Successful Arthroscopic Rotator Cuff Repair for Complete Tear of Right Shoulder

Chief Complaints

A 60-year-old male patient with a body mass index (BMI) of 21, presented to the Orthopaedic Department at PACE Hospitals, Hitech City, Hyderabad, with complaints of pain over the right shoulder joint, associated with difficulty in carrying out daily routine activities like movements over the right shoulder or lifting weights. The patient was admitted for further management. There was no history of trauma, any other joint pain, known drug allergies, or chronic illness.

The patient had no significant past medical history. There was no history of trauma, chronic medical illnesses, prior surgeries, or known drug allergies.

On examination, the patient was conscious, coherent, and oriented. He was afebrile and hemodynamically stable, with normal respiratory status and adequate oxygen saturation on room air. Systemic examination revealed normal cardiovascular and respiratory findings, with no abnormalities detected in the abdominal or neurological systems.

Local examination of the right shoulder showed tenderness over the acromioclavicular joint and bicipital groove. There was restriction and pain during abduction beyond mid-range, along with significantly limited internal and external rotation due to pain. The Neer impingement test was positive, while the Hawkins test was negative. No distal neurovascular deficits were noted.

Following the clinical evaluation, the Orthopaedic team at PACE Hospitals conducted a detailed assessment focusing on the patient’s complaints of right shoulder pain associated with difficulty in performing daily activities such as shoulder movements and lifting weights.

A comprehensive clinical and systemic examination was carried out to determine the severity of the condition. Examination of the right shoulder revealed tenderness over the acromioclavicular joint and bicipital groove. There was painful and restricted abduction beyond mid-range, along with gross limitation of internal and external rotation due to pain. The Neer impingement test was positive, suggestive of impingement pathology. No distal neurovascular deficit was noted. Systemic examination was within normal limits.

Based on these findings, the patient was advised to undergo Complete 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 prevent further degenerative changes.

After a detailed consultation with Dr. Anand Agroya, Senior Orthopaedic Consultant, along with cross consultation with Dr. Snigda Panuganti, General Physician, a comprehensive evaluation was carried out considering the patient’s clinical symptoms of right shoulder pain associated with significant difficulty in performing daily activities such as lifting objects and overhead movements, along with restriction of the shoulder range of motion. The findings were correlated with clinical examination and radiological investigations, which revealed a complete tear of the supraspinatus and subscapularis tendons associated with subacromial bursitis and impingement syndrome of the right shoulder.

Based on the clinical presentation and examination findings, it was determined that arthroscopic subscapularis repair, supraspinatus repair, and subacromial decompression with autologous platelet concentrate therapy were the most appropriate therapeutic interventions. This decision was made with the intent to relieve pain, restore shoulder stability and function, repair the torn rotator cuff tendons, improve range of motion, and prevent further degenerative changes and long-term disability.

The patient and his family members were counselled regarding the diagnosis, the planned procedure, potential risks and benefits, postoperative care including immobilization and physiotherapy, expected recovery course, and the importance of regular follow-up for optimal functional outcomes.

Following the diagnosis, the patient was scheduled to undergo Arthroscopic Subscapularis Repair, Supraspinatus Repair, and Subacromial Decompression Procedure in Hyderabad at PACE Hospitals under the supervision of the expert Orthopaedic Department.

The surgical procedure involved the following steps:

• Anaesthesia and Patient Positioning: The patient was administered general anaesthesia and positioned in the beach chair position. The right shoulder was carefully prepared and draped under strict aseptic conditions to ensure a sterile surgical field.

• Arthroscopic Portals and Diagnostic Evaluation: Standard arthroscopic portals (posterior, anterior, and lateral) were created. A diagnostic arthroscopy of the right shoulder joint was performed to evaluate intra-articular structures and confirm pathological findings.

• Intraoperative Findings Assessment: During arthroscopy, subacromial bursitis, Type III acromion, complete tears of the supraspinatus and subscapularis tendons, thickening of the superior and inferior glenohumeral ligaments, and fraying at the biceps tendon attachment were identified.

• Arthroscopic Repair and Decompression: Arthroscopic subscapularis repair and supraspinatus repair were performed using Sironix implants (Ceptre knotted PEEK sutures and Viplok knotless PEEK suture with titanium tip). Subacromial decompression was carried out to relieve impingement and improve subacromial space.

• Completion of Procedure and Closure: Autologous platelet concentrate system (Cyonics) was applied to enhance healing. Hemostasis was achieved, portals were sutured, a sterile dressing was applied, and the shoulder was immobilised. The procedure was completed successfully without complications.
  

Postoperatively, the patient was started on intravenous medications for infection prevention and pain control. The operated shoulder was supported with a shoulder immobilizer to protect the repair and aid healing. On postoperative day 1, the dressing was changed under sterile precautions and an X-ray confirmed proper implant positioning. The patient remained hemodynamically stable throughout the hospital stay. He was discharged with follow-up instructions.

Upon discharge, the patient was prescribed medications for the prevention of postoperative infection, control of pain and inflammation, and protection of the gastrointestinal tract. Additional medication was advised for relief of severe breakthrough pain if required. He was also continued on treatment for blood pressure control along with medication to maintain cardiovascular stability, including regulation of heart rate and blood pressure within normal limits.

The patient was advised to continue regular shoulder range of motion exercises as instructed to support rehabilitation and improve joint mobility and functional recovery.

The patient was advised to contact the emergency ward at PACE Hospitals immediately in case of any emergency or if symptoms such as fever, increasing shoulder pain, or persistent vomiting occur.

The patient was advised to return for follow-up with the Orthopaedic Doctor in Hyderabad at PACE Hospitals, after 5 days for wound dressing review in case of any soakage.

This case highlights a complete tear of the supraspinatus and subscapularis tendons associated with subacromial bursitis and impingement syndrome of the right shoulder. Arthroscopic rotator cuff repair with subacromial decompression was performed successfully using suture anchor fixation. The postoperative period was uneventful with stable clinical recovery. The patient was discharged in stable condition with advice for rehabilitation and follow-up.