Complications
Loss of the normal humeral head depressing function and force-couple of the rotator cuff results in superior migration of the humeral head with eccentric superior loading of the glenoid cartilage and progressive arthritis of the glenohumeral joint.
NSAIDs cause an increased risk of serious gastrointestinal adverse events, including bleeding, ulceration, and perforation of the stomach or intestines, which may be fatal.
Risk increases with longer use, concomitant use with corticosteroids or anticoagulants, smoking, use of alcohol, older age, and decline in general health status.
Use extreme caution in patients with a prior history of gastrointestinal bleeding or ulceration, and monitor for adverse effects.
This is the most common complication associated with repair of the rotator cuff. The re-tear rate has been found to be 15% within 3 months after surgery, 16% at 6-12 months follow-up, and 21% at 12-24 months follow-up.[92] However, failure of tendon healing may not necessarily correlate with poor outcome or reduced patient satisfaction.[86][87]
Risk after arthroscopic repair 0.1% to 0.5%. Risk after open repair 0.5% to 2%.
Also known as frozen shoulder, this involves loss of both passive and active motion due to soft-tissue contracture that results in mechanical block. It can occur with massive chronic tears as a result of injury or failure to move the shoulder (prolonged immobilisation) post-injury or post-surgery. Adhesive capsulitis is more common in patients with diabetes.[93]
Early aggressive mobilisation is effective in reducing adhesions and preventing adhesive capsulitis. Initial management consists of physiotherapy for joint mobilisation and capsular stretching. Treatment often requires surgery: manipulation under anaesthesia, arthroscopic capsular release, or open capsular release. Immediate postoperative therapy is required to prevent reformation of adhesions.
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