Surgical methods differ depending on conditions of rotator cuff tears [회전근개 힘줄 손상 여부 따라 수술 방법 달라요]
When you think about arthroplasty, you often think of your knee and hip joints. This is usually done when knee degenerative arthritis is severe and does not respond to non-surgical and arthroscopic treatment. Shoulder arthroplasty, on the other hand, is known to have a shorter history but is more difficult than artificial knee arthroplasty. Currently, shoulder arthroplasty is widely used in the United States and Europe due to the development of medical technology, and the number is increasing rapidly in Korea, including in Nasaret International Hospital.
# Retrograde shoulder arthroplasty replacing rotator cuff tendon.
Shoulder arthroplasty or shoulder replacement is a treatment for when the rotator cuff tendon suffers a widespread tear that also may result in severe ruptures, degenerative arthritis, or trauma, such as fractures (or when the muscle cannot lift on its own despite normal nerve performance, or the rotator muscles fail to function) common in patients older than 70 years.
When moving shoulder joints such as rotator cuffs, the artificial joint surgery is used to replace only the shoulder joint with severe wear on the joint without tearing tendons or muscles. There is a retrograde shoulder arthroplasty that allows one to replace the role of rotator cuff tendon. The surgical method is determined by the condition of the shoulder joint of the patient, and the key to the decision is whether the rotator cuff tendon is damaged.
# If a rotator cuff tear is chronic, surgery is required.
For arthritis with no rupture of the rotator cuff tendon and only severe joint damage, a joint arthroplasty similar to the conventional anatomical structure is used. In general, the degree of shoulder rotator cuff tear is divided into 1 stage of small tears, stage 2 of medium tears, stage 3 of large tear, and stage 4 being wide tears. Stages 1 to 4 differ in their treatment and rehabilitation. If surgical treatment is required for rotator cuff tears, it can be treated with arthroscopic rotator cuff repair, a relatively simple operation.
However, if the rotator cuff tear becomes chronic and progresses further with severe pain, arm being unable to lift itself (pneumoplegia), and extensive rotator cuff rupture (stage four rupture), the retrograde shoulder arthroplasty treatment is decided on. The operation time is about 1 hour and 30 minutes to 2 hours, and the brace is worn for 4 to 6 weeks after the operation. Surgical results are as good as with other joints (knees and hips). In general, the life expectancy of the shoulder joint is known to be 15-20 years.
First of all, early diagnosis and treatment of persistent shoulder pain is important to prevent situations requiring surgical treatment. However, rotator cuff tears, which are ineffective in conservative treatment and complain of chronic pain, can improve the quality of life through improvement of pain as well as functional improvement of the shoulder joint with proper surgical treatment.
Advances in medical technology are also improving surgical techniques, which are addressing previously neglected and incurable treatments. One of these is retrograde shoulder arthroplasty.
Written with the help of Dr. Ki Young Moon, Orthopedics Dept., Nasaret International Hospital
Original article by Kiho Ilbo
Published 2019 May 15
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