I will be operated on a rupture of a tendon of the headdress in about ten days. Can I get dressed normally after this procedure? Will I have to keep the splint permanently night and day?
It is difficult to give you any advice regarding the operative follow-up without knowing the importance of the lesions or the style of surgery that will be performed.
I can answer you that at the Clinic of the Union, our surgeons all operate under arthroscopy which makes it possible to dress normally (by respecting some instructions concerning the not working of sutured tendons).
It is possible to remove the splint but respecting a gap between the arm and the body if your splint is called abduction. In general, it is necessary to avoid any contraction of sutured tendons during the first month, which is equivalent to avoiding actively removing the arm from the body.
I just want to say that the instructions can be very different from one team to another or following an open surgery.
how does one repair a tendon of the headdress?
To repair a tendon of the cap is to re-fix it on the humerus at its tuberosity (tubercle bone) where it is normally attached (inserted).
It is necessary to use anchoring systems (so called ‘anchors’ but resembling screws) or using the passage of sutures crossing the bone.
These son or anchors have the objective of maintaining the tendon during the tendon healing phase with the bone, the only guarantee that the tendon will be firmly and permanently attached to the bone and therefore functional.
Why do physio when I consult for a torn tendon?
Inflammation is the main painful cause in the shoulders with a wear of the cuff, especially because the absence of tendon of the cuff favors the rise of the head under the acromion therefore the conflict with this bone.
It seems logical to try to reduce it (or even disappear).
The physiotherapist, by a work of referral of the humeral head (decoaptation) is able to limit the inescapable rise of the bone of the arm (humeral head) under the acromion (part of the scapula realizing the bone ceiling above the cap) which explains the friction of the cap so the inflammation.
Is there a risk that the tendons recur after the operation if I force a lot on the shoulder?
Unfortunately yes …
Final healing is never ensured if we always force a lot on the operated shoulder (especially before 6 months).
Many factors interact during healing (some remain unknown).
Fortunately in most cases the situation is well tolerated does not always lead to reoperation.
How long will my work stop? Can I rework as before? What to do otherwise?
For a sedentary work (office, computer, telephone, relational etc …) the stop can be short (a few days to 15 days the time of the cutaneous cicatrization) but is often brought back to 6 weeks if it is necessary for you to drive for go to work (no alternative).
For a moderately demanding job, allow 3 months to be able to re-serve the limb correctly (especially above the head).
For heavy manual work, recovery is not desirable before 6 months, otherwise tendinitis may not occur. Unfortunately, it is not always possible to resume such work, resulting in incapacity and professional reclassification (within the company or after dismissal). In this case the recognition of a disabled worker status can provide access to retraining courses and in theory allows access to protected positions within companies. For people under the general scheme a medical consultant usually follows convalescence and gives his opinion on the justification or not to continue the daily allowances.
When can I re-force with my arm? When can I do sports again?
Not before 3 months for low demand activities of the shoulders, in case of activities in force on the shoulders this period is doubled and thus goes to 6 months.
Not before 3 months for sports with little solicitation of the shoulders, in case of activity in force on the shoulders or sports of contact this delay is 6 months.
How long and how will I be immobilized after a repair of the cap? When can I drive?
It is necessary to count on 4 weeks of rest (more or less strict) of the operated member. A one-month consultation is planned in order to redo the point with your surgeon and wean the immobilization and start the active physiotherapist.
We use two types of immobilization, one body elbow (‘dujarrier’ or scarf scarf) and an abduction cushion (‘roll’) which does not generally exceed 30 degrees of arm spacing. vertical ratio. This position avoids forcing too much on the tendinous repair but can be uncomfortable especially if badly positioned …
It is considered that the fragility of tendons repaired lasts 6 weeks, it is therefore not possible (and recommended) to drive before this period of 6 weeks (ie 2 weeks after the beginning of the active physiotherapist) also for reasons of road safety and in case of simple operative follow-up.
Does a repair of the tendons of the cap guarantee it to me to serve me normally of the shoulder?
