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Reinsertion Of The Rotary Muscle Coffee

Article written by: ANDREI BOGDAN, MD, Orthopedics-traumatology doctor

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For all traumatic or chronic diseases of the musculoskeletal system, the Centrokinetic private clinic in Bucharest is prepared with an integrated Orthopedic Department, which offers all the necessary services to the patient, from diagnosis to complete recovery.

The Department of Orthopedic Surgery of Centrokinetic is dedicated to providing excellent patient care and exceptional education for young physicians in the fields of orthopedic surgery and musculoskeletal medicine.

Centrokinetic attaches great importance to the entire medical act: investigations necessary for correct diagnosis (ultrasound, MRI), surgery, and postoperative recovery.

Discover the open MRI imaging center in our clinic. Centrokinetic has a state-of-the-art MRI machine, dedicated to musculoskeletal conditions, in the upper and lower limbs. The MRI machine is open so that people suffering from claustrophobia can do this investigation. The examination duration is, on average, 20 minutes.

The shoulder joint is the most mobile joint of the body, allowing extremely complex movements at this level. We can discuss 3 joints that form the scapular girdle:
  • Scapulo-humeral joint
  • Acromio-clavicular joint
  • Scapulothoracic joint
Biomechanics or movements of the shoulder joint occur through a summation of movements, and the lack of normal functionality in one of the 3 compartments, will impact the entire scapular belt, appearing pain and functional impotence.

The rotator cuff is made up of four muscles that surround the shoulder joint resembling a cuff: subscapular, supraspinatus, infraspinatus, and ms. teres minor. The supraspinatus initiates the lifting movement of the arm (abduction), the infraspinatus and the small round perform the external rotation of the arm, and the subscapularis muscle the internal rotation movement. These four muscles act as a unit, rather than each individually, to maintain the dynamic stability of the shoulder. At the same time, they allow the arm to be raised.
One of the most common conditions that can cause shoulder pain is a partial or complete rupture of the hair, most often involving the supraspinatus muscle. The symptoms are varied and can consist of a small embarrassment sometimes, and other times the patient may have disabling pain for days. In the vast majority of cases, the treatment of choice is arthroscopic reinsertion of the rotator cuff. The operation is minimally invasive and is performed by a shoulder arthroscopy.

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Shoulder arthroscopy is a procedure by which our medical team inspects, diagnoses, and repairs problems that exist intra-articularly. The word arthroscopy comes from 2 Greek words: arthro which means joint and shopein which means to look. The word arthroscopy means to look at the joint. Shoulder arthroscopy involves the introduction of a camera (arthroscope) into the shoulder joint, so it takes 2 or 3 incisions of a few mm to perform this operation. This minimally invasive method generates very little postoperative pain, and the recovery period is shortened.

Shoulder arthroscopy has been performed since 1970, and surgical advances occur annually through improved surgical instruments and the emergence of new surgical techniques.

Arthroscopy necessary to resolve acromioclavicular osteoarthritis initially involves investigating the shoulder joint to visualize the main anatomical elements (humeral head, glenoid cavity, glenoid labrum, upper, middle, and lower scapulohumeral ligaments, coraco-humeral ligament, subscapular ms, ms suprascapular) and the lesions described following the investigations performed by the patient (X-ray, ultrasound, MRI), respectively the acromioclavicular joint.

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Surgical technique
The intervention involves the reinsertion of any injured muscle, whether we are talking about the supraspinatus or subscapularis muscle.
On average, the intervention lasts 1 hour, has a 1-day hospitalization, and is performed under general or loco-regional anesthesia, the anesthetist being able to perform latero-cervical anesthesia (on the side of the neck), under ultrasound control.
The first incision of about 5 mm in the postero-lateral area of the shoulder is made, and the camera is inserted to inspect the shoulder joint and acromioclavicular area. The posterior portal is placed 2 cm below the postero-lateral area of the acromion and 1 cm posteromedially from it. Subsequently, a second incision is made in the anterior part of the acromio-clavicular joint, placed as standard between the brachial biceps, the subscapular ms, and the humeral head. This portal can be performed from inside to outside or vice versa. Care must be taken with the musculocutaneous nerve, located 1 cm medially and 3 cm distal from the coracoid process. The external technique is performed with a needle, which establishes the ideal position of the portal.
 
Most of the time, depending on the scope of the intervention, one or two more side portals are needed.
After inspecting the joint cavity, the integrity of the joint capsule and the rotator cuff is supervized, and the diagnosis can be confirmed from this surgical stage. Subsequently, it penetrates the subacromial distance, resects the subacromial bursa, and highlights the rotator cuff and the existing lesion. An important step in achieving reinsertion is to establish the viability of the tendon in case of reinsertion in the initial position, where it came off. Viability depends on the degree of tendon retraction, which must be correlated with the MRI investigation previously performed by the patient.
After establishing the position of muscle reinsertion, the anchors necessary to complete the surgical technique are prepared. We can use titanium anchors, plastic bio inserts, suture anchors, details that depend on the quality of the bone where we are going to do the reinsertion, on the quality of the broken tendons, and the tension existing at the reinsertion place. Also, the diameter of the anchors can be different, from 3.5mm to 5.5mm.
Independently or simultaneously, there may be a disinsertion of the subscapularis muscle, a much rarer lesion compared to supraspinatus muscle lesions. The approach is similar in this situation, requiring reinsertion of the subscapularis muscle.

Post surgery
After the intervention, the patient remains hospitalized for 1-2 days. He will receive pain medication and antibiotics during his hospitalization. The operated limb is partially immobilized in a Dassault bandage for a few days.

At home

Although recovery from arthroscopy is much faster than a classic operation, it will still take a few weeks for you to fully recover your shoulder joint. You should expect pain and discomfort for at least a week postoperatively. Ice will reduce pain and inflammation.

You must be careful not to sleep on the operated shoulder in the first weeks because the pain and discomfort can worsen. You can take a bath, but without wetting the bandage and incisions. The threads are suppressed at 14 days postoperatively. Physical therapy plays a very important role in the rehabilitation program, and the exercises must be supervized by a physical therapist until the end of the recovery period.

It is very important to follow the recovery program strictly and seriously for the surgery to be a success. Our medical team works on average with the patient after this intervention, 18-24 weeks until the complete recovery of the shoulder.

Following any surgery, medical recovery plays an essential role in the social, professional, and family reintegration of the patient. Because we pursue the optimal outcome for each patient entering the clinic, recovery medicine from Centrokinetic is based on a team of experienced physicians and physical therapists and standardized medical protocols.

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