Rotator Cuff Injuries

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The rotator cuff is a group of four muscles that help to stabilize the shoulder joint. These muscles and their associated tendons can become worn and tear from overuse. The symptoms of a rotator cuff injury can include:

•  Dull ache deep in the shoulder
• Arm weakness
• Difficulty reaching overhead or behind the body. 

Conservative treatments for rotator cuff injury include rest, physical therapy, and resistance training to strengthen the rotator cuff muscles. Strong and active rotator cuff muscles are better at stabilizing the shoulder joint and reduce the risk of shoulder impingement. 

In cases where the tear is significant and conservative treatments are not enough, surgery to repair the torn tendons may be an option. Rotator cuff repair surgery usually consists of placing suture overtop of the torn tendon and securing it to the bone using suture anchors. This procedure is typically done arthroscopically. 

The labrum is a ridge of cartilage that lines the glenoid and provides stability to the shoulder joint. The labrum can become torn from trauma in sports, falls, or other forceful impacts to the shoulder as well as overuse of the shoulder.  

Conservative treatments for a labral tear include rest, physical therapy, and resistance training to strengthen the muscles of the shoulder.  

In cases where the labral does not heal on its own, surgery may be required. Labral repair surgery (sometimes referred to as a SLAP repair) aims to secure the labrum back to the glenoid using suture and suture anchors in an arthroscopic procedure. 

Bicep injuries can occur from both chronic wear and acute injuries. The bicep tendon has an origin on the shoulder blade, which can become inflamed and worn over time. This can be remedied by moving the origin of the muscle to the humerus so it is in a more favorable positions and sees less wear and tear. 

The bicep can also be torn acutely from lifting of excessive weight, in which the bicep tendon can tear off of its insertion site on the forearm. This results in a Popeye deformity where the bicep balls up in the upper arm. The surgical intervention for a distal biceps rupture is to reattach the tendon back to the radius. This can be accomplished using a suture and a suture button that is implanted inside, or on the radius.

A sprained ankle can occur from excessive inversion (rolling the ankle outward) during sports or physical activity. This movement puts strain on the ligaments that stabilize the ankle and can stretch and tear the tissue. 

More specifically, ankle instability can be attributed to a damaged or torn anterior talofibular ligament (ATFL). In cases where more conservative treatments are not enough, the Brostrom procedure can be performed to address a torn ATFL. This procedure involves fixing the torn ligament back to the fibula with suture anchors.

The tendon that attaches to the back of the heel is known as the Achilles tendon. Pain on the back of the heel can be caused by a bony prominence that can disturb the tenon. This bony prominence is known as a bone spur and is usually degenerative in nature. 

Conservative treatments a bone spur on the heel (Achilles insertional tendinopathy) include physiotherapy and medications. 

The most common surgical intervention for this pathology includes debridement of the Achilles tendon, removal of the bone spur, and repair of the tendon back to the heel.