Arthroscopic Rotator Cuff Repair Animation
Omaha Arthroscopic Rotator Cuff Repair
Introduction to Arthroscopic Rotator Cuff Repair by Dr. Keiser MD
This surgical procedure is used to inspect and reattach torn tendons of the rotator cuff. This minimally invasive surgery is performed through three or four small nick incisions around the shoulder, and avoids larger incisions. The rotator cuff is 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.
Rotator Cuff 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
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.
This 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.
After the repair, the 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.
Arthroscopic Rotator Cuff Repair Treatment
When Is Arthroscopic Rotator Cuff Repair Recommended?
Your doctor may recommend shoulder arthroscopy if you have a painful condition that does not respond to nonsurgical treatment. Nonsurgical treatment includes rest, physical therapy, and medications or injections that can reduce inflammation. Inflammation is one of your body’s normal reactions to injury or disease. In an injured or diseased shoulder joint, inflammation causes swelling, pain, and stiffness.
Injury, overuse, and age-related wear and tear are responsible for most shoulder problems. Shoulder arthroscopy may relieve painful symptoms of many problems that damage the rotator cuff tendons, labrum, articular cartilage, and other soft tissues surrounding the joint.
Arthroscopic Rotator Cuff Repair
Planning for Arthroscopic Rotator Cuff Repair Surgery
Your orthopedic surgeon may ask you to see your primary doctor to make sure that you do not have any medical problems that need to be addressed before your surgery.
Blood tests, an electrocardiogram, or chest x-ray may be needed to safely perform your surgery. If you have certain health risks, a more extensive evaluation may be necessary before your surgery. Be sure to inform your orthopaedic surgeon of any medications or supplements that you take. You may need to stop taking some of these prior to surgery.
If you are generally healthy, your arthroscopy will most likely be performed as an outpatient. This means you will not need to stay overnight at the hospital.
The hospital or surgery center will contact you ahead of time to provide specific details about your procedure. Make sure to follow the instructions on when to arrive and especially on when to stop eating or drinking prior to your surgery.
Before the operation, a member of the anesthesia staff will talk with you about anesthesia options. Shoulder arthroscopy is most commonly performed using regional nerve blocks which numb your shoulder and arm. This numbing medicine is injected in the base of your neck or high on your shoulder. This is where the nerves that control feeling in your shoulder and arm are located. In addition to its use as an anesthetic during surgery, a nerve block will help control pain for a few hours after the surgery is completed. Many surgeons combine nerve blocks with sedation or a light general anesthetic because patients can become uncomfortable staying in one position for the length of time needed to complete the surgery.
Most arthroscopic procedures take less than an hour, however, the length of your surgery will depend on what your surgeon finds and what repairs are required.
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Omaha shoulder information provided by Dr. Darren Keiser MD