On the 3rd and 4th of October 2016 a theoretical and practical course on the pathology of the rotator cuff (ie the shoulder) and its treatment with open-air and arthroscopic rotator cuff surgery techniques, was held at Humanitas.
Dr. Alessandro Castagna , coordinator of the course and Head of Unit of Shoulder and Elbow Orthopedics, answered our questions.
What is the pathology of the rotator cuff?
“The pathology of the rotator cuff, ie tendons that surround the humeral head and allow the movement of the arm, is very common and affects more people in the later stages in life. Therefore it is important to develop the best techniques for treating this disease.
Advances in this field have been enormous: just think that today you can work with fiber optics, under locoregional anesthesia in a one-day surgery”.
What causes can lead to rotator cuff injury?
“On the one hand there is the simple wear and tear, which tends to worsen with age, the other can be traumatic events, even at a young age.
Intense sports could be a cause of trauma, especially for sports in which the rotator cuff is often called upon to do most of the work: tennis, volleyball, baseball and so on”.
Are there several types of injury?
“There are differences in the severity of injury. There may be partial or complete injury affecting one or more tendons, of the four in total. Therefore different scenarios occur in regards to symptoms, function and for the treatment (and possibility of successful treatment)”.
What tests can detect the lesion?
“The first consideration is of course the case histor. Once you are visited by a patient who has shoulder pain, and you suspect that it has a cuff tear (that may require rotator cuff surgery) prescribe an instrumental examination that studies the soft tissue. The basic test for screening is an ultrasound which is a quick examination and non-invasive”.
What are the symptoms?
“Pain, especially overnight, and weakness in performing particular movements in elevation or abduction.”
What are the cures, excluding rotator cuff surgery?
“We may resort to anti-inflammatories, analgesics and functional rest. It is advisable not to force the arm in an attempt to bring it up. Physiotherapy is certainly very useful as well”.
Surgery is not mandatory but it is a good solution which leads to an improvement in your quality of life. Before resorting to surgery however, it is necessary to evaluate many parameters, among which is certainly the patient’s age. In very elderly individuals we usually do not recommend surgery”.
Can the tendons heal themselves?
“No, tendons that dont undergo surgery remain broken and cannot heal on their own. The drugs and rest can relieve pain, especially at night, but its not a complete and definitive solution”.
Can you give us some details on the course that took place here?
“The course consisted of a theoretical part and a practical part. The first morning of the course was devoted to lectures, held by me and Dr. Luca Balzarini, Head of Radiology at Humanitas, which introduced the diagnostic imaging on the headset. Following this scientific-cultural introduction we moved to the practical part, which wass divided into two parts.
The first exercise involved the ultrasound of the rotator cuff and its innovative aspects. The second part included the application of new arthroscopic techniques with practical tests and support of a “senior” surgeon (myself and other experts as members of my Unit Dr. Borroni, Dr. Delle Rose and Dr. Pitino). The practical tests were supervised and guided by Dr. Marco Conti a physician who also specializes in shoulder ultrasound. He transmitted his experience to the participants. I preferred that the tutor was not a radiologist. Thus allowing the physician to convey his point of view and the power of this diagnostic tools. Assuming therefore, an interactive collaboration with the group of orthopedics”.
Who took the course and what were the objectives?
“The course was limited to twelve specialists in orthopedics, already experts on the subject. Participants were divided into two groups of six who worked at different times, always under the supervision of the tutor. The objective of the course is to provide with a theoretical and practical approach cultural tools that make possible the best treatment options and the best patient care. ”
