Successful Arthroscopy, Rotator Cuff Repair & Acromectomy for Left Shoulder Rotator Cuff Tear

Chief Complaints

A 52-year-old female patient with a body mass index (BMI) of 21 presented to the Orthopaedic Department at PACE Hospitals, Hitech City, Hyderabad, with complaints of shoulder pain, difficulty performing overhead activities for the past few months, and associated difficulty in carrying out daily activities due to pain.

The patient had previously undergone conservative management, including physiotherapy, for her left shoulder condition; however, she did not experience significant symptomatic relief. Owing to the persistent nature of the condition and associated functional limitation, she presented for further evaluation and definitive management.

On general examination, the patient was conscious, coherent and oriented, with no evidence of pallor, icterus, lymphadenopathy, clubbing, or cyanosis. Local examination of the left shoulder revealed swelling with restriction of movements, particularly reduced internal rotation and abduction beyond shoulder level, along with a positive Jobe’s test suggestive of rotator cuff pathology. No neurovascular deficits were noted in the affected limb.

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

A thorough clinical and systemic examination was performed. The examination of the left shoulder revealed swelling with a restricted range of motion, including reduced internal rotation and abduction, along with a positive Jobe’s test suggestive of rotator cuff pathology. No distal neurovascular deficit was noted, and systemic examination findings were within normal limits. Investigations, including X-ray chest, complete urine examination, blood grouping and Rh typing, coagulation profile, and liver function tests, were performed, which were within acceptable limits and did not reveal any significant abnormalities contributing to the condition. Based on the clinical evaluation, examination findings, and investigation correlation, the patient was diagnosed with Rotator Cuff Tear with Periarthritis component and Type II Acromion of the left shoulder.

Based on these findings, the patient was advised to undergo Rotator Cuff Tear Treatment in Hyderabad, India, with Periarthritis component and Type II Acromion of the left shoulder, under the care of the Orthopaedic Department to achieve pain relief, improve range of motion, restore rotator cuff integrity, and enhance overall shoulder function.

After a detailed evaluation with Dr. Raghuram, Consultant Orthopaedic Surgeon at PACE Hospitals, the patient was assessed for left shoulder pain associated with difficulty in performing daily activities such as shoulder movements and overhead activities. Clinical examination revealed swelling over the left shoulder with restricted range of motion, including reduced internal rotation and abduction, along with a positive Jobe’s test suggestive of rotator cuff pathology, with no distal neurovascular deficit noted.

Based on the clinical findings and diagnostic correlation, the patient was diagnosed with Rotator Cuff Tear with Periarthritis component and Type II Acromion of the left shoulder.

Based on the above findings, it was determined that Diagnostic Arthroscopy, Subacromial Bursectomy, Capsular Release, Rotator Cuff Repair, and Acromectomy of the left shoulder was the most appropriate surgical management. This decision was made with the intent to relieve pain, improve range of motion, release capsular tightness, repair the rotator cuff tear, restore shoulder biomechanics, and improve overall functional outcome.

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

Following the diagnosis, the patient was scheduled for Diagnostic Arthroscopy, Subacromial Bursectomy, Capsular Release, and Rotator Cuff Repair Surgery in Hyderabad at PACE Hospitals, along with Acromectomy of the left shoulder, under the expert supervision of the Orthopaedic Department.

The surgical procedure involved the following steps:

• Patient Positioning and Anaesthesia: The patient was positioned in the beach chair position and the procedure was performed under general anaesthesia (GA) under strict aseptic precautions.

• Diagnostic Arthroscopy: Diagnostic arthroscopy of the left shoulder was performed, which revealed biceps tendon degeneration. Arthroscopic shaving was done to debride the degenerated tissue and assess intra-articular structures.

• Subacromial Decompression: Subacromial bursectomy was performed to remove inflamed bursal tissue, providing decompression of the subacromial space and improving visualization and shoulder mechanics.

• Capsular Release and Rotator Cuff Repair: Rotator interval synovitis and capsular tightness were noted, following which capsular release was performed to improve joint mobility. A rotator cuff tear was identified and repaired using two Syronix suture anchors, achieving a stable repair construct.

• Acromioplasty and Closure: Acromion burring (acromectomy) was performed to relieve impingement. Hemostasis was secured, and wound closure was done using Ethilon 2-0 sutures. Sterile dressings were applied at the end of the procedure.
  

The postoperative period was uneventful. The patient was mobilized during the hospital stay and was managed with medications for prevention of infection, pain control, and overall postoperative recovery support. Wound dressings were regularly performed and were found to be clean and healthy. The patient was stable at the time of discharge.

Upon discharge, the patient was prescribed medications for prevention of postoperative infection, pain control, protection of gastric mucosa from medication-related irritation, and nutritional and antioxidant support to promote wound healing and overall recovery following surgery.

The patient was advised to continue a normal diet as tolerated and she was instructed to follow prescribed physiotherapy with shoulder range of motion exercises as advised and to use an arm sling for support and protection of the operated shoulder during the recovery period.

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 pain in the operated shoulder, swelling, redness, wound discharge, or any other unusual or worsening symptoms develop.

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

This case highlights a Rotator Cuff Tear with periarthritis component and Type II acromion of the left shoulder, managed surgically with arthroscopic repair and decompression procedures. The patient had an uneventful postoperative course with stable clinical recovery and satisfactory wound healing at the time of discharge. Physiotherapy and shoulder rehabilitation were advised to restore function and ensure optimal long-term recovery.