Arthroscopic Rotator Cuff Repair for Left Shoulder Tear in a 54 Y.O. Female

PACE Hospitals’ expert Orthopaedic team successfully performed an arthroscopic rotator cuff repair on a 54-year-old female patient diagnosed with a rotator cuff tear in the left shoulder. The procedure aimed to restore shoulder stability, reduce pain, and improve the patient’s range of motion and overall shoulder function.

Chief Complaints

A 54-year-old female patient with a body mass index (BMI) of 23 presented to the Orthopaedic Department at PACE Hospitals, Hitech City, Hyderabad, with complaints of pain and difficulty performing daily activities. She reported restricted ability to perform overhead movements due to pain. The patient had a history of a slip and fall at home, which was associated with the onset of her symptoms.

The patient had no significant past medical history. She did not report any chronic illnesses such as diabetes, hypertension, or heart disease, nor any previous shoulder injuries or surgeries. There was no history of bleeding disorders, allergies, or other major medical conditions.

On general examination, the patient was conscious, coherent, and oriented, with no pallor, icterus, lymphadenopathy, clubbing, or cyanosis, all noted as normal. On systemic examination, the left shoulder was abnormal, with swelling present and reduced internal rotation and abduction beyond a certain range. Special tests revealed a positive Jobe’s test, indicating rotator cuff involvement, while distal neurovascular status was normal.

Following the clinical evaluation, the Orthopaedics team at PACE Hospitals conducted a detailed assessment focusing on the patient’s complaints of pain and difficulty performing routine daily activities, particularly overhead movements of the left shoulder. The patient had also reported a history of a slip and fall at home, which preceded the onset of her symptoms.

A comprehensive clinical and systemic examination was performed to assess the severity of the condition. Examination of the left shoulder revealed swelling, tenderness over the rotator cuff region, reduced internal rotation and abduction, and a positive Jobe’s test. Imaging and radiological evaluation, including X-ray and MRI, confirmed the presence of a complete rotator cuff tear of the left shoulder.

Based on these findings, the patient was advised to undergo Rotator Cuff Tear Treatment in Hyderabad, India, under the care of the Orthopaedic Department, to relieve pain, restore shoulder function, improve range of motion, and enable the patient to resume daily activities.

After a detailed consultation with Dr. Raghuram, Senior Orthopaedic Consultant, a comprehensive evaluation was performed to determine the most appropriate diagnostic and therapeutic approach. Considering the patient’s history of left shoulder pain, difficulty performing daily activities, and limited overhead movements, along with clinical findings of swelling, reduced internal rotation and abduction, and positive rotator cuff tests, a focused local examination and radiological assessment were undertaken to formulate an optimal treatment strategy.

Based on the clinical findings and imaging, which confirmed a complete rotator cuff tear of the left shoulder, it was determined that arthroscopic rotator cuff repair was identified as the most suitable intervention to relieve pain, restore shoulder function, improve range of motion, and enable the patient to resume daily activities.

The patient and her family members were thoroughly counselled regarding the diagnosis, need for surgery, procedure details, risks, and recovery process. Informed consent was obtained, ensuring their understanding and involvement in the treatment plan.

Following the diagnosis, the patient was scheduled to undergo Arthroscopic Rotator Cuff Repair surgery in Hyderabad at PACE Hospitals, under the supervision of the expert Orthopaedic Department.

The surgical procedure involved the following steps:

• Patient Positioning and Anesthesia: The patient was placed in the beach chair position under general anesthesia (GA) to provide optimal access to the left shoulder and facilitate arthroscopic visualization. Proper padding and positioning were ensured to prevent neurovascular compromise during the procedure.

• Arthroscopic Examination and Assessment: A diagnostic arthroscopy of the left shoulder was performed to evaluate the extent of the rotator cuff tear and associated pathologies. Examination revealed biceps tendon degeneration, which was addressed prior to the rotator cuff repair.

• Biceps Tenotomy: Due to degeneration of the long head of the biceps tendon, a biceps tenotomy was performed to remove the damaged portion and relieve associated pain and dysfunction.

• Rotator Cuff Repair: The torn rotator cuff was repaired using all-suture anchors (Syronix). The tendon edges were mobilized, and sutures were passed through the tendon and anchored securely to the humeral head. The repair was confirmed to be stable arthroscopically.

• Closure and Dressing: The sutures were tied using Ethilon 2-0, and the surgical portals were closed. Dressing was applied over the arthroscopic entry sites, and the arm was immobilized appropriately to protect the repair.
  

The postoperative period was uneventful. The patient was mobilized during her hospital stay under supervision. Adequate measures were provided to prevent infection, control pain, and support healing. Wound dressings were regularly performed and found to be clean. The patient remained clinically stable at the time of discharge.

Upon discharge, the patient was advised to take medications to prevent infection, manage pain, reduce stomach acidity, support bone health, and promote overall healing. These were to be taken as instructed for the prescribed duration to ensure proper recovery following the surgery.

The patient was advised to perform shoulder range of motion exercises as guided by the physiotherapist and to use an arm sling for support and protection of the operated shoulder. The patient was also advised to maintain a normal diet.

The patient was informed to contact the emergency ward at PACE Hospitals in case of any emergency or development of symptoms such as fever, shoulder pain, or vomiting.

The patient was advised to return for a follow-up visit with the Orthopaedic Doctor in Hyderabad at PACE Hospitals after 1 week for a wound dressing change.

This case highlights a complete rotator cuff tear of the left shoulder, managed successfully with arthroscopic repair and biceps tenotomy. The procedure was uneventful, and the patient remained clinically stable postoperatively. Physiotherapy and sling support were advised to aid recovery. The intervention aimed to relieve pain, restore shoulder function, and improve the range of motion for daily activities. The patient was discharged in stable condition.