Arthroscopic Rotator Cuff Repair
Omaha Orthopedic Animation by Dr. Darren Keiser MD
Omaha Arthroscopic Rotator Cuff Repair
Arthroscopic Rotator Cuff by Dr. Darren R. Keiser MD
Arthroscopic Rotator Cuff Repair is the surgical treatment of the rotator cuff, a group of four muscles that form tendons and attach to the ball of the humerus. These four muscles/tendons are: The supraspinatus, the infrapspinatus, the subscapularis, and the teres minor.
The supraspinatus attaches to the top of the ball of the humerus and is responsible for raising the arm outward. The supraspinatus tendon is the most commonly torn tendon. The subscapularis tendon is the tendon that attaches in the front of the ball of the humerus and rotates the arm inward. The infraspinatus and the teres minor attach to the back of the ball of the humerus and rotate the arm outwards. Together, the tendons of the rotator cuff act to keep the ball of the humerus in the socket and raise and rotate the arm.
Any of the tendons of the rotator cuff can be damaged by traumatic injury, repetitive overuse, or the wear and tear of life. The incidence of rotator cuff tears increases with advancing age.
Common symptoms include: pain at night, pain with overhead activity, or pain when reaching behind the back. Other symptoms of rotator cuff tear may include weakness with reaching or lifting. Tears can increase in size with time. Tears may range from small and partial in an elite throwing athlete to massive and irreparable in an elderly patient.
Some partial rotator cuff tears can be treated with rest, activity modification, gentle motion exercises, physical therapy, anti-inflammatory medication and corticosteroid injections. If symptoms are not relieved by these measures, or for those who have a full-thickness rotator cuff tear, surgical treatment may be recommended.
Arthroscopic rotator cuff repair is an outpatient surgical procedure. This means that the patient may go home the same day as the surgery or stay overnight. This procedure is used to inspect and reattach torn tendons of the shoulder’s rotator cuff.
The minimally invasive surgery is performed through three or four tiny nick incisions around the shoulder. It replaces the need for larger incisions, although sometimes larger incisions are necessary. Anchors are placed inside the bone. Special suturing techniques are utilized to reattach the torn tendon back to where it belongs. The rotator cuff repair animation shows a repair of the supraspinatus tendon (attaching on top of the ball). Tears to the other tendons of the rotator cuff can be treated in a similar way.
Signs of Arthroscopic Rotator Cuff Repair
A doctor may offer surgery as an option for a torn rotator cuff if your pain does not improve with nonsurgical methods. Continued pain is the main indication for surgery. If a patient is very active and uses arms for overhead work or sports, a doctor may also suggest surgery.
Other signs that surgery may be a good option for you include:
> Patients symptoms have lasted 6 to 12 months
> Patient has a large tear (more than 3 cm) and the quality of the surrounding tendon tissue is good
> Patient has significant weakness and loss of function in your shoulder
> Patient’s tear was caused by a recent, acute injury
After Arthroscopic Rotator Cuff Repair
After the repair, a patient is placed in a shoulder immobilizer or a sling and pillow. Proper rehabilitation is very important after rotator cuff repair. Physical therapy is required. Adherence to the rehabilitation protocol is necessary to maximize the results of the surgery.
The majority of patients report improved shoulder strength and less pain after surgery for a torn rotator cuff.
Each surgical repair technique (open, mini-open, and arthroscopic) has similar results in terms of pain relief, improvement in strength and function, and patient satisfaction. Surgeon expertise is more important in achieving satisfactory results than the choice of technique.
Factors that can decrease the likelihood of a satisfactory result include:
> Poor tendon/tissue quality
> Large or massive tears
> Poor patient compliance with rehabilitation and restrictions after surgery
> Patient age (older than 65 years)
> Smoking and use of other nicotine products
> Workers’ compensation claims
Omaha Arthroscopic Rotator Cuff Repair Information by Dr. Darren Keiser MD