Orthopaedics Q&A: Treating rotator cuff

Orthopaedics expert, Dr VV Prasad answers readers’ questions on bone health. Get your doubts cleared and see them featured on our FAQ page every Monday.

This week’s answers:

Hi there,

I am hoping to get some clarification regarding proper procedure of a diagnostic shoulder arthroscopy.

This is in reference to a arthroscopy I had in 2011 that was intended to address complaints of night time anterior instability, biceps pain, posterior pain, and pain on the outside edge of the arm. There was also a planned distal clavical resection and subacromial decrompression based on MRI and XRAY findings.

I had a history of multidirectional instability, posterior labral tear due to a traumatic injury. It should be noted that the performing surgeon had operated on this shoulder previously, so history was known.

So the procedure starts and according to the op report there was a single posterior portal established for the scope, the scope was inserted, there was mild DJD noted then he just reported that all of the other structures appeared intact and that there was no SLAP tear. The report then moves on to the subacromial procedures.

There was no mention of any stability tests or exam under anesthesia, no anterior portal established, no diagnostic probing or posterior visualization from a anterior portal.

This my question……you have a patient with a history of multidirectional instability which has required 2 surgeries prior, you have visual evidence of DJD on the glenoid, posterior inferior labrum abnormality, and slight fraying on the anterior labrum and biceps tendon (Ill attach the scope pics)…..all of this plus the complaints of instability, night pain, biceps pain, posterior pain, and lateral humeral pain. So we have all of these issues, but you don’t establish a anterior portal and probe the structures that showing possible injury? My question is wouldn’t it be somewhat standard to probe the labrum, biceps, capsule, and articular surfaces if you have any indicators of injury?

The second part of this story is that my symptoms remained after I recovered from surgery and I ended up having surgery 2 weeks ago by a different doctor where I was found to be grossly unstable anteriorly and posteriorly, a SLAP tear present, posterior capsule laxity, a large anterior bankhart tear, and both glenoid and humeral head chondromalasia……..so I cant help but wonder if this last surgery could have been avoided or at least limited if a proper arthroscopic exam had been performed. I know that’s very subjective and I wouldn’t expect you to comment on that, but as far as the diagnostic scope, would you agree that a anterior portal and probing we processes that would have been warrented based on history, complaints, and visual presentation?

I appreciate any feedback you are able to provide and appreciate your time spent with this.

Thanks
Nat Haskell

Dear sir,
its only the style of the surgeon. All surgeons don’t use all the portals. When the surgeon is satisfied with what he sees then he doesn’t need another portal. As you rightly said this issue is purely subjective. you ask opinion to 4 doctors Iám sure you will get 16 different opinions. all you need now is a pain free stable shoulder. But sometimes even in the best of hands the patient may be still left out with residual pain and instability. I think with this recent surgery you will get a good result.

She have pain in both knee , pain is shifting in nature one knee toanother, no swelling, tenderness in knee . please suggest the expecting diagnosis she have.. we have consults more doctors in delhi, they all have different opinions. But no relief to anyboby. She is taking diclofenac an calcitrol satchet.
name. sulekha
age. 60 y

Your complaints are more towards arthritis of knee. Can you please mail me a JPEG of the X-ray.

Hi Sir,

I am 31 years old IT engineer from Delhi. I am suffering from spondylitis and lower backache. In the past when I suffered with first pain for spondylitis, i got MR injection due to which my stiffed neck worked fine for few days but now there is a light pain continuously. Please let me know the medicine or the right exercise with which I can get rid of these 2 problems.

Thanks
nitinsrivastava

Do you get early morning pains. Have you done the blood test for HLA-B-27. Please send me those reports.

Dear Sir,

I am 47 year old, my BMI is normal, I do rigorous fitness exercises regularly do not have any problem what so ever and leading a healthy life. My question is I am running on a tread mill at a speed of 9 to 10kms p.h for 15 minutes and walk for about 10 minutes, I do not have any issues, but people are advising me to not jog, please advice,

Tirumalacnc Elango

Its better not to jog on a treadmill. the amount of stress your knee takes whenever your foot lands on the treadmill is enormous. I think its better for you to walk on a treadmill and to take a jog outside. this will prevent your knees from faster degeneration.

hi sir,

i got a injury 2 years while pulling weight in the gym..i took therapy and left gym for certain time..then it was ok..but again i started gym and i started to pull heavy weight..i again started to have pain on my rotator cuff..so i feels pain in bench press in chest exercise and in shoulder exercise. i am not to able to balance rod in heavy weight.kindly provide me a solution.

regards
Aman Senwal

I understood that you had rotator cuff injury. what investigation have you done? did your MRI show any complete tear of the rotator cuff? If yes you need to surgically repair it then undergo physiotherapy. if you rotator cuff is intact you need good exercises to improve your shoulder strength.

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