Rotator cuff is the group of tendons in the shoulder joint providing support and enabling wider range of motion. Major injury to these tendons may result in tear of these tendons and the condition is called as rotator cuff tear. It is one of the most common causes of shoulder pain in middle aged adults and older individuals. It may occur with repeated use of arm for overhead activities, while playing sports or during motor accidents. Rotator cuff tear causes severe pain, weakness of the arm, and crackling sensation on moving shoulder in certain positions. There may be stiffness, swelling, loss of movements, and tenderness in the front of the shoulder.
Rotator cuff tear is best viewed on magnetic resonance imaging. Symptomatic relief may be obtained with conservative treatments – rest, shoulder sling, pain medications, steroidal injections and certain exercises. However surgery is required to fix the tendon back to the shoulder bone. Rotator cuff repair may be performed by open surgery or arthroscopic procedure.
Surgery to repair the rotator cuff has traditionally been done through a large shoulder incision, about 6-10cm long, and the muscle over the rotator cuff was separated. Newer, advanced surgical techniques have been developed to minimize pain and recovery time. Arthroscopic rotator cuff repair is a minimally invasive surgery performed through tiny incisions, about 1 cm each, with an arthroscope. In arthroscopy procedure space for rotator cuff tendons will be increased and the cuff tear is repaired using suture anchors. These anchor sutures help in attaching the tendons to the shoulder bone. Following the surgery you may be advised to practice motion and strengthening exercises.
The arthroscope is a small fiber-optic viewing instrument made up of a tiny lens, light source and video camera. The surgical instruments used in arthroscopic surgery are very small (only 3 or 4 mm in diameter) but appear much larger when viewed through an arthroscope.
The television camera attached to the arthroscope displays the image of the joint on a television screen, allowing the surgeon to look throughout the shoulder-at cartilage, ligaments, and the rotator cuff. The surgeon can determine the amount or type of injury, and then repair or correct the problem.
The benefits of arthroscopy compared to the alternative, open shoulder surgery, include:
Ultrasound is a common imaging technique that employs high frequency sound waves to create images of organs and other internal structures of the body. These images provide valuable information of underlying pathology of the tissues and assists with diagnosis and planning the treatment of a particular condition. Ultrasound provides a clear view of the organs, tendons, muscles or joints and any associated disorders.
Ultrasound guided injection is a minimally invasive procedure used for treating various musculoskeletal painful conditions such as tendonitis, bursitis and neuritis or to perform cyst aspiration.
It is also an excellent tool for guiding the placement of needles for both diagnostic as well as therapeutic purposes.
Injection of a pain medication in combination with a local anesthetic directly to the site of injury helps to relieve pain. The advanced imaging of ultrasound provides high resolution images that enable the physician to precisely locate the injections deep into the target tissue without harming surrounding tissues.
The advantages of ultrasound imaging compared to other imaging techniques include the following:
The indications for diagnostic ultrasound imaging technique include the following:
The procedure is used for diagnostic as well as therapeutic purposes. Anti-inflammatory medications such as corticosteroids and hyaluronans are the most commonly used medications to relieve pain, inflammation and swelling or to stimulate synovial fluid production to improve lubrication.
Shoulder joint injection technique
Shoulder joint injections are commonly used for certain conditions such as osteoarthritis, frozen shoulder, or tendonitis. The administration of the injection to the shoulder joint depends upon the condition to be treated. The approach for application of the injection may be anterior, posterior, superior or inferior aspect of the joint.
During an ultrasound guided injection, the patient will be asked to lie or sit down on a table depending on the site of the injection. A clear water based conducting gel is applied over the skin to assist with transmission of the sound waves. The doctor moves a hand held probe, called a transducer, over the targeted area. The transducer emits sound waves and detects the rebound echoes from the tissue. Images are created from these sound waves and can be viewed on the video display screen attached to the scanner. The waves provide a clear view of the targeted area and help the doctor locate the correct site for injection.
Ultrasound guided injection is a relatively safe and painless procedure. Some of the associated complications include bleeding at the site of insertion, and injury to adjacent structures. Patients can resume their normal activities immediately after the completion of the procedure.