair if I wait?
• How long will I have to wear a sling and who will help me at home?
• When can I return to my particular job, driving and sport?
• How can I help the tendon to heal?

The future outlook

After rotator cuff repair, many patients experience significant reduction in pain and improvement in function, with the final result often becoming clear between nine and twelve months. Some patients feel much better pain relief when imaging shows some part of a big repair has not healed, but the strength may not be what they hoped for. The gains made from formal rehabilitation are maintained by continuing exercises to strengthen the shoulder blade and cuff.

How to Protect Your Rotator Cuff Moving Forward

• Perform a brief program of resistance-band exercises for the rotator cuff and upper back two or three times weekly.
• No sudden lifting, particularly away from the body or overhead.
• Instead of reaching up, reach for high shelves with step stools or a sturdy ladder.
• Break up repetitive overhead work with frequent short rest periods.
• Good posture is important when using a desk or phone.
• If new pain or weakness occurs, seek early assessment instead of waiting many months.
• Lightly swing the shoulder to warm it up prior to sport, gardening or other strenuous physical tasks.

Rotator Cuff Repair Cost in Indore

Cost is related to tear size, number and type of anchors, other procedures, hospital and room category, duration of stay, pre-operative imaging and physiotherapy. A written estimate is given following your assessment. 

Insurance and Cashless Treatment

Rotator cuff repair is typically covered by health insurance when medically necessary and as specified in the policy. Please check the waiting periods, sub-limits and cashless availability at the hospital.

Dr. Murtuza Rassiwala’s Expertise

Dr. Rassiwala is an arthroscopic and orthopedic surgeon based in Indore. He has MBBS from Baroda University (2013), DNB in Orthopedics (National Board of Examinations, 2018), MNAMS and fellowships like F.I.A.S.M and F.I.A.J.R. He regularly performs arthroscopic shoulder surgeries like rotator cuff repair at Hakimi Ortho Care.

Why Choose Dr. Rassiwala for Rotator Cuff Treatment?

• Thorough tear assessment – repairability, tendon quality and muscle health are assessed on MRI and in clinic.
• Non-surgical care first where appropriate – many patients avoid surgery through guided physiotherapy.
• Arthroscopic technique, when repair is recommended.
• Realistic expectations of healing time and results.
• Co-ordinated structured rehabilitation via follow-up visits.

Book Your Shoulder Consultation

If shoulder pain is disturbing your sleep or weakness is affecting your daily life, an assessment can tell you if a rotator cuff tear is the cause and what treatment is best for you. Call +91-7224888071, 0731-4981538 or 0731-3695285 or book online to visit Dr. Murtuza Rassiwala at Hakimi Ortho Care, Jawahar Marg or Phadnis Colony, Indore.