Repairing the rotator cuff is the best guarantee possible to reuse normally of his shoulder, but the final result is often long to acquire and the practice of soliciting activities can remain troublesome.
The repair of the cap is also the best guarantee that the cap does not continue to deteriorate over time.
However, there is a distinction between tendon repair (= surgical procedure) and definitive healing of the tendon with the bone (objective of repair).
Can I be guaranteed the result by repairing the tendon?
Refixing the tendon is not always possible despite additional examinations (MRI, arthroscanner) performed before the operation in case of very retracted rupture or very damaged tendons …
In addition we repair fragile tendons (‘used’ !!, new spare parts do not exist !!!).
However, in case of good fixation to the tendon bone, definitive cicatrization of the tendon depends on many additional factors:
Factors that are detrimental to healing:
-Tabagism ++++ (it’s now proven, smoking is like shooting yourself in the foot when you want to walk !!)
– Diabetes and other co-morbidities
– wear and delamination of the tendons
– practice of very demanding activities in the shoulders in force
To conclude your surgeon will certainly tell you how he sees technically tendon fixation for the rest a lot of factors come into play …
After a fall, my ultrasound concludes to a rupture of the cap, is this serious?
This is indeed a frequent reason for consultation !!
Firstly any traumatized shoulder has the right to be painful without necessarily that the damage is serious …
The assessment of a traumatized shoulder should include at least standard radiographs and an ultrasound of the rotator cuff.
It is often in the light of these results that anxiety grows because it also affects your doctor !!
– A procedure of repair of the cap is never put on the conclusions only of an ultrasound, a more advanced examination (arthroscanner the most precise or well arthro-MRI or even MRI) must first confirm this rupture, to define its size , its recent character and the absence of a contraindication to a repair (particularly fatty degeneration)
– in general is diagnosed an old ‘degenerative’ rupture of the tendon (= wear), that the accident made it possible to discover or could aggravate … The patience, the rest (without durable immobilization !!) and the reeducation are Desirable and can distinguish the shoulders that can recover as before those that remain disabling or painful.
-The true traumatic rupture of the cuff in the young and active subject are genuine indications of operation of relative urgency because the shoulder adapts less to the rupture which retracts sometimes fast and the possibilities of perfect repair of the tendons decreases more quickly with time…
Can I infiltrate my shoulder if my tendon is broken?
As we have seen in another answer, the pain is most associated with the presence of inflammation in the shoulder (tendon and subacromial bursa in particular, long biceps etc …)
In the same way as rehabilitation work, infiltration is a very effective method of reducing inflammation.
Caution: the cortisone used during an infiltration tends to weaken the tendons so is not recommended if a surgical repair of the cap is possible (especially the reproduction of infiltrations).
Why do I have shoulder pain at rest or at night when I can strain with it during the day?
These painful manifestations are typically ‘inflammatory’ which confirms the reasoning.
On the contrary, ‘mechanical’ painful manifestations would appear in the use of the shoulder (and would be more directly linked to tendon rupture).
Do I have a sore shoulder because my tendon is torn, broken?
In most cases it is more of a progressive wear of the tendon (and not a break), this wear is not painful but it promotes the accumulation of inflammation in the shoulder.
In some cases the pain is related to rupture, mainly in case of trauma and especially when the long biceps tendon is no longer maintained by tendons of the rotator cuff (subscapularis in particular) and is dislocated or subluxated.
I consult a surgeon because I have a tendon of the headdress torn (broken). Will I have to have surgery?
All the ruptures of the cap are not operated! It should be noted that a cuff rupture (particularly supraspinous) is common from 50 years old but often asymptomatic.
In most cases it is more of a progressive wear of the tendon (and not a rupture), this wear is not painful but it promotes the accumulation of inflammation in the shoulder (the humeral head comes into conflict with the acromion).
Surgery (in these initially well-tolerated cases of wear) is only a last resort. On the other hand, a traumatic rupture of the rotator cuff in a young and active patient is an indication of rapid repair.
Making the difference between decompensated wear and a recent break is difficult and requires experience …